HOSPICE ALLIANCE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
HOSPICE ALLIANCE INC (EIN 39-1403883)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-04
IRS object ID
201122779349300722
Schema version
2010v3.2
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

FieldValueIRS element (for citing)
Timestamp2011-10-04T12:03:01-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ANDREA & ORENDORFF LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line16300 76TH ST STE 200AddressLine1
CityKENOSHACity
StateWIState
ZIP Code531424018ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391403883EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone2626524400Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRICHARD REGNERName
TitlePRESIDENTTitle
Phone2626524400Phone
Date Signed2011-05-19DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameALLISON WRIGHTName
Phone2626577716Phone
Date Prepared2011-08-16DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRICHARD REGNERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9857275GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.HOSPICEALLIANCE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionHOSPICE ALLIANCE HAS SERVED OVER 5,000 TERMINALLY ILL PATIENTS AND THEIR FAMILIES SINCE 1981; SERVICING KENOSHA, EASTERN WALWORTH, AND RACINE COUNTIES. HOSPICE ALLIANCE REMAINS COMMITTED TO CARING FOR THE TERMINALLY ILL AND EMPOWERING THOSE WHO SUPPORT THEM. INCORPORATED IN 1981 IN KENOSHA, WISCONSIN, HOSPICE ALLIANCE, INC. WAS ESTABLISHED BY A GROUP OF COMMUNITY CITIZENS THAT WERE CONCERNED WITH THE LACK OF END OF LIFE CARE AVAILBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES. THESE COMMUNITY CITIZENS BELIEVED THAT IF TERMINALLY ILL PEOPLE WERE GIVEN A CHOICE AS TO WHERE THEY WOULD LIKE TO BE, IT WOULD BE IN THEIR HOME SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. HOSPICE ALLIANCE, INC. LIVES THIS MISSION DAILY THROUGH COMMITMENT, COMPASSION, AND CHOICES. HOSPICE ALLIANCE, INC. PROVIDES CARE IN THE FOLLOWING SETTINGS: 1. IN THE PATIENT'S HOME, SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. THIS CHOICE ALLOWS FAMILY AND FRIENDS TO SUPPORT THEIR LOVED ONE IN COMFORT AND PRIVACY. 2. INActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees132TotalNbrEmployees
Total Nbr Volunteers165TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year204307ContributionsGrantsPriorYear
Contributions Grants Current Year204304ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8804959ProgramServiceRevenuePriorYear
Program Service Revenue CY9593979ProgramServiceRevenueCY
Investment Income Prior Year6856InvestmentIncomePriorYear
Investment Income Current Year4799InvestmentIncomeCurrentYear
Other Revenue Prior Year53634OtherRevenuePriorYear
Other Revenue Current Year54193OtherRevenueCurrentYear
Total Revenue Prior Year9069756TotalRevenuePriorYear
Total Revenue Current Year9857275TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2000000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY800000GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4203130SalariesEtcPriorYear
Salaries Etc Current Year4598775SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3778134OtherExpensePriorYear
Other Expenses Current Year3834156OtherExpensesCurrentYear
Total Expenses Prior Year9981264TotalExpensesPriorYear
Total Expenses Current Year9232931TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-911508RevenuesLessExpensesPriorYear
Revenues Less Expenses CY624344RevenuesLessExpensesCY
Total Assets BOY2304863TotalAssetsBOY
Total Assets EOY2997211TotalAssetsEOY
Total Liabilities BOY644929TotalLiabilitiesBOY
