2023-11-15T10:03:27-06:00 2022-12-31 113266576 GRASSI & CO CPA'S PC 750 THIRD AVENUE 28TH FLOOR NEW YORK NY 10017 990 2022-01-01 541920770 CAPITAL HOSPICE CAPI 7035382065 3180 FAIRVIEW PARK DR FALLS CHURCH VA 22042 JOSEPH MURRAY CFO 7035382065 2023-11-14 1 JOSEPH MURRAY 999009999 0 JAIME RAPPS P01426990 2126616166 2023-11-14 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z CAPITAL CARING JOSEPH MURRAY 3180 FAIRVIEW PARK DR FALLS CHURCH VA 22042 97050485 0 X WWW.CAPITALCARING.ORG X 1998 VA THE MISSION OF CAPITAL HOSPICE IS TO IMPROVE CARE FOR THOSE FACING LIFE-LIMITING ILLNESSES THROUGH DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES, PUBLIC EDUCATION AND ADVOCACY. 10 9 879 533 0 0 7828621 5971305 97888206 84039648 3688721 847754 151956 293431 109557504 91152138 8295 0 0 0 68628557 51592674 0 0 1246481 44353204 37093658 112990056 88686332 -3432552 2465806 46704036 69346718 27228746 48698443 19475290 20648275 THE MISSION OF CAPITAL HOSPICE IS TO IMPROVE CARE FOR THOSE FACING LIFE-LIMITING ILLNESSES THROUGH DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES, PUBLIC EDUCATION AND ADVOCACY. 0 0 58452068 77641728 CAPITAL HOPSICE PROVIDES EXPERT MEDICAL, EMOTIONAL, SPIRITUAL AND PRACTICAL CARE AND SUPPORT TO PATIENTS WITH SERIOUS, PROGRESSIVE ILLNESS AND THEIR FAMILIES 24 HOURS A DAY, SEVEN DAYS A WEEK WHEREVER THEY LIVE BY QUALIFIED PHYSICIANS, NURSES, NURSES' AIDES, SOCIAL WORKERS AND NON-DENOMINATIONAL CHAPLAINS AND OTHER PROFESSIONALS. IT IS THE OBJECTIVE OF CAPITAL HOSPICE TO PROVIDE CARE TO ANYONE MEDICALLY ELIGIBLE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. CAPITAL HOSPICE PROVIDED SERVICES TO 14,710 PATIENTS DURING 2022 AND PROVIDED 392,581 PATIENT DAYS OF CARE. CAPITAL HOSPICE HAD COSTS RELATED TO SERVICES AND SUPPLIES UNDER ITS CHARITY CARE POLICY OF APPROXIMATELY $1,568,000 IN 2022. 7304394 4530978 THE ADLER CENTER FOR CARING INPATIENT UNIT AND THE WASHINGTON HOME CAPITAL CARING HEALTH INPATIENT CENTER AT SIBLEY MEMORIAL HOSPITAL PROVIDE CARE FOR THOSE PATIENTS THAT REQUIRE CONSTANT MONITORING AND WHOSE PAIN AND SYMPTOMS CAN'T BE ADEQUATELY MANAGED AT HOME. IT IS THE GOAL OF THE ADLER CENTER FOR CARING AND THE WASHINGTON HOME CAPITAL CARING HEALTH AT SIBLEY MEMORIAL HOSPITAL INPATIENT UNITS TO MAKE OUR PATIENTS AS SYMPTOM FEE AND AS COMFORTABLE AS POSSIBLE. THE ADLER CENTER FOR CARING INPATIENT CENTER PROVIDED CARE TO 1,041 PATIENTS AND HAD 2,942 PATIENT DAYS OF CARE IN 2022. THE WASHINGTON HOME CAPITAL CARING HEALTH INPATIENT CENTER AT SIBLEY MEMORIAL HOSPITAL PROVIDED CARE TO 661 AND HAD 2,506 PATIENT DAYS OF CARE IN 2022. 