2011-09-15T07:44:48-05:00 2010-12-31 RSM MCGLADREY INC 230 N ELM ST STE 1100 GREENSBORO NC 27401 990 2010-01-01 581343313 HOSPICE & PALLIATIVE CARECENTER HOSP 3367683972 101 HOSPICE LANE WINSTONSALEM NC 27103 BRIAN PAYNE 3367683972 2011-09-08 ADRIENNE MCKINNEY 3362724551 2010 2016-03-07 17:11:31Z BRIAN PAYNE 101 HOSPICE LANE WINSTONSALEM NC 27103 32281378 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 2010 HOSPICE & PALLIATIVE CARECENTER CARED FOR 3,128 PATIENTS. 25 25 431 555 0 0 4748696 2350063 28847967 29557634 23653 34873 85809 145704 33706125 32088274 0 0 0 0 16065095 16997329 136958 5000 1317249 11482090 11656752 27684143 28659081 6021982 3429193 23120831 26409553 5158346 5267875 17962485 21141678 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 17089054 23880962 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 2010, HOSPICE & PALLIATIVE CARECENTER PROVIDED 152,329 DAYS OF CARE TO 2,044 PATIENTS IN THIS CAPACITY. 5118559 5440253 KATE B. REYNOLDS (KBR) HOSPICE HOME - 30-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 2010, KATE B. REYNOLDS HOSPICE HOME PROVIDED 10,464 DAYS OF CARE TO 1,005 INPATIENTS. 414186 138639 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 2010, THE HOME HEALTH PROGRAM PROVIDED 8,253 DAYS OF CARE TO 79 PATIENTS. 148023 111390 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 SIMILTANEOUSLY WITH ALL OTHER MEDICAL TREATMENTS.IN 2010, THE PALLIATIVE CARE SERVICES PROGRAM PROVIDED 40,741 DAYS OF CARE TO 428 PATIENTS. 111779 COMPLEMENTARY THERAPIES 163266 12886 COMMUNITY PARTNERSHIP/COMMUNITY EDUCATION 265779 2225 GRIEF COUNSELING CENTER 170108 HOSPICE BEREAVEMENT SERVICES 858955 126501 23480754 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 98 0 1 431 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 X MONY CHAMBERS 3367683972 101 HOSPICE LANE WINSTONSALEM NC 27103 X DALE E DRISCOLL 1.00 X X 0 0 0 R SCOTT BOWEN JR 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 KENNETH P CARLSON MD 1.00 X 0 0 0 CAROLYN R FERREE MD 1.00 X 0 0 0 CHARLES H HAUSER 1.00 X 0 0 0 REV DAVID B HODGES 1.00 X 0 0 0 SALLY LACY 1.00 X 0 0 0 DONNY LAMBETH 1.00 X 0 0 0 A THAD LEWALLEN 1.00 X 0 0 0 CAROL MAULTSBY 1.00 X 0 0 0 WARD MILLER 1.00 X 0 0 0 JAMES O'NEILL 1.00 X 0 0 0 MICHAEL L ROBINSON 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 CAROLE H SULLIVAN 1.00 X 0 0 0 DR PEGGY VALENTINE 1.00 X 0 0 0 GORDON WILLIAMS 1.00 X 0 0 0 CANDICE WOOTEN 1.00 X 0 0 0 RICHARD V BENNETT 1.00 X X 0 0 0 MARGARET ANN HOFLER 1.00 X X 0 0 0 ROBERT COLI 1.00 X 0 0 0 JIMMY STRICKLAND 1.00 X 0 0 0 JOANN E DAVIS 36.00 X 497821 0 22463 KATHERINE F CECIL 40.00 X 79347 0 7825 RICHARD C STEPHENSON 40.00 X 232292 0 20729 KAREN L CROSS 40.00 X 170381 0 10208 BRENTON L SHARPE 40.00 X 148475 0 8329 CHRISTINA R TUCKER 40.00 X 102166 0 11032 1230482 0 80586 5 0 1 0 IL LONG CONSTRUCTION CO INC PO BOX 4186 WINSTONSALEM NC 27115 GENERAL CONTRACTOR 2961664 ADVANCED HOME CARE INC PO BOX 890492 CHARLOTTE NC 28289 DURABLE MEDICAL EQUIPMENT 870152 CARDINAL DISTRIBUTION GREENSBORO DIVISI PO BOX 402603 ATLANTA GA 30384 PHARMACEUTICALS 620709 GRACE HEALTHCARE OF WINSTON-SALEM 1900 W FIRST STREET WINSTONSALEM NC 27104 NURSING HOME ROOM & BOARD 557755 UNIVERSAL HEALTHCARE OF KING 115 WHITE ROAD KING NC 27021 NURSING HOME ROOM & BOARD 301938 18 350798 174554 1824711 71987 2350063 PATIENT SERVICE REVENU 621610 29557634 29557634 29557634 34134 34134 30942 1407 31289 321 -347 1086 739 739 278477 174554 161494 116983 116983 OTHER INCOME 621610 28721 28721 28721 32088274 29586355 0 151856 307456 307456 13818732 11783430 1390730 644572 130256 118655 4538 7063 1720123 1274696 307611 137816 1020762 857440 112284 51038 134139 83810 50329 26950 26950 5000 5000 5500471 5093315 331475 75681 236986 73179 163807 524066 122064 286253 115749 217895 217895 373463 184744 188719 675571 623723 33816 18032 200673 200673 558639 200154 358485 136358 136358 PATIENT