Total Liabilities EOY712933TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1659934NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2284278NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHOSPICE ALLIANCE HAS SERVED OVER 5,000 TERMINALLY ILL PATIENTS AND THEIR FAMILIES SINCE 1981; SERVICING KENOSHA, EASTERN WALWORTH, AND RACINE COUNTIES. HOSPICE ALLIANCE REMAINS COMMITTED TO CARING FOR THE TERMINALLY ILL AND EMPOWERING THOSE WHO SUPPORT THEM. INCORPORATED IN 1981 IN KENOSHA, WISCONSIN, HOSPICE ALLIANCE, INC. WAS ESTABLISHED BY A GROUP OF COMMUNITY CITIZENS THAT WERE CONCERNED WITH THE LACK OF END OF LIFE CARE AVAILBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES. THESE COMMUNITY CITIZENS BELIEVED THAT IF TERMINALLY ILL PEOPLE WERE GIVEN A CHOICE AS TO WHERE THEY WOULD LIKE TO BE, IT WOULD BE IN THEIR HOME SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. HOSPICE ALLIANCE, INC. LIVES THIS MISSION DAILY THROUGH COMMITMENT, COMPASSION, AND CHOICES. HOSPICE ALLIANCE, INC. PROVIDES CARE IN THE FOLLOWING SETTINGS: 1. IN THE PATIENT'S HOME, SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. THIS CHOICE ALLOWS FAMILY AND FRIENDS TO SUPPORT THEIR LOVED ONE IN COMFORT AND PRIVACY. 2. INMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense7851329Expense
Grants800000Grants
Revenue9593979Revenue
DescriptionHOSPICE ALLIANCE PROVIDED 54,658 DAYS OF SERVICE WHICH INCLUDES, 1,113 DAYS OF RESIDENTIAL HOSPICE CARE IN OUR HOSPICE HOUSE AND 1,726 DAYS OF HOME HEALTH CARE IN 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense78664Expense
DescriptionBEREAVEMENT SERVICES - HOSPICE ALLIANCE BEREAVEMENT SERVICES ARE AVAILABLE FOR 13 MONTHS FOLLOWING THE DEATH OF A LOVED ONE. COUNSELORS COMMUNICATE REGUALRY WITH FAMILY MEMBERS, FACILITATE SUPPORT GROUPS AND COORDINATE THE SOCIAL GROUP GATHERINGS. THE BEREAVEMENT DEPARTMENT ALSO HOLDS SEMI-ANNUAL MEMORIAL SERVICES AND PLANS THE ANNUAL GRIEF TELECONFERENCE. MOST IMPORTANTLY, BEREAVEMENT SERVICES ARE AVAILABLE TO ALL IN THE COMMUNITY, NOT JUST THOSE WHO HAVE LOST A LOVED ONE WHILE IN HOSPICE CARE.Description
FieldValueIRS element (for citing)
Total Program Service Expense7929993TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109653NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees132NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonLAWRENCE HAASNamePerson
Telephone Number2626524400TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
JOSHUA BLOOM MD
MEDICAL DIR15.00X1077500
ROBERT BICHLER
MEMBER1.00X000
CHUCK DUFORD
MEMBER1.00X000
RITA HAGEN
MEMBER1.00X000
DANIEL HEYDEN
MEMBER1.00X000
MICHAEL LANGENDORF
MEMBER1.00X000
SCOTT MCARTHEY
MEMBER1.00X000
SHERYL MUELLER
MEMBER1.00X000
KATHLEEN NUZZO
MEMBER1.00X000
GENE OLSON
MEMBER1.00X000
TOM O'NEAL
MEMBER1.00X000
NANCY PIASECKI
MEMBER1.00X000
JOHN PLOUS
MEMBER1.00X000
KATHLEEN RUSS RN
MEMBER1.00X000
PAMELA THOMEY
MEMBER1.00X000
RICHARD FIEGEL
PAST PRESIDE1.00X000
CONNIE MATTER RN
EXEC DIRECTR45.009391000X
RICHARD REGNER
PRESIDENT2.00000X
DENNIS MATTIOLI
SEC/TREAS2.00000X
ESTHER LETVEN
VICE PRESIDE2.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org104685TotalReportableCompFromOrg
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Federated Campaigns7275FederatedCampaigns
Related Organizations188997RelatedOrganizations
Government Grants8032GovernmentGrants
Noncash Contributions188997NoncashContributions
Total Contributions204304TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE92878989287898
HOSPICE HOUSE REVENUE280279280279
ROOM & BOARD SPONSORSHIP2580225802
FieldValueIRS element (for citing)
Total Program Service Revenue9593979TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4799TotalRevenueColumn
Related Or Exempt Function Income4799RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ADMINISTRATION FEES-FDN4577545775
SUPPORT & SUPPLIES-FDN79387938
OTHER REVENUE480480
FieldValueIRS element (for citing)
Total Other Revenue54193TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9857275TotalRevenueColumn
Related Or Exempt Function Income9652971RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total800000Total
Program Services800000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total104685Total
Program Services10775ProgramServices