4820254 1866942 CAPITAL PALIATIVE CARE CONSULTANTS PROVIDES PHYSICIAN SERVICES TO OUR HOSPICE PATIENTS, AND TO NON-HOSPICE ELIGIBLE PATIENTS WHO ARE IN NEED OF SYMPTOM MANAGEMENT, IT IS THE OBJECTIVE OF CAPITAL PALLIATIVE CARE CONSULTANTS TO PROVIDE PHYSICIAN SERVICES TO ALL PATIENTS IN NEED OF SYMPTOM MANAGEMENT, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. CAPITAL PALLIATIVE CONSULTANTS PROVIDED 20,688 PATIENT VISITS DURING 2022. 70576716 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0 1 176 0 879 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 CA CO DC FL GA IL MA MD MO NC NJ NY OH PA SC TN VA WV X THE ORGANIZATION 7035382065 3180 FAIRVIEW PARK DR FALLS CHURCH VA 22042 TOM NELSON BOARD MEMBER 1.00 3.00 X 0 0 0 LYNN MENTO BOARD CHAIR AND SECRETARY 1.00 3.00 X X 0 0 0 REV DR TYRONE PITTS VICE CHAIR 1.00 3.00 X X 0 0 0 JOHN ADAMS BOARD MEMBER 1.00 3.00 X 0 0 0 DIANE TY BOARD MEMBER 1.00 3.00 X 0 0 0 CLIFFORD E BARNES BOARD MEMBER 1.00 3.00 X 0 0 0 BILL NOVELLI BOARD MEMBER 1.00 3.00 X 0 0 0 ANGELA WEBB INTERIM TREASURER 1.00 3.00 X X 0 0 0 JEANNINE ENGLISH BOARD MEMBER 1.00 3.00 X 0 0 0 JOHN T KOUTSOUMPAS PRESIDENT/CEO 30.00 10.00 X X 496429 0 13544 JOSEPH MURRAY CHIEF FINANCIAL OFFICER 40.00 0.00 X 251039 0 76 STEVE CONE CHIEF OF COMMUNICATIONS, MARKETING & PHILANTHROPY 40.00 0.00 X 193360 0 9291 GARY BACHER CHIEF OF STRATEGY, POLICY & LEGAL AFFAIRS 30.00 10.00 X 196717 0 9723 LIN MAURANO CHIEF OF CLINICAL OPERATIONS 40.00 0.00 X 221011 0 1710 DR J CAMERON MUIR CHIEF INNOVATIONS OFFICER 5.00 35.00 X 0 322452 9723 DR MATHEW KESTENBAUM CHIEF MEDICAL OFFICER 30.00 10.00 X 256066 0 12865 KIMBERLY GROVE CHIEF OF STAFF 40.00 0.00 X 181496 0 23174 DR EMILY ALBELDA ASSOCIATE CHIEF MEDICAL OFFICER 40.00 0.00 X 243189 0 5350 DR JASON SOBEL SENIOR MEDICAL DIRECTOR 40.00 0.00 X 259348 0 1121 DR RAY JAY GARCIA HPM PHYSICIAN 40.00 0.00 X 254188 0 1220 DR ELIZABETH PHAN HPM PHYSICIAN 30.00 10.00 X 263655 0 9838 DR HEIDI YOUNG ASSOCIATE CHIEF MEDICAL OFFICER 5.00 35.00 X 0 290522 1363 2816498 612974 98998 83 0 1 0 INOVA FAIRFAX HOSPITAL 3300 GALLOWS ROAD FALLS CHURCH VA 22042 GENERAL INPATIENT SERVICES 1581366 FORTRESS GLOBAL SOLUTIONS 4746 BATES DRIVE ELLICOTT CITY MD 21043 CONSULTING SERVICES 939759 MANORCARE LARGO 600 LARGO ROAD LARGO MD 20774 NURSING HOME SERVICES 779039 POTOMAC VALLEY LLC 1235 POTOMAC VALLEY ROAD ROCKVILLE MD 20850 NURSING HOME SERVICES 704230 HOSPICE OF MICHIGAN INC DBA NORTHST 2366 OAK VALLEY DRIVE ANN ARBOR MI 48103 CALL CENTER SERVICES 686673 21 7061 1828875 4135369 175594 5971305 NET PATIENT SERVICE REVENUE 621620 84039648 84039648 84039648 196218 196218 72051 80940 -8889 -8889 -8889 6452673 5801137 651536 651536 651536 11090 7061 16270 -5180 -5180 THRIFT STORE REVENUE 900099 232956 232956 CONTRACT STAFF REVENUE 900099 71154 71154 3390 3390 307500 91152138 84039648 0 1141185 X 1866770 380725 1384585 101460 135000 135000 41643122 35644451 5502919 495752 1935 1769 166 4747497 3971700 714860 