MEDICAL SUPPLIE 2564206 2564206 EQUIPMENT & MAINTENANCE 237640 79010 87738 70892 EMPLOYEE PROCUREMENT 121832 121832 CONTINUING EDUCATION 65005 43865 15542 5598 HOSPITALITY 61390 17768 21621 22001 21468 20968 500 28659081 23480754 3861078 1317249 8002831 8809982 300698 42508 2029890 1458075 3245354 3063202 70794 118673 150318 195110 17201204 4698467 9132290 12502737 188656 219266 23120831 26409553 1681904 1829224 3230597 3360880 245845 77771 5158346 5267875 X 13607738 19733493 4333747 1387185 21000 21000 17962485 21141678 23120831 26409553 X 3429193 -250000 X X 0 1 1 X 0 X 1845522 1661013 2128589 4748696 2350063 12733883 1845522 1661013 2128589 4748696 2350063 12733883 447033 12286850 38111 65613 137589 31069 34134 306516 22874 98571 165508 177819 307198 771970 13812369 121982034 0.88960 0.91470 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME $28,721 SPECIAL EVENTS INCOME $278,477 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 756977 756977 7817749 1864342 5953407 2876253 2434362 441891 5750225 399763 5350462 12502737 CAPITAL LEASE OBLIGATION 77771 77771 32088274 28659081 3429193 -250000 -250000 3179193 32121356 33082 33082 32088274 0 32088274 28498049 39641 39641 28458408 200673 200673 28659081 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 XII, LINE 2D - OTHER ADJUSTMENTS: INTEREST EXPENSE ($200,673) THE HOSPICE FOUNDATION (OF WINSTON-SALEM/FORSYTH CO.) INC. REVENUE $233,755 PART XIII, LINE 2D - OTHER ADJUSTMENTS: THE HOSPICE FOUNDATION (OF WINSTON-SALEM/FORSYTH CO.), INC. EXPENSES $39,641 PART XIII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSE $200,673 HOSPICE HOPE RUN 203660 65832 137828 47467 3285 1842 32386 GOLF TOURNAMENT 68907 16120 52787 801 5165 2798 5397 17 180464 92602 87862 11390 8432 13274 375 28882 453031 174554 278477 59658 16882 17914 375 66665 161494 116983 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 17 TOTAL EVENTS LISTED IN THE OTHER COLUMN, FOUR EVENTS GENERATED GROSS RECEIPTS GREATER THAN $5,000. X X X X 0 1 0 0 0 0 0 0 0 JOANN E DAVIS 172720 0 25101 0 300000 0 11000 0 11463 0 520284 0 0 0 RICHARD C STEPHENSON 227191 0 5101 0 0 0 10999 0 9730 0 253021 0 0 0 KAREN L CROSS 170030 0 351 0 0 0 0 0 10208 0 180589 0 0 0 BRENTON L SHARPE 147624 0 851 0 0 0 7381 0 948 0 156804 0 0 0 PART I, LINE 4B JOANN DAVIS, PRESIDENT/CEO - $300,000 HOSPICE ENTERED INTO A SUPPLEMENTAL DEFERRED COMPENSATION AGREEMENT TO FUND A MAXIMUM OF $300,000 IN RETIREMENT BENEFITS. HOSPICE PAID $300,000 ACCORDING TO THE AGREEMENT DURING 2010. HOSPICE ACCRUED $60,000 PER YEAR THROUGH 2009 TO FUND THIS OBLIGATION. X 13 7935 EST. FAIR MARKET VALUE X 14024 EST. FAIR MARKET VALUE X 8 31290 FMV AT DONATION DATE X 4 1252 EST. FAIR MARKET VALUE X GIFT CERTIFICATES 2 750 FACE VALUE X OFFICE SUPPLIES & EQUIPMENT 18 5857 EST. FAIR MARKET VALUE X VACATION STAYS 17 10879 FACE VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTORS 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, OR ITS FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC ONLY ON REQUEST. HOURS DEVOTED TO A RELATED ORGANIZATION FORM 990, PART VII, LINE 1A, COLUMN B: HOURS DEVOTED TO RELATED ORGANIZATIO THE CHAIR AND VICE CHAIR OF HOSPICE & PALLIATIVE CARECENTER JOINTLY SERVE ON THE HOSPICE FOUNDATION (OF WINSTON-SALEM/FORSYTH COUNTY), INC.'S 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 (OF WINSTON-SALEM/FORSYTH COUNTY), INC. 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: TRANSFER TO HOSPICE FOUNDATION -250,000. TOTAL TO FORM 990, PART XI, LINE 5: -250,000. FORM 990, PART XI, LINE 2C: FINANCE COMMITTEE THE FINANCE COMMITTEE'S PROCESS OF EVALUATION HAS NOT CHANGED SINCE PRIOR YEAR. THE HOSPICE FOUNDATION (OF WINSTON-SALEMFORSYTH COUNTY) INC 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 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 THE HOSPICE FOUNDATION (OF WINSTON-SALEMFORSYTH COUNTY) INC B 250000 TRANSFER FOR INVESTMENT