2011-02-01T08:20:13-06:00 2010-09-30 Gilliam Coble & Moser LLP P O Box 41196 Greensboro NC 274041196 990 2009-10-01 561249146 Hospice and Palliative Care of Greensboro Inc HOSP 3366212500 2500 Summit Avenue Greensboro NC 27405 Patricia A Soenksen 3366212500 2011-01-28 1 Bert Davis 3362300350 2009 2016-02-24 21:20:13Z Hospice & Palliative Care of Patricia A Soenksen 2500 Summit Avenue Greensboro NC 27405 20608953 0 X www.hospicegso.org X 1979 NC Hospice and Palliative Care of Greensboro, Inc. (the "Organization") is a North Carolina nonprofit organization that provides nursing and psychosocial support to the terminally ill and their families in Guilford County and immediately surrounding areas. The Organization received Medicare and Medicaid certification in June 1985 and is reimbursed on a fee-for-service basis from Medicare, Medicaid and other third party coverage. The Agency is currently doing business as Hospice and Palliative Care of Greensboro, Beacon Place and Kids Path. 16 16 238 218 0 0 1202440 1524383 17569979 18543147 219634 276192 32585 239715 19024638 20583437 0 0 10773323 11204092 0 326302 7712005 7370853 18485328 18574945 539310 2008492 18098995 20888106 1493538 1808104 16605457 19080002 The mission of Hospice and Palliative Care of Greensboro is to enhance the quality of life by providing expert interdisciplinary care, consultation, support and education for those affected by serious illness, death or grief. 0 0 14756730 17721783 Hospice is a comprehensive, team-oriented program of medical care, pain management, emotional and spiritual support provided for terminally ill patients and their families. 373862 318737 Palliative Care Services is a hospital-based consultation team (physician, nurse practitioner, nurse liaison, social worker and chaplain) that addresses palliative care needs such as symptom and pain management, assistance in determining goals of care, emotional and/or spiritual support. 749555 432445 Kids Path provides home care for medically fragile and terminally ill children; counseling and support for children experiencing serious illness or loss; and consultation for adults who care for children experiencing grief and loss. 125028 137748 Counseling and Education Center (CEC) provides individual and group counseling for grief and loss for families of hospice patients and the community. 125028 137748 16005175 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 42 0 1 238 1 0 0 0 0 0 0 0 0 0 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X Patricia A Soenksen 3366212500 2500 Summit Avenue Greensboro NC 27405 Larry Roland 1.00 X X 0 0 0 Bob Newton 1.00 X X 0 0 0 Alan Tutterow 1.00 X X 0 0 0 Noel Burt 1.00 X 0 0 0 Howard Chubbs 1.00 X 0 0 0 Griselda Clark 1.00 X 0 0 0 Ross Harris 1.00 X 0 0 0 Ron Johnson 1.00 X 0 0 0 Ann Lineweaver 1.00 X 0 0 0 David Marker 1.00 X 0 0 0 Everette Mills 1.00 X 0 0 0 Mohamed Mohamed 1.00 X 0 0 0 Carolyn Rice 1.00 X 0 0 0 Ralph Shelton 1.00 X 0 0 0 Patrick Wright 1.00 X 0 0 0 John G Redmond 1.00 X X 0 0 0 Patricia Soenksen 40.00 X 135501 0 1583 Tab Haigler 40.00 X 100555 0 3878 Juan Monguilod 40.00 X 190000 0 13571 Nimish Gosrani 40.00 X 105159 0 4750 Donald Hertweck 40.00 X 146539 0 6866 Rita Layson 26.00 X 121299 0 2846 799053 0 33494 6 0 1 0 Blue CrossBlue Shield of North Carolina PO Box 580017 Charlotte NC 28258 Health Insurance 1212607 Procare PBM 3090 Premiere Parkway Duluth GA 30097 Pharmacy Benefits Manager 894341 Advanced Home Care Inc PO Box 65081 Charlotte NC 28265 DME and IV Therapy Provider 738028 Moses Cone Hospital 1200 North Elm St Greensboro NC 27401 Health Services 637360 Camden Place 4007 W Wendover Ave Greensboro NC 27407 Long-term Care Facility 442135 17 1524383 50406 1524383 Per Diem Reimbursement 623000 15185470 15185470 Pass-through Revenues( 623000 2681253 2681253 Per Visit Reimbursemen 623000 676424 676424 18543147 277432 277432 400 1640 -1240 -1240 -1240 196025 23876 172149 172149 Change in Beneficial I 900099 67566 67566 67566 20583437 18610713 0 448341 8180298 6813620 1176238 190440 2336942 1946510 336027 54405 686852 572100 98762 15990 9524 9524 39950 39950 62721 62721 20758 20758 281946 154210 120270 7466 663244 492154 171090 227889 223023 4791 75 429405 429405 230290 137558 92069 663 Inpatient and Consultin 2735466 2735466 Medicines/Drugs/Supplie 2317630 2317630 Patient Services 116478 116478 Miscellaneous 68684 26693 34241 7750 Continuing Education 51535 40328 9526 1681 