60937 3198350 2650763 503958 43629 485058 485058 297246 297246 31008 31008 16965861 14524490 2329190 112181 514156 426442 85750 1964 2341698 734282 1520196 87220 1674059 493843 1172882 7334 3501362 1798551 1473271 229540 1210195 878873 331322 58855 58855 318666 298861 19805 1211281 1165292 31880 14109 557616 511593 37457 8566 MEDICAL SUPPLIES 7281218 7280175 1043 UNCOLLECTIBLE INTEREST 183801 183801 0 AIP 149999 149999 MISCELLANEOUS FINANCIAL 135795 135795 175784 56681 55285 63818 88686332 70576716 16863135 1246481 2880 6566 1374684 4416212 420881 843865 12500099 12348618 509002 1330358 39251502 19814023 20484298 19437479 7134207 3176898 16373 20212 4261612 27766510 46704036 69346718 18280071 15768137 8731745 5000000 429554 216930 27500752 27228746 48698443 X 10584662 13701842 8890628 6946433 19475290 20648275 46704036 69346718 2465806 -1292821 0 X X 0 1 X 1 1 1 X 4614921 4493942 10258650 7828621 5971305 33167439 91297648 89863153 97018241 97888206 87043486 463110734 68375 63125 0 0 0 131500 95980944 94420220 107276891 105716827 93014791 496409673 0 0 0 496409673 1042647 1125379 595637 545799 268269 3577731 1042647 1125379 595637 545799 268269 3577731 382081 485262 196375 226052 302320 1592090 97405672 96030861 108068903 106488678 93585380 501579494 0.98970 0.98890 0.00710 0.01000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 382,081. 2019 AMOUNT: $ 485,262. 2020 AMOUNT: $ 245,339. 2021 AMOUNT: $ 228,052. 2022 AMOUNT: $ 307,500. NET LOSS FROM FUNDRAISING EVENTS - 2020 AMOUNT: $ -48,964. 2021 AMOUNT: $ -2,000. 2022 AMOUNT: $ -5,180. SCHEDULE A, PART I-509(A)(1) PUBLIC CHARITY DESIGNATION AS A THE HALQUIST MEMORIAL INPATIENT CENTER WAS LICENSED IN 1981 AS ONE OF THE FIRST HOSPICE INPATIENT CENTERS IN THE UNITED STATES AND THE FIRST IN THE STATE OF VIRGINIA. AS SUCH, THE STATE OF VIRGINIA HAD NO CATEGORY FOR LICENSURE THAT WOULD FIT THE FACILITY AND THEREFORE LICENSED THE UNIT AS A GENERAL HOSPITAL. AS A HOSPICE INPATIENT CENTER, THE FACILITY HAS NO EMERGENCY ROOM, OUTPATIENT CENTER, LABS, OR OTHER DIAGNOSTIC SERVICES AS WOULD A GENERAL HOSPITAL. IT SERVES ONLY CAPITAL HOSPICE PATIENTS REQUIRING ACUTE SYMPTOM MANAGEMENT OR PATIENTS IN THEIR FINAL DAYS OF A TERMINAL ILLNESS WHO CAN NO LONGER BE SERVED AT HOME. THE UNIT HAS 15 BEDS AND REPRESENTS ON AVERAGE ONLY 13 OF THE MORE THAN 1300 PATIENTS THAT ARE TREATED BY CAPITAL HOSPICE ON A DAILY BASIS. AS A RESULT, THE COMMUNITY HEALTH NEEDS ASSESSMENT IS NOT APPLICABLE TO HOSPICE INPATIENT BEDS. IN STATES OTHER THAN VIRGINIA, UNITS LIKE HALQUIST ARE LICENSED AS HOSPICE CENTERS AND ARE NOT SUBJECT TO EITHER THE COMMUNITY HEALTH NEEDS ASSESSMENT OR FORM 990, SCHEDULE H. IT IS FOR THIS REASON THAT CAPITAL CARING IS FILING FORM 990 AS A PUBLIC CHARITY DESCRIBED UNDER SECTION 170(B)(1)(A)(VI) OF