2011-08-11T18:16:33-05:00 2010-12-31 HOLLAND HENRY & BROMLEY LLP PO BOX 8878 SAVANNAH GA 31412 990 2010-01-01 581393820 HOSPICE SAVANNAH INC HOSP 9123552289 PO BOX 13190 SAVANNAH GA 31416 ARTHUR GNANN 9123552289 2011-08-11 1 SHANNON L BRETT 9122353410 2011-08-04 X 2010 2016-02-24 21:20:13Z ARTHUR GNANN PO BOX 13190 SAVANNAH GA 31416 13862294 0 X WWW.HOSPICESAVANNAH.ORG X 1979 GA TO PROVIDE MEDICAL SERVICES TO PATIENTS WITH TERMINAL ILLNESSES. 21 21 252 271 0 0 1516194 150858 13315434 13615734 14416 16133 86823 79569 14932867 13862294 0 0 0 0 8987413 9314045 0 0 0 4552961 4907651 13540374 14221696 1392493 -359402 10579957 10393555 1318823 1491823 9261134 8901732 TO PROVIDE THE BEST SERVICES AND RESOURCES FOR THE COMMUNITY ON DYING, DEATH, GRIEF AND LOSS 0 0 11728541 13657436 THE ORGANIZATION PROVIDED CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES THROUGH HOSPICE HOUSE AND HOME CARE PROGRAMS AND PROVIDED EDUCATIONAL OPPORTUNITIES ON DEATH AND DYING, GRIEF AND LOSS. GRIEF AND LOSS PROGRAM FOR PATIENTS, FAMILY MEMBERS AND THE COMMUNITY AT LARGE. 11728541 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 116 0 1 252 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 21 21 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 GA X ARTHUR GNANN 9123552289 PO BOX 13190 SAVANNAH GA 31416 CHRISTOPHER E KLEIN 1.00 X 0 0 0 FLOYD ADAMS JR 1.00 X 0 0 0 R VINCENT MARTIN III 1.00 X 0 0 0 KACEY RATTERREE 1.00 X 0 0 0 EB ZEKE GAINES III 1.00 X 0 0 0 THEODORA T GONGAWARE MD 1.00 X 0 0 0 MARTIN GREENBURG MD 1.00 X 0 0 0 HOLDEN HAYES 1.00 X 0 0 0 MYRA PHILLIPS 1.00 X 0 0 0 FRAN KAMINSKY 1.00 X 0 0 0 RAMON V MEGUIAR MD 1.00 X 0 0 0 W DOUGLAS SKELTON 1.00 X 0 0 0 LYNN WIRTH 1.00 X 0 0 0 JEAN BELTRAMINI 1.00 X 0 0 0 SISTER MAUREEN CONNOLLY 1.00 X 0 0 0 VIRGINIA A EDWARDS 1.00 X 0 0 0 FRED RABHAN DPM 1.00 X 0 0 0 WILLIAM A BAKER 1.00 X 0 0 0 BRUCE BARRAGAN 1.00 X 0 0 0 KATHLEEN DELOACH BENTON 1.00 X 0 0 0 ROENIA DELOACH 1.00 X 0 0 0 DEBRA LARSON 40.00 X X 105249 0 0 ARTHUR GNANN 40.00 X 97422 0 0 JUDSON HENDRY 40.00 X 98268 0 0 MONICA ANDERSON 40.00 X 91699 0 0 LAWANDA LAW 40.00 X 77196 0 0 KELLY EROLA 40.00 X X 198589 0 0 CYNTHIA CARTER 33.00 X 144865 0 0 JENNIFER HENDRIX 40.00 X 106090 0 0 919378 0 0 4 0 1 0 BCBS PO BOX 100376 ATLANTA GA 30384 EMPLOYEE HEALTH INSURANCE 1026975 HOSPICE PHARMACIA LLC PO BOX 510818 PHILADELPHIA PA 191750818 PATIENT MEDICATIONS 867778 MUTUAL OF AMERICA ROCKEFELLER CTR UNIT PO BOX 2493 NEW YORK NY 101850049 403B 524801 EDM ENTERPRISES INC BLDG 6 2600 CHAMBLEE ROAD SUITE 2 ATLANTA GA 30341 DURABLE MEDICAL EQUIPMENT 502265 BRYAN COUNTY HEALTH & REHAB 127 CARTER STREET RICHMOND HILL GA 31324 NURSING HOME 493801 12 150858 150858 PATIENT SERVICE REVENU 621610 17852047 17852047 CHARITY CARE 621610 -502306 -502306 CONTRACTUAL ADJUSTMENT 621610 -3734007 -3734007 13615734 16133 16133 54000 54000 54000 54000 MANAGEMENT FEES 561000 24000 24000 SPECIAL EVENTS 621610 1085 1085 MISCELLANEOUS INCOME 621610 484 484 25569 13862294 13657436 0 54000 919378 350250 569128 6730221 6218852 511369 1664446 1429256 235190 4045 4045 66871 66871 118190 118190 60159 2704 57455 54085 48525 5560 439466 325865 113601 MEDICATIONS 941265 941265 DME 575987 575987 MILEAGE, MEETINGS, CELL 364688 294759 69929 CONTRIBUTION TO FOUNDAT 336009 336009 MEDICAL SUPPLIES 203140 203140 1743746 1001929 741817 14221696 11728541 2493155 0 2011040 2196233 1546607 