2011-04-04T16:04:56-05:00 2010-06-30 DOPKINS & COMPANY LLP 200 INTERNATIONAL DR BUFFALO NY 142215794 990 2009-07-01 222524016 NIAGARA HOSPICE INC NIAG 7164394417 4675 SUNSET DRIVE LOCKPORT NY 14094 Paul c Collins 7164394417 2011-03-31 1 james sciarrino 7166348800 X 2009 2016-02-24 21:20:13Z john lomeo 4675 SUNSET DRIVE LOCKPORT NY 14094 12468225 0 X WWW.NIAGARAHOSPICE.ORG X 1982 NY to provide specialized services to persons with a life limiting illness and their families. 16 16 143 122 0 0 1007154 485604 11527767 11784296 44947 102723 29721 67699 12609589 12440322 0 0 4841038 5060431 0 69302 6786169 7160229 11627207 12220660 982382 219662 12144976 11488502 4691285 3815148 7453691 7673354 to provide specialized services to persons with a life limiting illness and their families. 0 0 7275329 9608539 Patient revenue for Niagara Hospice (nh)is earned based on patients services provided and then reimbursed by insurances. There are a few types of patient service fees, which are explained below. Patients receive various types of services, in which the largest revenue types include Homecare Routine, Nursing Home Reimbursement and in-patient general. Homecare routine consists of the basic in-home visists to the patients own home at least once a week to do various care-taking services (ie. baths, laundry, visiting). The nursing home reimbursement revenue is from the hospice patients that are in nursing homes, in which the nursing homes bill niagara hospice and NH, in turn, bills the insurances for reimbursement. Inpatient general consists of patients in the various hospitals, in which the hospitals bill NH and NH seeks reimbursement from the insurances. the continuous care program provides "extended care" versus the regular home health aides. This extended care is billed at a higher rate due to the increased amount of time the LPNs. This service requires at least 12 hours of time with a registered nurse. 2900050 2175757 Although hospice care will always be primarily provided in a patient's or caregiver's home, there are some individuals who do not have a home environment appropriate for hospice care, or lack the family or friends necessary to provide 24/7 care in a home environment. Additionally, some hospice patients need around-the-clock medical attention during medication adjustments or for symptom management. In response to these needs, Niagara Hospice House was built.Niagara Hospice House is Niagara County's only residential hospice house, providing services to patients and their families who are not able to receive home hospice care. The residential wing consists of eight suites specifically designed for longer stays when the home caregiving structure is compromised. The in-patient wing has ten suites designed for patients needing short-term medical monitoring and symptom management.Each suite is designed with patient and family in mind with a sitting area and easy-chair sleeper. Each family also has access to gathering rooms, fireplaces, a chapel, kitchen and the Hospice Memorial Gardens. 10175379 1 1 0 0 0 0 0 0 1 1 1 1 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 1 41 0 143 1 0 0 0 0 0 0 0 0 0 0 0 16 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X X CARLO FIGLIOMENI 7164394417 4675 SUNSET DRIVE LOCKPORT NY 14094 X patrICIA EVANS 0.50 X 0 0 0 sharon jean hewner phd 0.50 X 0 0 0 LINDA FLESSEL RN 0.50 X 0 0 0 DAN MANDAVILLE 0.50 X 0 0 0 frank demart 0.50 X 0 0 0 Nicholas Granchelli 0.50 X 0 0 0 PAUL BEATTY sr 0.50 X 0 0 0 eugene nenni 0.50 X 0 0 0 mary brennan-taylor 0.50 X 0 0 0 john j m readon 0.50 X 0 0 0 rev lou perez 0.50 X 0 0 0 janice p litz lcsw-r 0.50 X 0 0 0 PAUL C COLLINS 0.50 X 0 0 0 STEVEN M SINCLAIR 0.50 X 0 0 0 ANDREA SAMMARCO ESQ 0.50 X 0 0 0 JAMES M SHAW DDS 0.50 X 0 0 0 carlo figliomeni VIA HPCG 37.50 X 0 147383 16995 john lomeo via hpcg 37.50 X 0 226213 61243 alfred bax via hpcg 37.50 X 0 266986 12164 sarina bax-debiaso 26.50 X 114267 0 1560 114267 640582 91962 3 0 1 0 Hospi-Script Services PO Box 933273 atlanta GA 31193 Pharmacy 311650 1 6992 275933 202679 485604 Home Care 623990 9608539 9608539 Hospice House 623990 2175757 2175757 11784296 102723 102723 28800 28800 28800 28800 66802 27903 38899 38899 12440322 11784296 0 170422 4156175 3851379 304796 86616 74734 11882 495871 461074 34797 321769 298197 23572 960274 960274 28173 2204 25969 21303 21303 2232241 2221588 10653 45558 12271 