115333 67501 47832 18574945 16005175 2243468 326302 751 750 2405365 2952259 350160 562297 1982203 1627988 2300198 2186426 28150 27588 56097 74649 8299436 4336644 4133823 3962792 6842248 9493357 18098995 20888106 1493538 1808104 1493538 1808104 X 12564367 15448491 431380 565471 3609710 3066040 16605457 19080002 18098995 20888106 X 0 1 1 X 0 X 1213060 1567136 3622341 1202440 1554971 9159948 1213060 1567136 3622341 1202440 1554971 9159948 9159948 240533 407086 637329 217879 276192 1779019 118027 128299 248870 32585 209127 736908 11675875 74362488 0.78450 0.81330 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6842247 1827015 875408 -40325 -18488 9485857 5736575 592288 538420 -13951 -11085 6842247 0.57150 0.37380 0.05470 1 0 323250 323250 4723607 1930605 2793002 585614 264626 320988 2666965 2141413 525552 3962792 Long Term Investments 8684153 F Beneficial Interests in Endowment F 809204 C 9493357 20583437 18574945 2008492 516458 -50405 466053 2474545 18314024 516458 1 516459 17797565 2785872 2785872 20583437 15839479 0 15839479 2735466 2735466 18574945 Part V, Line 4: Description of Intended Use of Endowment Funds: The endowment funds are used to fund continuing operations and special projects of the organization. Part XI, Line 8 - Other Adjustments: Noncash Contributions recorded on tax return not on Financial Statements: -50406. Rounding Adjustment: 1. Part XII, Line 2d - Other Adjustments: Rounding: 1. Part XII, Line 4b - Other Adjustments: Noncash Contributions: 50406. Inpatient and consulting charges, netted with revenue on financial statement: 2735466. Part XIII, Line 4b - Other Adjustments: Inpatient and consulting charges, netted with revenue on financial statement: 2735466. Corks for Kids Path 75040 75040 2155 11682 3395 Light Up a Life 72759 72759 6644 4 48226 48226 196025 196025 2155 11682 10039 23876 172149 X X 0 1 0 0 0 1 0 0 0 Juan Monguilod 182924 0 0 0 7076 0 0 0 13571 0 203571 0 156046 0 Donald Hertweck 146539 0 0 0 0 0 0 0 6866 0 153405 0 0 0 Supplemental Information Part III Schedule J, Part I, Line 4b. Juan Monguilod received $7,076 as a retirement plan match, $10,144 in cafeteria plan medical expenses, $155 in group term-life insurance, and $3,272 in dependent care benefits for the 2009 calendar year. Donal Hertweck received $6783 in cafeteria plan medical expenses, and $83 in group term-life insurance. X 175 Selling Price X 3589 Selling Price X 4 Market Value X 37 10878 Selling Price X 32 13462 Selling Price X Art & Craft Supplies 23 1370 Selling Price X Gift Cards 13 8833 Selling Price X Miscellaneous Gifts & Toys 64 12099 Selling Price 0 0 0 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the Finance Committee and, once approved, is reviewed with the full Board of Directors before it is filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c All new employees sign a conflict of interest policy. In addition, the Board of Directors review and update the conflict of interest policy annually before signing themselves. Form 990, Part VI, Section B, line 15 The CEO's salary is evaluated by the Board of Directors annually. The CEO's base salary is determined using benchmark market data obtained from the Hospice Salary and Benefits Report published by Hospital and Healthcare Compensation Service in cooperation with the National Association for Homecare & Hospice (NAHC). This is the most comprehensive survey done by hospice organizations and it is widely used. At the beginning of every fiscal year, the Board Chair and the CEO jointly develop quantifiable objectives to measure and evaluate the CEO's performance. These include indicators such as: volume (average daily census) targets; net margin; medication cost per day; employee turnover rates; and employee satisfaction. The Organization maintains a salary schedule for all exempt positions and a pay scale for all non-exempt positions. Compensation for officers and key employees is determined through the use of this schedule. Each is reviewed annually by comparing to benchmark position within the hospice market and related salary and wage data. Where needed, appropriate and feasible, pay ranges may be modified, with Board approval, to more closely reflect the market. Form 990, Part VI, Section C, line 18 The organization's tax forms are all available on the website www.guidestar.org. They are also available upon request. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available upon request.