THE INTERNAL REVENUE CODE. SIMILARLY, MEDICARE HAS RECOGNIZED THAT OUR UNIT IS NOT ACTUALLY A HOSPITAL AND HAS NOT REQUIRED US TO COMPLY WITH MANY OF THE REPORTING REQUIREMENTS APPLICABLE TO HOSPITALS. SERVICES AT THE HALQUIST MEMORIAL INPATIENT CENTER HAVE ALWAYS BEEN BILLED TO MEDICARE UNDER THE CAPITAL HOSPICE MEDICARE PROVIDER NUMBER SO EFFECTIVE FEBRUARY 2020 - CAPITAL HOSPICE SURRENDERED ITS HALQUIST MEMORIAL INPATIENT CENTER MEDICARE IDENTIFICATION NUMBER BACK TO THE CENTER FOR MEDICARE SERVICES (CMS) AND SURRENDERED ITS HALQUIST "HOSPITAL" LICENSE BACK TO THE STATE OF VIRGINIA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5257354 -518042 -1500002 3176310 5207434 741914 -691994 5257354 5780402 233796 -806764 5207434 5661714 1218688 -1100000 5780401 6090370 0 -428656 6551714 0.00000 1.00000 0.00000 0 0 1793980 1793980 19924154 7329902 12594252 4100703 725347 3375356 13394362 11722311 1672051 38303 36463 1840 19437479 DEFERRED COMPENSATION 42535 CHARITABLE REMAINDER TRUST 98730 OPERATING LEASE RIGHT-OF-USE ASSETS 23525108 FINANCE LEASE RIGHT-OF-USE ASSETS 49638 AIP MANAGMENT FEE RECEIVABLE 100000 INTERCOMPANY ACCOUNTS RECEIVABLE- CAPITAL CARING ADVANCED ILLNESS SERVICES 2559943 INTERCOMPANY ACCOUNTS RECEIVABLE-CAPITAL CARING STAY AT HOME SERVICES, INC. 1322244 INTERCOMPANY ACCOUNTS RECEIVABLE- CAPITAL CARING HEALTH 68312 27766510 CHARITABLE GIFT ANNUITIES 115267 OPERATING LEASE LIABILITIES 27317940 FINANCE LEASE LIABILITIES 67545 27500752 X 83041095 -1292821 1539504 246683 82794412 31008 8326718 8357726 91152138 83098409 2769803 2769803 80328606 31008 8326718 8357726 88686332 PART V, LINE 4: ENDOWMENT FUNDS UNTIL THEY REACH FIVE MILLION DOLLARS AT WHICH TIME, WITH THE BOARD OF TRUSTEES APPROVAL, EIGHTY PERCENT OF ANY EARNINGSWOULD BE USED TO SUPPORT ONGOING OPERATIONS AND TWENTY PERCENT WOULD WOULD BE ADDED TO THE FUND. TEMPORARILY RESTRICTED FUNDS ARE USED AS INTENDED. THE BOARD DESIGNATED RESTRICTED FUNDS ARE TO BE USED FOR ANY EMERGENCY OR NEW SERVICE THAT THE BOARD APPROVES. PART X, LINE 2: THE CONSOLIDATED GROUP HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE CONSOLIDATED GROUP IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE CONSOLIDATED GROUP BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS PRIOR TO 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: CAPITAL CARING ADVANCED ILLNESS SERVICES INC. REVENUE 783,738. CAPITAL CARING STAY AT HOME SERVICES REVENUE 658,554. ARLINGTON RENTAL EXPENSE 80,940. SPECIAL EVENT EXPENSE 16,272. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRACT NURSING HOME 8,104,668. ARLINGTON RENTAL INCOME 72,051. ADVANCED ILLNESS PARTNERS REVENUE 149,999. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSE 16,272. CAPITAL CARING HEALTH EXPENSES INCLUDED IN CONSOLIDATED EXPENSES 1,514,295. CAPITAL CARING ADVANCED ILLNESS EXPENSES INCLUDED IN CONSOLIDATED EXPENSES 1,158,296. ARINGTON RENT EXPENSE NETTED IN REVENUE 80,940. PART XII, LINE 4B - OTHER ADJUSTMENTS: MEDICAID CONTRACT NURSING HOME EXPENSE 8,104,668. ARLINGTON RENTAL INCOME NETTED IN EXPENSE 72,051. ADVANCED ILLNESS PARTNERS REVENUE RECLASSED TO OTHER EXPENSE 149,999. EMBASSY NIGHT 18151 7061 11090 5000 11090 180 18151 7061 11090 5000 11090 180 16270 -5180 X X X X X 0 1 0 0 0 0 0 1 0 JOHN T KOUTSOUMPAS PRESIDENT/CEO 496429 0 0 0 0 0 11548 0 1996 0 509973 0 0 0 DR J CAMERON MUIR CHIEF INNOVATIONS OFFICER 0 297984 0 0 0 24468 0 0 0 9723 0 332175 0 0 DR HEIDI YOUNG ASSOCIATE CHIEF MEDICAL OFFICER 0 290522 0 0 0 0 0 692 0 671 0 291885 0 0 DR ELIZABETH PHAN HPM PHYSICIAN 263655 0 0 0 0 0 682 0 9156 0 273493 0 0 0 DR MATHEW KESTENBAUM CHIEF MEDICAL OFFICER 256066 0 0 0 0 0 600 0 12265 0 268931 0 0 0 DR JASON SOBEL SENIOR MEDICAL DIRECTOR 259348 0 0 0 0 0 450 0 671 0 260469 0 0 0 DR RAY JAY GARCIA HPM PHYSICIAN 254188 0 0 0 0 0 549 0 671 0 255408 0 0 0 JOSEPH MURRAY CHIEF FINANCIAL OFFICER 217039 0 34000 0 0 0 0 0 76 0 251115 0 0 0 DR EMILY ALBELDA ASSOCIATE CHIEF MEDICAL OFFICER 243189 0 0 0 0 0 4881 0 469 0 248539 0 0 0 LIN MAURANO CHIEF OF CLINICAL OPERATIONS 221011 0 0 0 0 0 0 0 1710 0 222721 0 0 0 GARY BACHER CHIEF OF STRATEGY, POLICY & LEGAL AF 196717 0 0 0 0 0 0 0 9723 0 206440 0 0 0 KIMBERLY GROVE CHIEF OF STAFF 181496 0 0 0 0 0 438 0 22736 0 204670 0 0 0 STEVE CONE CHIEF OF COMMUNICATIONS, MARKETING & 193360 0 0 0 0 0 0 0 9291 0 202651 0 0 0 PART I, LINE 4B DURING THE 2022 CALENDAR YEAR, CAPITAL HOSPICE MAINTAINED A SUPPLEMENTAL NON-QUALIFIED 457(F) DEFERRED COMPENSATION PLAN. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: -JAMES CAMERON MUIR MD DURING 2022, THE THERE WERE NO CONTRIBUTIONS MADE BY CAPITAL HOSPICE TO THE PLAN. DURING 2022, THE FOLLOWING DISTRIBUTIONS WERE MADE BY CAPITAL HOSPICE FROM THE PLAN: -JAMES CAMERON MUIR MD - $24,468 DURING THE 2022 CALENDAR YEAR, THE COMPANY MAINTAINED A NON QUALIFIED 457(B) DEFERRED COMPENSATION PLAN FOR THE FOLLOWING EMPLOYEE: JOHN T. KOUTSOUMPAS DURING 2022, THE COMPANY MADE CONTRIBUTIONS TO THE PLAN TOTALING $10,400. IN 2022, THERE WERE NO DISBURSEMENTS FROM THE PLAN. PART I, LINE 7 IF THE ORGANIZATION REACHES ITS BUDGETED AMOUNT OF NET INCOME FROM OPERATIONS FOR THE YEAR THEN EMPLOYEES ARE ELIGIBLE FOR A BONUS, WHICH IS BASED UPON CERTAIN KEY METRICS THAT ARE UNRELATED TO NET INCOME. HEALTHSPERIAN LLC PRESIDENT/CEO > 35% INTEREST 135000 PAYMENT FOR PERFORMANCE OF SERVICES 0 X 1 500 FMV X 25 FMV X 461 FMV X 5 106335 FMV X 4 1145 FMV X HOTEL/MEAL/TRAVEL 4 51400 FMV X OTHER 4 14113 FMV X GIFT CERTIFICATES/TICKETS 4 1488 FMV X JELWERY 1 128 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE CORPORATE MEMBER IS CAPITAL CARING HEALTH, A RELATED TAX-EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE CORPORATE MEMBER SHALL APPOINT THE DIRECTORS TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER, THROUGH ITS CHAIR OR CEO, OR THROUGH ANY OTHER OFFICER OF THE MEMBER WHO IS AUTHORIZED BY THE BOARD OF DIRECTORS OF THE MEMBER (THE "MEMBER BOARD"), SHALL EXERCISE ALL AUTHORITY AT MEETINGS OF THE CORPORATION AS MEMBERS ARE AUTHORIZED TO EXERCISE FORM 990, PART VI, SECTION B, LINE 11B THE 990 FOR CAPITAL HOSPICE IS REVIEWED BY THE CONTROLLER, VICE-PRESIDIENT OF FINANCE AND CFO. NEXT, THE 990 IS SENT TO ALL OF THE MEMBERS OF THE BOARD OF TRUSTEES INCLUDING PRESIDENT OF CAPITAL HOSPICE FOR THEIR REVIEW AND TO SOLICIT ANY COMMENTS OR QUESTIONS. THE FINANCE AUDIT INVESTMENT COMMITTEE (FAIC) OF THE BOARD MEETS TO REVIEW AND DISCUSS THE FORM 990 IN DETIAL. THIS MEETING IS OPEN TO ALL BOARD MEMBERS INCLUDING THE COMPENSATION AND OTHER COMMITTEE CHAIRS. AFTER THE FROM 990 HAS BEEN REVIEWD BY THE BAORD AND COMMENTS OR QUESTIONS FROM BOARD MEMEBERS HAVE BEEN RESPONDED TO, THE FORM 990 WILL BE FINALIZED, SIGNED BY THE PRESIDENT/CEO AND SUBSEQUENTLY FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMEBERS, OFFICERS AND KEY MANAGERS ARE REQUIRED TO REPORT ANY REAL OR POTENTIAL OR PERCEIVED CONFLICT OF INTEREST INVOLVING THEM OR ANOTHER PERSON BY PROMPTLY FILING A WRITTEN DISCLOSURE STATEMENT WITH THE PRESIDENT OR CHAIR OF THE BOARD OF TRUSTEES. THE PRESIDENT WILL REVIEW ALL SUCH STATEMENTS AND THE ANNUAL DISCLOSURE STATEMENTS AND DISCUSS WITH THE CHAIR OF THE BOARD ANY POTENTIAL CONFLICTS OF INTEREST. IF THE PRESIDENT AND THE CAHIR OF THE BOARD DETERMINE THAT A POTENTIAL CONFLICT EXISTS, THEN THE BOARD SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND ALLOW THE PERSON TO EXPLAIN AND DISCLOSE. FOR ANY TRANSACTION/ARRANGEMENT DISCUSWSED DURING A BOARD MEETING FOR WHICH A CONFLICT OF INTEREST IS DEEMED TO EXIST, THE AFFECTED BOARD MEMBER SHALL NOT BE COUNTED IN DETERMINING THE QUOROM FOR THE MEETING BUT SHALL BE PERMITTED TO BRIEFLY STATE THEIR POSITION ON THE MATTER AND ANSWER PERTINENT QUESTIONS OF OTHER BOARD MEMBERS BEFORE VACATING THE GOVERNING BOARD. THE BAORD MEMBER SHALL LEAVE THE GOVERNING BAORD AND A MAJORITY OF THE REMAINING BOARD MEMBERS SHALL DETERMINE WHETHER TO UNDERTAKE SUCH TRANSACTION/ARRANGEMENT. IF THE BOARD DECIDES THAT A PERSON HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST. THE BOARD SHALL TAKE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15A IN 2019 THE EXECUTIVE COMMITTEE OF THE BOARD ENGAGED QUATT AND ASSOCIATES, AN INDEPENDENT CONSULTING GROUP, TO PREPARE A REPORT TO ASSIST IN ESTABLISHING COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND OTHER KEY PERSONNEL. THE REPORT WAS REVIEWD AND