3013 30274 172594 130637 22806 19151 46529 44874 1655 4583 4583 121162 117071 4091 154573 153951 622 102530 78212 24318 439767 378814 44787 16166 71933 68743 3190 Nursing Home Expense 1193815 1193815 Medical Equipment 696474 696474 Workers Comp Assessment 398158 398158 HH Supplies 180235 180235 Repairs and Maintenance 137480 137480 152847 73626 77165 2056 12220660 10175379 1975979 69302 1100 1100 3313869 1086510 228757 186775 1121810 2131145 71801 387939 164766 148380 8979907 2237986 6466640 6741921 14914 16155 714431 788577 46888 0 12144976 11488502 667157 1217864 48485 30671 3827649 2394349 147994 172264 4691285 3815148 X 7443691 7663354 10000 10000 7453691 7673354 12144976 11488502 X 0 1 1 X 0 X 33265 565861 811445 1012875 520509 2943955 8368833 8550840 9922773 11527767 11852456 50222669 8402098 9116701 10734218 12540642 12372965 53166624 0 0 0 53166624 52054 96451 102856 68947 131523 451831 52054 96451 102856 68947 131523 451831 1982 450 450 2882 8456134 9213602 10837524 12609589 12504488 53621337 0.99150 0.99250 0.00840 0.00710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16694 1043 17737 13710 -2570 11140 1.00000 0 0 108248 108248 6896326 995340 5900986 1975333 1242646 732687 6741921 LAND INVESTMENT 15000 C sentinel common stock fund 55586 F oppenheimer funds 283516 F merrill lynch 13172 F balloon payment account 115652 F capital fund 287698 F endowment account 12434 F niagara area endowment 5519 F 788577 due to palliative home care of niagara 172264 172264 12440322 12220660 219662 0 219662 12465575 25253 25253 12440322 0 12440322 11847754 25253 25253 11822501 398158 398158 12220659 Part V, Line 4: Description of Intended Use of Endowment Funds: permanent endowment of $10,000 with generated income available for unrestricted operations. Part X: Description of Uncertain Tax Positions Under FIN 48: The Agency is an organization exempt from taxation under Section 501(c)(3) of the Internal Revenue Code. Effective July 1, 2009, the Agency adopted the accounting standard regarding accounting for uncertainty in income taxes. This standard clarifies the financial statement recognition and measurement criteria of tax positions taken or expected to be taken in a tax return. There was no effect of adopting this standard on the financial statements. It is highly certain that some positions taken for income tax purposes would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would be ultimately sustained. The benefit of a tax position is recognized in the financial statements only to the extent that an uncertain tax position (if any) is attributable to the Agency. The tax returns for the tax years 2007 through 2010 remain subject to examination by the Internal Revenue Service for U.S. Federal tax purposes and also by New York State for state tax purposes. Schedule D, Page 4, Part XIII, line 4b: This adjustment is due to workers comp assessment of $398,158 - See schedulue 0 for explanation lomeo golf 53264 53264 319 15810 7139 butterfly release 13539 13539 4621 66803 66803 319 15810 11760 27889 38914 0.00000 1.00000 carlo figliomeni 4675 SUNSET DRIVE LOCKPORT NY 14094 X X X X 0 0 0 0 0 0 0 0 0 carlo figliomeni (VIA HPCG) 0 147383 0 0 0 0 0 6953 0 10042 0 164378 0 0 john lomeo (via hpcg) 0 226213 0 0 0 0 0 45540 0 15703 0 287456 0 0 alfred bax (via hpcg) 0 266986 0 0 0 0 0 12014 0 150 0 279150 0 0 Form 990, Part VI, Section A, line 3 Niagara Hospice, Inc. delegates control over its management duties to the Hospice and Palliative Care Group, inc. (a related 501c(3) organization). A management fee is charged between the two entities. Form 990, Part VI, Section B, line 11 the 990 is presented in draft form to the members of the governing body of niagara hospice, inc. after it has been reviewed by agency fiscal personnel. each member of the board has the opportunity to review the return and suggest any changes prior to filing with the internal revenue service. Form 990, Part VI, Section B, line 12c Niagara Hospice, Inc. is committed to identify and disclose all individuals that may have a potential to influence or direct decisions to his/her own gain. All board members and employees participating in the activities and/or operations of the Niagara Hospice, Inc. must sign a conflict of interest form, and disclose any direct or indirect relationship, investment or interest which may require his/her exclusion from participating