2023-09-26T09:10:41-05:00 2022-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2022-01-01 341352875 LIFECARE HOSPICE LIFE 9372569507 1900 AKRON ROAD WOOSTER OH 44691 ROBERT MORRIS CFO 9372569507 2023-09-26 1 ROBERT MORRIS 999009999 1 AMY CIMINELLO P00796388 6148493000 2023-09-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KURT HOLMES 1900 AKRON ROAD WOOSTER OH 44691 18720114 0 X WWW.LIFECAREHOSPICE.COM X 1980 OH THE MISSION OF HOSPICE IS TO PROVIDE MEDICAL CARE, NURSING CARE, PAIN RELIEF, AND EMOTIONAL AND SPIRITUAL SUPPORT SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 9 9 179 183 0 0 2024922 2356566 12695339 16166759 19168 65166 68810 11067 14808239 18599558 0 0 0 0 10431323 11417234 0 0 0 5427255 7823453 15858578 19240687 -1050339 -641129 15889841 15507594 13620570 15344002 2269271 163592 THE MISSION OF HOSPICE IS TO PROVIDE MEDICAL CARE, NURSING CARE, PAIN RELIEF, AND EMOTIONAL AND SPIRITUAL SUPPORT SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES. 0 0 14406911 0 16166759 LIFECARE HOSPICE IS COMMITTED TO BEING THE PREMIER PROVIDER DEDICATED TO PRESERVING THE QUALITY OF LIFE BY PROVIDING EXPERT PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE TO PATIENTS AND FAMILIES WITH LIFE-LIMITING ILLNESSES. 14406911 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 179 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X ROBERT MORRIS 9372569507 7575 PARAGON ROAD DAYTON OH 45459 SHARON POOLER PAST CHAIR 2.00 0.00 X X 0 0 0 DAVID REYNOLDS VICE CHAIR 2.00 2.00 X X 0 0 0 RICHARD GUTTMAN BOARD MEMBER 2.00 0.00 X 0 0 0 BRIAN HINKLE BOARD MEMBER 2.00 0.00 X 0 0 0 JOHN MILLER BOARD MEMBER 2.00 0.00 X 0 0 0 SALLY PATTON BOARD MEMBER 2.00 0.00 X 0 0 0 GENE THORN BOARD MEMBER 2.00 0.00 X 0 0 0 TITUS YODER BOARD MEMBER 2.00 0.00 X 0 0 0 TOM CIHA BOARD MEMBER 2.00 0.00 X 0 0 0 KENT ANDERSON CHIEF EXECUTIVE OFFICER 2.00 58.00 X 0 522223 59655 ROBERT MORRIS CHIEF FINANCIAL OFFICER 2.00 38.00 X 0 304009 35339 KURT HOLMES EXECUTIVE DIRECTOR OF LIFE 40.00 0.00 X 162401 0 22414 JODI HANNAN MEDICAL DIRECTOR LIFECARE 40.00 0.00 X 240123 0 33210 ALEXANDROS NICOLOZAKES TEAM PHYSICIAN 40.00 0.00 X 233196 0 38555 LEANN SPARR RN EXTENDED HOURS 40.00 0.00 X 133188 0 14936 MARY SHETLER RN HOSPICE HOUSE/INPATIENT CARE 40.00 0.00 X 107556 0 15692 KIM HALBLAUB RN HOSPICE HOUSE/INPATIENT CARE 40.00 0.00 X 107527 0 143 983991 826232 219944 9 0 1 0 0 2170981 185585 2356566 PATIENT SERVICE REVENUE 624100 16166759 16166759 16166759 4800 4800 345 180577 0 120556 345 60021 60366 60366 CAFETERIA REVENUE 900099 9859 9859 INSURANCE INCENTIVE 900099 1208 1208 11067 18599558 16166759 0 76233 184814 184814 8829273 8286793 542480 329007 304554 24453 1422417 1339693 82724 651723 593175 58548 8838 8838 16025 16025 5331 5331 89262 27809 61453 27361 514 26847 280865 130555 150310 90979 90979 410237 298597 111640 492811 444798 48013 74178 23928 50250 151088 151088 414030 334154 79876 61788 61788 ALLOCATED COSTS 2999229 2999229 MEDICAL SUPPLIES 1706892 1706892 ROOM & BOARD 244823 244823 PATIENT SERVICE 130822 112161 18661 618894 558465 60429 19240687 14406911 4833776 0 5429 1930 339607 0 1867231 2073986 17479 16425 14256766 2051703 12462466 12205063 901180 275139 250000 250000 46449 685051 15889841 