2024-10-08T14:58:58-05:00 2023-12-31 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2023-01-01 311243376 HOSPICE OF FAYETTE COUNTY INC HOSP 9372569507 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 ROBERT MORRIS CFO 9372569507 2024-10-07 1 1 AMANDA M COON P01754645 6148493000 2024-10-07 2023 2024-10-15 13:58:12Z GAIL STOKES 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 5724225 0 X WWW.HOSPICEOFFAYETTECOUNTY.ORG X 1988 OH OUR MISSION IS TO CELEBRATE THE LIVES OF THOSE WE HAVE THE PRIVILEGE OF SERVING BY PROVIDING SUPERIOR CARE AND SUPERIOR SERVICES TO EACH PATIENT AND FAMILY. WE ARE A NOT-FOR-PROFIT, COMMUNITY-BASED HOSPICE. 11 11 36 48 0 0 178390 225107 5898257 5427783 46281 70604 0 0 6122928 5723494 0 0 0 0 3060122 3245172 0 0 0 2295650 2234463 5355772 5479635 767156 243859 3786304 3954063 589760 455163 3196544 3498900 PROVIDE HOME OR NURSING HOME CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES. PROVIDED EDUCATION & SUPPORT TO FAYETTE COUNTY AND SURROUNDING COMMUNITIES ABOUT QUALIFY OF LIFE ISSUES. 0 0 4133089 0 5427783 COORDINATES A PROGRAM OF HOME, OUTPATIENT, AND INPATIENT HOSPICE CARE THAT PROVIDES PALLIATIVE CARE, SUPPORTIVE MEDICAL SERVICES, AND OTHER SUPPORT SERVICES TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. 4133089 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 36 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 1 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 CHARLES BANE BOARD MEMBER 2.00 0.00 X 0 0 0 KEVIN BLACK BOARD MEMBER 2.00 4.00 X 0 0 0 PETER HALEY VICE CHAIR 2.00 2.00 X X 0 0 0 MARY JUSTICE BOARD MEMBER 2.00 4.00 X 0 0 0 GARY LEROY BOARD MEMBER 2.00 0.00 X 0 0 0 THOMAS MANN CHAIR 2.00 2.00 X X 0 0 0 DAVID REYNOLDS BOARD MEMBER 2.00 2.00 X 0 0 0 TONI SPRINKEL BOARD MEMBER 2.00 0.00 X 0 0 0 GENE THORN TREASURER 2.00 0.00 X X 0 0 0 PEGGY MARK BOARD MEMBER 2.00 0.00 X 0 0 0 DOUG HELMAN SECRETARY 2.00 4.00 X X 0 0 0 KENT ANDERSON CHIEF EXECUTIVE OFFICER 2.00 58.00 X 0 432625 46218 ROBERT MORRIS CHIEF FINANCIAL OFFICER 2.00 38.00 X 0 296275 36130 MILISSA KNISLEY EXECUTIVE DIRECTOR, HOFC 40.00 0.00 X 130757 0 31282 PEGGY KENNEY RN EXTENDED HOURS 40.00 0.00 X 124367 0 13271 LISA CAPPER RN EXTENDED HOURS 40.00 0.00 X 107380 0 6445 362504 728900 133346 3 0 1 0 0 61688 163419 225107 PATIENT SERVICE REVENU 624100 5427783 5427783 5427783 68646 68646 2689 0 731 2689 -731 1958 1958 5723494 5427783 0 70604 162076 162076 2429024 2252580 176444 87244 82350 4894 369224 358982 10242 197604 173534 24070 1510 1510 4700 4700 9679 9679 106384 96848 9536 5505 5505 28172 17676 10496 23254 10500 12754 111117 79550 31567 185226 185226 15773 6857 8916 26069 26069 15253 15253 ALLOCATED EXPENSES 825502 825502 MEDICAL SUPPLIES 503096 503096 ROOM & BOARD 195917 195917 PATIENT SERVICE 52251 48426 3825 125055 95478 29577 5479635 4133089 1346546 0 87193 845919 663858 4847 8845 667045 239582 453531 427463 1928369 2048371 250000 250000 216445 555526 3786304 3954063 377529 315956 212231 139207 589760 455163 X 3196544 3498900 3196544 3498900 3786304 3954063 243859 58497 0 X X 0 1 X 1 0 X 182330 291996 140478 178390 225107 1018301 182330 291996 140478 178390 225107 1018301 1018301 56503 43145 36613 38858 68646 243765 8200 390 8590 1270656 27719201 0.80140 0.86500 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 26286 26286 269606 62045 207561 247167 67159 180008 123986 110378 13608 427463 RELATED PARTY RECEIVABLES 416240 LEASE ASSET 139286 555526 LEASE LIABILITY 139207 139207 0 0 0 0 0 0 0 0 0 KENT ANDERSON CHIEF EXECUTIVE OFFICER 0 432625 0 0 0 0 0 20250 0 25968 0 478843 0 0 ROBERT MORRIS CHIEF FINANCIAL OFFICER 0 296275 0 0 0 0 0 7062 0 29068 0 332405 0 0 MILISSA KNISLEY EXECUTIVE DIRECTOR, HOFC 130757 0 0 0 0 0 9214 0 22068 0 162039 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. FORM 990, PART VI, SECTION A, LINE 4 IN ORDER TO PROVIDE A MORE EFFECTIVE BOARD OF GOVERNANCE, OHIO'S HOSPICE INC SHIFTED FROM HAVING A SEPARATE BOARD OF DIRECTORS FOR EACH INDIVIDUAL ENTITY, TO ONE MAIN GOVERNING BOARD TO OVERSEE OHIO'S HOSPICE INC AND EACH OF ITS REGIONS. IN ADDITION, THERE WAS THE CREATION OF THREE REGIONAL ADVISORY BOARDS TO PROVIDE GENERAL GUIDANCE AND SUBJECT MATTER EXPERTISE. GOVERNING DOCUMENTS WERE ADJUSTED IN 2023 TO CLARIFY THE RESPONSIBILITIES OF THE ADVISORY BOARDS. FORM 990, PART VI, SECTION A, LINE 6 OHIO'S HOSPICE, INC ("OHI") BECAME THE SOLE MEMBER OF HOSPICE OF FAYETTE COUNTY WITH AN AFFILIATION AGREEMENT SIGNED IN NOVEMBER 2017. FORM 990, PART VI, SECTION A, LINE 7A OHI HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS. THE BOARD SHALL RECOMMEND INDIVIDUALS TO FILL ANY OPENINGS. OHI HAS THE RIGHT TO ELECT FROM THESE INDIVIDUALS OR OTHER INDIVIDUALS AT ITS DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B OHI 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. 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 10 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 10 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 LIFECARE HOSPICE 1900 AKRON ROAD WOOSTER OH 44691 341352875 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 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 NATIONAL HOSPICE COOPERATIVE 7575 PARAGON RD DAYTON OH 45459 832087147 BUSINESS SUPPORT OH N/A C 1 CENTRAL OHIO GERIATRICS 7575 PARAGON RD DAYTON OH 45459 264273198 PHYSICIAN OFFICE OH N/A S 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0