APPORVED BY THE EXECUTIVE COMMITTEE AFTER THOROUGH DISCUSSION OF THE DATA, ITS SOURCES AND FINDINGS. THE ORGANIZATION AS SUBJECT TO INTERMEDIATE SANCTIONS UNDER INTERNAL REVENUE CODE (IRD) SECTION 4958, CONSIDERS THAT THE INTERMEDIATE SANCTIONS MARKET BENCHMARKING METHODOLOY FOR DISQULAIFIED INDIVIDUALS, CONDUCTIED BY QUATT AND ASSOICAIATES, HAS PROVDIED A VALID AND ROBUST MEANS FOR DETERMINING MARKET BASED COMPENSATION COMPETITIVENESS. 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. FORM 990, PART IX, LINE 11G CONTRACT PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 242,251. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 242,251. CONTRACT SERVICES- NURSING HOME: PROGRAM SERVICE EXPENSES 8,104,668. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,104,668. CONTRACT SERVICES- LABOR: PROGRAM SERVICE EXPENSES 1,999,646. MANAGEMENT AND GENERAL EXPENSES 4,694. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,004,340. CONTRACT SERVICES- CONSULTANTS: PROGRAM SERVICE EXPENSES 101,100. MANAGEMENT AND GENERAL EXPENSES 2,104,983. FUNDRAISING EXPENSES 108,681. TOTAL EXPENSES 2,314,764. CONTRACT SERVICES- GENERAL INPATIENT: PROGRAM SERVICE EXPENSES 1,801,924. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,801,924. CONTRACT SERVICES- OTHER PATIENT RELATED: PROGRAM SERVICE EXPENSES 798,627. MANAGEMENT AND GENERAL EXPENSES 23,226. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 821,853. CONTRACT SERVICES-OTHER: PROGRAM SERVICE EXPENSES 1,476,274. MANAGEMENT AND GENERAL EXPENSES 196,287. FUNDRAISING EXPENSES 3,500. TOTAL EXPENSES 1,676,061. FORM 990 PART XI, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEARS. CAPITAL PALLIATIVE CARE CONSULTANTS 3180 FAIRVIEW PARK DRIVE SUITE 500 FALLS CHURCH VA 22042 522361003 PALLIATIVE CARE VA 838106 5640694 CAPITAL HOSPICE CAPITAL CARING HEALTH INC 3180 FAIRVIEW PARK DR SUITE 500 FALLS CHURCH VA 22042 843773372 MEDICAL SUPPORT SERVICES VA 501(C)(3) 12 N/A 0 CAPITAL CAING ADVANCED ILLNESS INC 3180 FAIRVIEW PARK DR SUITE 500 FALLS CHURCH VA 22042 843787656 ILLNESS, PALLIATIVE AND PRIMARY CARE SERVICES VA 501(C)(3) 7 CAPITAL CARING HEALTH 0 CAPITAL CARING STAY AT HOME SERVICES INC 3180 FAIRVIEW PARK DR SUITE 500 FALLS CHURCH VA 22042 843797085 AT HOME MEDICAL SERVICES VA 501(C)(3) 7 CAPITAL CARING HEALTH 0 ADVANCED ILLNESS PARTNERS LLC 3180 FAIRVIEW PARK DR SUITE 500 FALLS CHURCH VA 22042 861633085 MEDICARE DIRECT CONTRACTED MEDICAL SERVICES DE CAPITAL HOSPICE RELATED 0 1 CHARITABLE REMAINDER TRUST 3180 FAIRVIEW PARK DRIVE SUITE 500 FALLS CHURCH VA 22042 INVESTMENTS KY CAPITAL HOSPICE T 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 CAPITAL CARING HEALTH S 255000 FMV CAPITAL CARING STAY AT HOME SERVICES S 580163 FMV CAPITAL CARING ADVANCED ILLNESS SERVICES INC S 621353 FMV