in certain decision - making processes. In addition, each member of the board of directors must complete a disclosure of potential conflict of interest form. No employee of Niagara Hospice, Inc. may have employment, consulting or other business relationship with a competitor, patient/family, supplier, or invest in any competitor or supplier (except for moderate holdings of publicly traded securities) unless written permission is granted by the CEO and CCO in advance. Outside employment may constitute a conflict of interest if it places an employee in the position of appearing to represent the agency, involves services similar to those the agency provides or lessens the efficiency, alertness or productivity normally expected of employees on their jobs. Outside employment may also constitute a conflict of interest if employees perform services either for individuals or entities that make referrals. All outside employment that is in question must be disclosed to the agency and be evaluated by the CCO. Form 990, Part VI, Section B, line 15 The Executive committee is charged by the Board of Directors with the responsibility to determine the compensation of the chief executive & chief operating officer. The purpose of this committee is to: Approve the annual performance standards of the executive director. Determine appropriate performance measures and establish criteria for any incentive based compensation. Conduct the annual performance appraisal. Determine the total compensation package. Annually review, and approve any change to, the total compensation of the chief executive & chief operating officer. Form 990, Part VI, Section C, line 19 the organization makes its form 1023 and form 990 availiable to the public upon request over the phone, in writing, in person, and via e-mail. the 990 is also available through the guidestar and ny ags websites. the organizations governing documents, conflict of interst policy, and financial statements are not available to the public. form 990; part xi; line 2c the process has not changed from prior year. Schedule d, Page 4, Part xiii, line 4b In a prior year The Company was a member of a self-insurance trust, which provided workers' compensation benefits and short-term disability to eligible Company employees. Under the terms of the Trust, the Company made annual contributions to the Trust based on reported salaries paid to employees. Effective June 30, 2009, the Trust was dissolved and the Company entered into a traditional insurance agreement. Under the Trust agreement, each participating organization has joint and several liability for trust obligations until all final claims of the Trust are settled which could take several years. Therefore, the Company has continued exposure to receive a refund of past contributions paid or to be assessed additional contributions until the point in time that all claims have been settled. The Trust has informed the Company that additional assessments may be charged in thefuture. For the year ended June 30, 2010 the Company recorded a charge, relating to year prior to 2010, totaling $398,158 for such assessments. SCHEDULE D, PAGE 4, PART XI, LINE 8 This amount is the net income from fundraising activities listed in schedule J. FORM 990; SCHEDULE D; PAGE 4; PART XII LINE 2B AND PART XIII LINE 2A DONATED SERVICES NIAGARA HOSPICE, INC. RECEIVED VOLUNTEER SERVICES IN THE AMOUNT OF $22,250. THEY RECEIVED AN ADDITIONAL 6,500 HOURS FROM VOLUNTEERS WHO ASSISTED WITH PATIENT SERVICES AND FUNDRAISING, THE VALUE OF WHICH CANNOT BE DETERMINED. hospice and palliative care group inc 4675 SUNSET DRIVE lockport NY 14094 562298553 to provide human resource,accounting,& computer services for niagara hospice NY 501c3 170(b)(1)(a)(iv) palliative home care of niagara inc 4675 SUNSET DRIVE lockport NY 14094 161611701 to provide home care & pain care services to pre-hospice & hospice patients NY 501c3 170(b)(1)(a)(iv) niagara hospice alliance 4675 SUNSET DRIVE lockport NY 14094 261101852 To provide fundraising activities for all other incs. NY 501c3 170(b)(1)(a)(iv) 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 PALLIATIVE HOME CARE OF NIAGARA INC I 24000 niagara hospice alliance inc I 4800 PaLLIATIVE HOME CARE OF NIAGARA INC L 1358380 palLIATIVE HOME CARE OF NIAGARA INC L 686888 niagara hospice alliance inc C 118500 hospice and palliative care group L 960724