1627761 28821 25982 36128 70206 10154286 3826123 6773578 6328163 183783 145210 10579957 10393555 1291303 1491323 27520 500 1318823 1491823 X 9261134 8901732 9261134 8901732 10579957 10393555 -359402 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8514520 2367654 6146866 1627516 1458469 169047 12250 12250 6328163 DUE TO RELATED PARTIES 500 500 13862294 14221696 -359402 0 -359402 13526285 0 13526285 336009 336009 13862294 13885687 0 13885687 336009 336009 14221696 PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO FOUNDATION 336,009. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO FOUNDATION 336,009. 1 1 X 0 0 1 1 0 0 252974 252974 0.01780 252974 252974 0.01780 619580 619580 0.04360 163130 163130 0.01150 782710 782710 0.05510 1035684 1035684 0.07290 1 324081 252974 11910426 11910426 X 1 1 1 3 HOSPICE SAVANNAH INC

1352 EISENHOWER DRIVE SAVANNAH GA 31406

HOSPICE CARE INPATIENT UNIT HOSPICE SAVANNAH INC 1 0 1 0 0 1 X X 1 1 X 1 X 0 0 X X 0 1 2 HOSPICE SAVANNAH INC

1674 CHATHAM PARKWAY SAVANNAH GA 31405

ADMINISTRATIVE OFFICES HOSPICE SAVANNAH INC

450 MALL BLVD SUITE H SAVANNAH GA 31416

BEREAVEMENT CENTER PART I, LINE 3C: THE FOLLOWING POLICY IS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A FINANCE REPRESENTATIVE OR SOCIAL WORKER WILL MEET WITH THE PATIENT AND/OR RESPONSIBLE PARTY PRIOR TO PATIENT BEING ADMITTED TO COMPLETE A FINANCIAL ASSESSMENT FORM. THIS FORM DETERMINES THE LEVEL OF PAY THAT IS REQUIRED PER DAY FROM THE PATIENT OR FAMILY, DEPENDING ON THE FINANCIAL RESOURCES AVAILABLE. THE PATIENT/FAMILY WILL PROVIDE VERIFICATION AND APPROPRIATE PROOF OF RESOURCES AND COMMITMENTS.THE FINANCIAL ASSESSMENT FORM IS SIGNED BY THE PATIENT OR RESPONSIBLE PARTY AND A HOSPICE SAVANNAH REPRESENTATIVE. SIGNING THE FORM IS AN AGREEMENT TO PAY THE AMOUNT DETERMINED. REFUSAL TO PAY THE AGREED TO AMOUNT WILL RESULT IN APPROPRIATE MEASURES BEING TAKEN TO COLLECT THE FUNDS.REFUSAL TO COMPLETE AND SIGN THE FORM WILL RESULT IN THE PATIENT BEING CHARGED THE FULL RATE PER DAY.THE ORIGNIAL AGREEMENT WILL BE PLACED IN THE PATIENT'S FINANICAL CHART. THE PATIENT OR RESPONSIBLE PARTY WILL BE BILLED BI-MONTHLY BASED ON THE PER DIEM RATE ESTABLISHED USING THE FINANCIAL ASSESSMENT FORM. PART I, LINE 7: WORKSHEET 2 FROM FORM 990 INSTRUCTIONS IS USED AS COSTING METHODOLOGY. THERE WERE NO SUBSIDIZED HEALTH SERVICES. PART II: THERE WERE NO COMMUNITY BUILDING ACTIVITIES HELD IN 2010. PART III, LINE 4: WORKSHEET 2 IN THE FORM 990 INSTRUCTIONS WAS USED AS THE COSTING METHODOLOGY FOR PART III, LINE 4. PART III, LINE 8: THERE WAS NO SHORTFALL ON PART III, LINE 7. THE MEDICARE ALLOWABLE COSTS OF CARE WERE DERIVED FROM THE CMS PUBLISHED PER DIEM RATE. PART III, LINE 9B: HOSPICE'S COLLECTION POLICY IS TO SEND THREE STATEMENTS AND PAST DUE LETTERS. IF NO PAYMENT IS RECEIVED AFTER STATEMENTS AND LETTERS ARE SENT, THE ACCOUNT IS WRITTEN OFF. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 15E: HOSPICE'S COLLECTION POLICY IS TO SEND THREE STATEMENTS AND PAST DUE LETTERS ONCE AN ACCOUNT IS DEEMED PAST DUE. IF NO PAYMENT IS RECEIVED AFTER STATEMENTS AND LETTERS ARE SENT, THE ACCOUNT IS WRITTEN OFF. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 18D: HOSPICE SAVANNAH IS NOT A HOSPITAL AND PROVIDES HOSPICE SERVICES, NOT EMERGENCY CARE SERVICES. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 19D: HOSPICE SAVANNAH USES A FINANCIAL ASSESSMENT FORM TO DETERMINE THE AMOUNT OWED. SEE EXPLANATION ABOVE UNDER PART I, LINE 3C FOR ADDITIONAL DETAIL. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 21: ALL SELF PAY PATIENTS THAT DO NOT QUALIFY FOR A REDUCED RATE AFTER COMPLETING THE FINANCIAL ASSESSMENT FORM ARE CHARGED FULL PRICE. PART VI, LINE 2: HOSPICE SAVANNAH PREPARES AN ANNUAL MARKET ANALYSIS ON DEMOGRAPHICS IN THE REGION. CUSTOMER SATISFACTION SURVEYS ARE USED TO PROVIDE FEEDBACK ON EFFECTIVITY OF SERVICES PROVIDED. NHPCO AND GHPCO RESOURCES ARE USED TO TRACK TRENDS IN HOSPICE CARE AND BEST PRACTICES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE IS DONE THROUGH THE ADMISSIONS PROCESS. THEY RECEIVE A FAMILY RESOURCE GUIDE EXPLAINING FINANCIAL OPTIONS. HOSPICE SAVANNAH ALSO ASSISTS PATIENTS WITH COMPLETING MEDICAID APPLICATIONS. PART VI, LINE 4: HOSPICE SAVANNAH SERVES A 5 COUNTY AREA IN SOUTHEAST GEORGIA. CHATHAM, BRYAN, EFFINGHAM, LIBERTY AND LONG COUNTIES ARE ALL SERVED BY HOSPICE SAVANNAH. MOST OF THE POPULATION IS IN CHATHAM COUNTY IN AN URBAN SETTING. PART VI, LINE 6: HOSPICE SAVANNAH OFFERS GRIEF AND LOSS SERVICES TO NOT ONLY HOSPICE SAVANNAH PATIENTS AND THEIR FAMILIES BUT THE COMMUNITY AT LARGE AT NO COST TO THE PARTICIPANTS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO, INDIVIDUAL AND GROUP COUNSELING, MASSAGE THERAPY, MUSIC THERAPY, STORYTELLING, ETC. SCHOOLS, HOSPITALS, NURSING HOMES AND WORD OF MOUTH ARE USED TO INFORM THE COMMUNITY OF THESE SERVICES. PART VI, LINE 7: N/A X 0 0 0 0 0 0 0 0 0 KELLY EROLA 188888 0 0 0 9701 0 0 0 0 0 198589 0 0 0 HOLDEN HAYES VICE CHAIRMAN OF HOSPICE AND PRESIDENT OF BANK WHERE CASH ACCOUNTS ARE HELD EMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICEEMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICE 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE REVIEWED AND APPROVED BY CEO, VP OF FINANCE AND EXECUTIVE/FINANCE COMMITTEE OF BOARD OF DIRECTORS VIA EMAIL PRIOR TO SUBMISSION TO IRS. FORM 990, PART VI, SECTION B, LINE 12C AN ACKNOWLEDGEMENT IS SIGNED BY ALL EMPLOYEES AND BOARD MEMBERS. THIS FORM IS MAINTAINED IN THE HUMAN RESOURCES DEPARTMENT. FORM 990, PART VI, SECTION B, LINE 15B HOSPICE SAVANNAH TYPICALLY UTILIZES AN OUTSIDE AGENCY TO PERFORM A COMPENSATION SURVEY. THIS SURVEY ENSURES THAT ALL SALARIES ARE COMPARABLE WITH AVERAGE GOING RATES FOR ORGANIZATIONS OF SIMILAR SIZE AND IN THE SAME INDUSTRY. ALL SALARIES ARE BASED ON RELEVANT EXPERIENCE AND EDUCATION WITHIN COMPENSATION STRUCTURE. THE COMPENSATION SURVEY IS PERFORMED EVERY TWO YEARS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FROM THE ADMINSTRATIVE OFFICE. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24F CLEANING AND EXTERMINATING: PROGRAM SERVICE EXPENSES 147,723. MANAGEMENT AND GENERAL EXPENSES 30,074. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 177,797. INSURANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 162,332. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 162,332. BAD DEBT: PROGRAM SERVICE EXPENSES 140,711. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,711. UTILITIES: PROGRAM SERVICE EXPENSES 76,462. MANAGEMENT AND GENERAL EXPENSES 63,872. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,334. TELEPHONE: PROGRAM SERVICE EXPENSES 1,390. MANAGEMENT AND GENERAL EXPENSES 104,931. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,321. EQUIPMENT: PROGRAM SERVICE EXPENSES 71,996. MANAGEMENT AND GENERAL EXPENSES 31,305. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 103,301. CONSULTING AND SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 6,939. MANAGEMENT AND GENERAL EXPENSES 73,769. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,708. AMBULANCE: PROGRAM SERVICE EXPENSES 79,558. MANAGEMENT AND GENERAL EXPENSES 364. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,922. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 59,372. MANAGEMENT AND GENERAL EXPENSES 15,365. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,737. CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 49,921. MANAGEMENT AND GENERAL EXPENSES 22,429. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,350. COMPUTER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 70,797. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,797. FACILITY RELATED CONTRACTS: PROGRAM SERVICE EXPENSES 39,181. MANAGEMENT AND GENERAL EXPENSES 27,026. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,207. CABLE AND LINEN: PROGRAM SERVICE EXPENSES 63,977. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,977. DIETARY AND FOOD: PROGRAM SERVICE EXPENSES 62,100. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,100. SECURITY EXPENSE: PROGRAM SERVICE EXPENSES 32,363. MANAGEMENT AND GENERAL EXPENSES 25,875. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,238. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 7,762. MANAGEMENT AND GENERAL EXPENSES 47,089. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,851. PASS THROUGHS: PROGRAM SERVICE EXPENSES 54,130. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,130. LAB AND IMAGING: PROGRAM SERVICE EXPENSES 49,544. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,544. THERAPIES: PROGRAM SERVICE EXPENSES 40,201. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,201. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 1,895. MANAGEMENT AND GENERAL EXPENSES 24,208. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 26,103. POSTAGE AND PRINTING: PROGRAM SERVICE EXPENSES 2,981. MANAGEMENT AND GENERAL EXPENSES 21,105. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,086. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 11,251. MANAGEMENT AND GENERAL EXPENSES 6,430. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,681. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 14,846. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,846. OUTPATIENT: PROGRAM SERVICE EXPENSES 2,472. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,472. AS IN PREVIOUS YEARS, THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. OLD RIVER HOSPICE PROPERTIES LLC 24 DRAYTON STREET SUITE 712 SAVANNAH GA 31410 270888923 PROPERTY MANAGEMENT GA 390207 390707 HOSPICE SAVANNAH INC THE STEWARD CENTER FOR PALLIATIVE CARE INC POST OFFICE BOX 13190 SAVANNAH GA 31416 510545338 COUNSELING GA 501(C)(3) LINE 9 HOSPICE SAVANNAH INC 0 HOSPICE SAVANNAH FOUNDATION INC POST OFFICE BOX 13190 SAVANNAH GA 31416 582215819 FUNDING ASSISTANCE FOR HOSPICE SAVANNAH, INC. AND THE STEWARD CENTER GA 501(C)(3) LINE 11A, I N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 HOSPICE SAVANNAH FOUNDATION INC B 336009 FMV HOSPICE SAVANNAH FOUNDATION INC M THE STEWARD CENTER FOR PALLIATIVE CARE INC M HOSPICE SAVANNAH FOUNDATION INC N THE STEWARD CENTER FOR PALLIATIVE CARE INC N THE STEWARD CENTER FOR PALLIATIVE CARE INC P 35874 FMV