Management And General93910ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3691985Total
Program Services3164986ProgramServices
Management And General526999ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total526210Total
Program Services434076ProgramServices
Management And General92134ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total275895Total
Program Services230646ProgramServices
Management And General45249ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total7672Total
Management And General7672ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total10500Total
Management And General10500ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total33205Total
Program Services24190ProgramServices
Management And General9015ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total53096Total
Program Services11474ProgramServices
Management And General41622ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total130377Total
Program Services114586ProgramServices
Management And General15791ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total42666Total
Management And General42666ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total384070Total
Program Services114678ProgramServices
Management And General269392ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total203350Total
Program Services182353ProgramServices
Management And General20997ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total41793Total
Management And General41793ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total40625Total
Management And General40625ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PATIENT MEDICAL EXPENSES27399412739941
MEDICAL SUPPLIES7697376973
REPAIRS/MAINTENANCE3877138771
DUES/SUBSCRIPTIONS1928419284
BOOKS39052932973

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total7928Total
Program Services3099ProgramServices
Management And General4829ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9232931Total
Program Services7929993ProgramServices
Management And General1302938ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1102624BOY
EOY1822691EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY43000BOY
EOY43862EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY953002BOY
EOY914669EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY16311BOY
EOY19551EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY45250BOY
EOY61292EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis725880LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec590734LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY144676BOY
EOY135146EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2304863BOY
EOY2997211EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY328482BOY
EOY317463EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY316447BOY
EOY395470EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY644929BOY
EOY712933EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1659934BOY
EOY2284278EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1659934BOY
EOY2284278EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2304863BOY
EOY2997211EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses624344ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6250CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10500CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years199897CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year204307CurrentTaxYearMinus1Year
Current Tax Year204304CurrentTaxYear
Total625258Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7050071CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7261551CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7782226CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8804959CurrentTaxYearMinus1Year
Current Tax Year9652971CurrentTaxYear
Total40551778Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7056321CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7272051CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7982123CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9009266CurrentTaxYearMinus1Year