15507594 2086876 9351347 568211 0 5435428 5304029 5530055 688626 13620570 15344002 X 840219 163592 1429052 0 2269271 163592 15889841 15507594 X -641129 -35498 -1429052 X X 0 1 X 1 1 1 X 657582 686895 1395937 2024922 2356566 7121902 657582 686895 1395937 2024922 2356566 7121902 105087 7016815 62 345 2320 4171 4800 11698 -1714 8058 13597 81030 11067 112038 7245638 65688032 0.96840 0.92420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1155107 1155107 11641620 1164023 10477597 1457021 884662 572359 3018 3018 0 12205063 LEASE LIABILITY 688626 688626 0 0 0 0 0 0 0 1 0 KENT ANDERSON CHIEF EXECUTIVE OFFICER 0 455023 0 67200 0 0 0 35750 0 23905 0 581878 0 0 ROBERT MORRIS CHIEF FINANCIAL OFFICER 0 292759 0 11250 0 0 0 8336 0 27003 0 339348 0 0 JODI HANNAN MEDICAL DIRECTOR LIFECARE 233373 0 6750 0 0 0 7412 0 25798 0 273333 0 0 0 ALEXANDROS NICOLOZAKES TEAM PHYSICIAN 233196 0 0 0 0 0 12113 0 26442 0 271751 0 0 0 KURT HOLMES EXECUTIVE DIRECTOR OF LIFE 157713 0 4688 0 0 0 8382 0 14032 0 184815 0 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. PART I, LINE 7 THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL PERFORMANCE REVIEW TO DETERMINE THE COMPENSATION AND BENEFITS OF THE CEO. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS MAY ALSO AWARD BONUS COMPENSATION TO THE CEO BASED UPON THE ANNUAL PERFORMANCE REVIEW. THE CEO CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE OTHER OFFICERS AND EMPLOYEES TO DETERMINE THEIR COMPENSATION AND BENEFITS. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE CEO, WITH THE APPROVAL OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, MAY ALSO AWARD BONUS COMPENSATION TO THE OTHER OFFICERS AND EMPLOYEES BASED UPON THEIR ANNUAL PERFORMANCE REVIEW. A COUNTY OF MONTGOMERY OHIO 316000172 2020-04-23 5541784 SEE PART VI 0 0 0 A 5541784 80000 5461784 2022 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 PART I, LINE A, (F) THE PROCEEDS OF THE SERIES 2020 BONDS WERE USED TO REFINANCE CERTAIN TAXABLE INDEBTEDNESS THAT WAS USED TO FINANCE THE ACQUISITION, CONSTRUCTION, IMPROVEMENT, RENOVATION AND/OR EQUIPPING OF THE LIFECARE HOSPICE FACILITIES. PART I AND II THE SERIES 2020 BONDS WERE ISSUED FOR THE BENEFIT OF OHIO'S HOSPICE, INC., THE HOSPICE OF DAYTON, INCORPORATED, PURE HEALTHCARE, LLC, A DISREGARDED ENTITY OF HOSPICE OF DAYTON, HOSPICE OF MIAMI COUNTY, INC. AND LIFECARE HOSPICE. ONLY A PORTION OF THE PROCEEDS OF THE SERIES 2020 BONDS ARE ALLOCABLE TO LIFECARE HOSPICE AND THE AMOUNTS IN PART I AND PART II LINES 1-15 REFLECT SUCH ALLOCATION. THE PORTION OF THE SERIES 2020 BONDS ALLOCABLE TO THE OTHER ENTITIES IS BEING REPORTED ON SCHEDULE K TO EACH OTHER ENTITY'S FORM 990. FORM 990, PART VI, SECTION A, LINE 6 OHIO'S HOSPICE, INC. BECAME THE SOLE MEMBER OF LIFECARE HOSPICE WITH AN AFFILIATION AGREEMENT SIGNED IN JUNE 2017. FORM 990, PART VI, SECTION A, LINE 7A OHIO'S HOSPICE INC. HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS. THE BOARD SHALL RECOMMEND INDIVIDUALS TO FILL ANY OPENINGS. OHIO'S HOSPICE HAS THE RIGHT TO ELECT FROM THESE INDIVIDUALS OR OTHER INDIVIDUALS AT ITS DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B OHIO'S HOSPICE INC. RETAINS THE POWER TO AMEND THE ARTICLES OF INCORPORATION, CODE OF REGULATIONS, ETC. OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED BY THE CFO PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS SENT VIA EMAIL TO THE FULL BOARD AND WILL BE REVIEWED IN SESSION BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AT THEIR NEXT MEETING. FORM 990, PART VI, SECTION B, LINE 12C IN THE EVENT ANY DIRECTOR, OFFICER OR EXECUTIVE OF THE ORGANIZATION SHALL HAVE ANY DIRECT OR INDIRECT INTEREST IN OR RELATIONSHIP WITH ANY INDIVIDUAL OR ORGANIZATION THAT PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE ORGANIZATION FOR THE SALE, PURCHASE, LEASE OR RENTAL OF PROPERTY OR TO RENDER OR EMPLOY SERVICES, PERSONAL OR OTHERWISE, SUCH DIRECTOR, OFFICER OR EXECUTIVE SHALL FORTHWITH GIVE THE BOARD OF DIRECTORS, CHAIR OF THE BOARD OR PRESIDENT OF THE ORGANIZATION NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER NOT BE COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM AND SHALL REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO AFFECT ITS DECISION TO PARTICIPATE IN SUCH TRANSACTION. IN THE EVENT THAT A CHALLENGE OR QUESTION IS RAISED WHETHER CONFLICT OR DUALITY OF INTEREST EXISTS, THE BOARD OR CHAIR OF THE BOARD OF THE ORGANIZATION SHALL DETERMINE THAT A DUALITY OF INTEREST EXISTS (BY A 2/3 VOTE OF THE BODY). MINUTES OF APPROPRIATE MEETINGS SHOULD REFLECT THAT SUCH DISCLOSURE WAS MADE, AND THAT SUCH DIRECTOR REMOVED HIMSELF/HERSELF FROM THE ROOM AND DID NOT PARTICIPATE IN THE FINAL DISCUSSION, AND WAS NOT COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM. THE CONFLICT OF INTEREST STATEMENT SHALL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF DIRECTORS, OFFICERS OR EXECUTIVES AND THAT ANY NEW DIRECTORS, OFFICERS OR EXECUTIVES BE ADVISED OF THE POLICY UPON UNDERTAKING THE DUTIES OF SUCH OFFICE. FORM 990, PART VI, SECTION B, LINE 15B THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. 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 WRITTEN REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO FOUNDATION -1,429,052. OHI HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 371495725 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 311059756 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE FOUNDATION 7575 PARAGON ROAD DAYTON OH 45459 311769696 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, OHIO'S HOSPICE INC OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF DAYTON INC 324 WILMINGTON AVE DAYTON OH 45420 310933339 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF MIAMI COUNTY INC 3230 N COUNTY RD 25A TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 463215586 TO PROVIDE MANAGEMENT SERVICES AS A SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12A, I N/A 0 LOVING CARE HOSPICE 779 LONDON AVENUE MARYSVILLE OH 43040 311370625 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 10 OHIO'S HOSPICE INC 1 HOSPICE OF FAYETTE COUNTY 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 311243376 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 NATIONAL HOSPICE COOPERATIVE 7575 PARAGON ROAD DAYTON OH 45459 832087147 BUSINESS SUPPORT OH N/A C 1 CENTRAL OHIO GERIATRICS 7575 PARAGON ROAD DAYTON OH 45459 264273198 PHYSICIAN OFFICE OH N/A S 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0