Current Tax Year9857275CurrentTaxYear
Total41177036Total
FieldValueIRS element (for citing)
Public Support Total50941177036PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1802CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20129CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24467CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6856CurrentTaxYearMinus1Year
Current Tax Year4799CurrentTaxYear
Total58053Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1802CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20129CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24467CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6856CurrentTaxYearMinus1Year
Current Tax Year4799CurrentTaxYear
Total58053Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7058123CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7292180CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8006590CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9016122CurrentTaxYearMinus1Year
Current Tax Year9862074CurrentTaxYear
Total41235089Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99860PublicSupportPercentage509
Prior Year Support Percentage0.99020PriorYearSupportPercentage
Investment Income Percentage0.00000InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
Form1120 Pol FiledfalseForm1120PolFiled
Form4720 FiledfalseForm4720Filed
VolunteersfalseVolunteers
Paid Staff Or ManagementtruePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$421DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB421TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax
Substantially All Dues NondeductfalseSubstantiallyAllDuesNondeduct
Only In House LobbyingfalseOnlyInHouseLobbying
Agree To Carryover Prior YearfalseAgreeToCarryoverPriorYear

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationDURING 2010, HOSPICE ALLIANCE, INC. MET BRIEFLY WITH LEGISLATORS TO EDUCATE THEM ON THE IMPACT OF HEALTH CARE AND MEDICARE REFORM ON HOSPICE CARE.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis725880OtherCostOrOtherBasis
Depreciation590734Depreciation
Book Value135146BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings135146TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED PAYROLL$173,434
ACCRUED VACATION$167,632
DEFERRED REVENUE$54,404
FieldValueIRS element (for citing)
Total Of Amounts395470TotalOfAmounts
Total Revenue9857275TotalRevenue
Total Expenses9232931TotalExpenses
Excess Or Deficit For Year624344ExcessOrDeficitForYear
Excess Or Deficit Per FS624344ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9857275TotRevenueEtcAuditedFinclStmt
Revenue Subtotal9857275RevenueSubtotal
Total Revenue Per Form9909857275TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9232931TotExpensesEtcAuditedFinclStmt
Expenses Subtotal9232931ExpensesSubtotal
Total Expenses Per Form9909232931TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationHOSPICE QUALIFIES AS A TAX-EXEMPT NON-PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SIMILAR STATUTES OF WISCONSIN LAW. HOSPICE IS SUBJECT TO FEDERAL INCOME TAX ONLY ON NET UNRELATED BUSINESS INCOME UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION CURRENTLY HAS NO OBLIGATION FOR UNRELATED BUSINESS INCOME TAX. ACCORDINGLY, NO PROVISIONS FOR FEDERAL OR STATE INCOME TAXES ARE REQUIRED. HOSPICE'S FEDERAL AND STATE TAX RETURNS ARE POTENTIALLY OPEN FOR EXAMINATIONS FOR THE YEARS 2006-2009.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient391822945EINOfRecipient
IRC Section501IRCSection
Amount Of Cash Grant800000AmountOfCashGrant
Purpose Of GrantFOR OPS FUTURE USEPurposeOfGrant

Schedule L IRS990ScheduleL

DQP Table DQPTable (2 entries)

Description Of TransactionDescriptionOfTransactionTransaction CorrectedTransactionCorrected
DR JOSHUA BLOOM
BOARD MEMBERtrue
JOHN PLOUS
BOARD MEMBERfalse

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionIN-KIND RENTDescription
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990188997NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONHOSPICE ALLIANCE HAS SERVED OVER 5,000 TERMINALLY ILL PATIENTS AND THEIR FAMILIES SINCE 1981; SERVICING KENOSHA, EASTERN WALWORTH, AND RACINE COUNTIES. HOSPICE ALLIANCE REMAINS COMMITTED TO CARING FOR THE TERMINALLY ILL AND EMPOWERING THOSE WHO SUPPORT THEM. INCORPORATED IN 1981 IN KENOSHA, WISCONSIN, HOSPICE ALLIANCE, INC. WAS ESTABLISHED BY A GROUP OF COMMUNITY CITIZENS THAT WERE CONCERNED WITH THE LACK OF END OF LIFE CARE AVAILBLE TO TERMINALLY ILL PERSONS AND THEIR FAMILIES. THESE COMMUNITY CITIZENS BELIEVED THAT IF TERMINALLY ILL PEOPLE WERE GIVEN A CHOICE AS TO WHERE THEY WOULD LIKE TO BE, IT WOULD BE IN THEIR HOME SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. HOSPICE ALLIANCE, INC. LIVES THIS MISSION DAILY THROUGH COMMITMENT, COMPASSION, AND CHOICES. HOSPICE ALLIANCE, INC. PROVIDES CARE IN THE FOLLOWING SETTINGS: 1. IN THE PATIENT'S HOME, SURROUNDED BY THE PEOPLE AND THINGS THEY LOVE. THIS CHOICE ALLOWS FAMILY AND FRIENDS TO SUPPORT THEIR LOVED ONE IN COMFORT AND PRIVACY. 2. IN LONG TERM CARE AND ASSISTED LIVING FACTILITES, SUCH AS NURSING HOMES, SENIOR APARTMENTS AND GROUP HOMES. HOSPICE ALLIANCE PROFESSIONALS COMPLEMENT THE CARE ALREADY PROVIDED BY STAFF IN THESE SETTINGS. 3. THE HOSPICE ALLIANCE HOSPICE HOUSE OFFERS AN OPTION FOR THOSE WHO, FOR WHATEVER REASON, CANNOT REMAIN IN THEIR OWN HOME. THE HOUSE OPERATES AT A SIGNIFICANT LOSS DUE TO HOSPICE'S MISSION. 4. PRE-HOSPICE PALLIATIVE CARE MAY BE THE CHOICE FOR SOMEONE WHO IS NOT READY FOR THE HOSPICE PROGRAM. 5. BEREAVEMENT SERVICES AND GRIEF SUPPORT GROUPS ARE AVAILABLE WHEN THE TIME IS APPROPRIATE
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITSFORM 990, PAGE 1, PART I, LINE 6HOSPICE ALLIANCE VOLUNTEERS ARE A VITAL PART OF THE HOSPICE TEAM. WHILE ENHANCING THE LIVES OF PATIENTS AND THEIR FAMILIES, VOLUNTEERS GAIN SATISFACTION AND ENRICHMENT IN THEIR OWN LIVES. THERE ARE MANY WAYS VOLUNTEERS HELP, INCLUDING: COMPANIONSHIP, RESPITE CARE, RUNNING ERRANDS, NURSING HOME VISITS, MAILINGS, OFFICE HELP, COMPUTER WORK, EXPOS AND HEALTH FAIRS, FUNDRAISING, GARDENING, PREPARING MEALS AND BAKING. ALL VOLUNTEERS TAKE PART IN AN EIGHT SESSION TRAINING CLASS WHICH COVERS AN INTRODUCTION TO HOSPICE SERVICES, COMMUNICATION, DISEASE PROCESS, AND THE ROLE OF HOSPICE ALLIANCE TEAM MEMBERS. IN 2010, VOLUNTEERS COMMITTED 10,015 HOURS OF THEIR TIME.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE 990 WAS REVIEWED IN DETAIL BY THE COMPTROLLER AND THEN FURTHER REVIEWED BY THE ORGANIZATION'S FINANCE COMMITTEE AND THEN APPROVED BY THE FULL BOARD OF DIRECTORS. ALL FINANCIAL INFORMATION IN THIS RETURN IS BASED OFF OF THE AUDITED FINANCIAL STATEMENTS.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CFULL DISCLOSURE, BY NOTICE IN WRITING, SHALL BE MADE BY THE INTERESTED PARTIES TO THE FULL BOARD OF DIRECTORS IN ALL CONFLICTS OF INTEREST. THIS IS DONE ON AN ANNUAL BASIS WITH BOARD MEMBERS, STAFF, AND VOLUNTEERS. IF THERE IS A POTENTIAL CONFLICT OF INTEREST, THE POLICY STATES PROCEDURES ON HOW TO HANDLE DIFFERENT SITUATIONS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION WILL FURNISH AUDITED FINANCIAL STATEMENTS UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE FOUNDATION INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1
CityPLEASANT PRAIRIECity
StateWIState
ZIP Code53158ZIPCode
FieldValueIRS element (for citing)
EIN391822945EIN
Primary ActivitiesFUNDRAISERPrimaryActivities
Legal Domicile StateWILegalDomicileState
Exempt Code Section501ExemptCodeSection
Public Charity Status11APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
HOSPICE ALLIANCE FDN INC
B800000GRANT
HOSPICE ALLIANCE FDN INC
C188997INKIND CONTRIB OF RENT
HOSPICE ALLIANCE FDN INC
J99996COST OF RENT
HOSPICE ALLIANCE FDN INC
M53713COST OF SERVICES

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