2022-11-14T15:02:34-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-01-01 930738493 WILLAMETTE VALLEY HOSPICE WILL 5035883600 1015 3RD STREET NW SALEM OR 97304 IRIA NISHIMURA EXECUTIVE DIRECTOR 5035883600 2022-11-14 1 IRIA NISHIMURA XXX-XX-XXXX KURT BENNION CPA P01469618 4252506100 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z IRIA NISHIMURA 1015 3RD STREET NW SALEM OR 97304 15946165 0 X WWW.WVH.ORG X 1978 OR COMPREHENSIVE CARE FOR THE TERMINALLY ILL. 15 15 154 118 0 0 610463 2058457 16157495 13548004 165732 219397 -5831 -5453 16927859 15820405 0 0 0 0 11079525 10965691 0 0 162145 3824334 3250763 14903859 14216454 2024000 1603951 13666328 13915866 2904801 1028439 10761527 12887427 X TO CHANGE THE END OF LIFE EXPERIENCE FOR TERMINALLY ILL PERSONS AND THEIR FAMILIES, TO PROVIDE BEREAVEMENT SUPPORT FOR THE CAREGIVERS AND FAMILIES OF OUR PATIENTS AND MEMBERS OF THE COMMUNITY, AND TO EDUCATE THE COMMUNITY ABOUT END OF LIFE PHILOSOPHY AND PROGRAMS. 0 0 9076705 0 13548004 WILLAMETTE VALLEY HOSPICE PROVIDES COMPASSIONATE HOSPICE CARE TO TERMINALLY ILL PATIENTS AND THEIR CAREGIVERS. SERVICES INCLUDE IN-HOME NURSING VISITS, PAIN AND SYMPTOM MANAGEMENT, PERSONAL CARE ASSISTANCE, SOCIAL SERVICE ASSISTANCE, RESPITE, SPIRITUAL COUNSELING, MASSAGE, MUSIC AND PET THERAPY, AND BEREAVEMENTS SUPPORT FOR CAREGIVERS AND THE COMMUNITY. WVH RECEIVES FUNDING FROM MEDICARE AND OTHER INSURANCE PLANS. HOWEVER, THIS DOES NOT COVER VOLUNTEER SERVICES, BEREAVEMENT SERVICES, AND ADDITIONAL THERAPIES SUCH AS MUSIC AND MASSAGE. SERVICES ARE ALSO PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY. WVH PROVIDES A UNIQUE SERVICE AS IT IS THE ONLY FREE-STANDING NONPROFIT HOSPICE CARE ORGANIZATION WITHIN A 35-MILE RADIUS OF SALEM. WVH WORKS AS A PARTNER WITH OTHER HEALTHCARE COMMUNITIES, RESIDENTIAL CARE FACILITIES, ADULT FOSTER HOMES, AND ASSISTED LIVING CENTERS, PROVIDING SUPPORT AND EDUCATION ABOUT END OF LIFE CARE.DURING 2021, WVH PROVIDED COMPREHENSIVE HOSPICE CARE TO 857 TERMINALLY ILL PATIENTS AND THEIR FAMILIES, INCLUDING NURSING CARE AND MEDICAL AND PSYCHOSOCIAL ASSISTANCE. 3,979 VOLUNTEER HOURS WERE UTILIZED IN PERFORMING THE SERVICES OF THE ORGANIZATION. WVH PROVIDED ADULT FOSTER CARE TO 32 HOSPICE PATIENTS WHO COULD NO LONGER RESIDE IN THEIR OWN HOME. WVH PROVIDED PALLIATIVE CARE TO 87 PATIENTS AND FAMILIES. WVH PROVIDED 94 INSTANCES OF INDIVIDUAL AND FAMILY COUNSELING, SERVED 89 INDIVIDUALS IN BEREAVEMENT GROUPS, AND HOSTED 2 COMMUNITY BEREAVEMENT EVENTS. 9076705 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 43 0 154 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X X OLIVER FRASER 5035883600 1015 3RD STREET NW SALEM OR 97304 CHERYL MACDONALD MEDICAL DIRECTOR 40.00 X 297558 0 7077 NANCY BOUTIN HOSPICE PHYSICIAN 40.00 X 241727 0 24986 IRIA NISHIMURA EXECUTIVE DIRECTOR 40.00 X 188600 0 16344 BARB FARMER CLINICAL MANAGER 40.00 X 159358 0 16996 HILARY LICARDI NURSE PRACTITIONER 40.00 X 127091 0 15573 KATHY BIRD SOCIAL SERVICES MANAGER 40.00 X 121971 0 15336 JENNIFER MCKENZIE REGISTERED NURSE 40.00 X 120035 0 11477 CAROLYN VAN OTTEN PRESIDENT & PAST PRESIDENT 0.50 X X 0 0 0 ANDREW BONE SECRETARY & PRESIDENT 0.50 X X 0 0 0 REV JOHN MOODY VICE PRESIDENT 0.50 X X 0 0 0 BETTY O'BRIEN TREASURER 0.50 X X 0 0 0 DR RICK COOK DIRECTOR & SECRETARY 0.50 X X 0 0 0 MARK BIDWELL DIRECTOR 0.50 X 0 0 0 JINX BRANDT DIRECTOR 0.50 X 0 0 0 CHAD CAMPBELL DIRECTOR 0.50 X 0 0 0 MYCHAL CHERRY DIRECTOR 0.50 X 0 0 0 SCOTT GALLANT DIRECTOR 0.50 X 0 0 0 NAOMI HORMANN PAST PRESIDENT & DIRECTOR 0.50 X 0 0 0 JULIE HUCKESTEIN DIRECTOR 0.50 X 0 0 0 WAYNE KINKADE DIRECTOR 0.50 X 0 0 0 SHERRIE LESINGER DIRECTOR 0.50 X 0 0 0 GAIL STECK DIRECTOR 0.50 X 0 0 0 1256340 0 107789 16 0 1 0 INTELLA TRIAGE 8011 BROOKS CHAPEL ROAD BRENTWOOD TN 37027 AFTER HOURS TRIAGE SERVICES 147357 MAXIM STAFFING SOLUTIONS 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 RECRUITING 109285 2 5723 1743377 309357 35440 2058457 PATIENT SERVICES 621610 13026473 13026473 ADULT FOSTER HOME 621610 521531 521531 13548004 78817 78817 260887 120307 140580 140580 140580 0 5723 5453 -5453 -5453 15820405 13548004 0 213944 297558 238046 59512 8677102 5672310 2904237 100555 164982 106884 55518 2580 1174315 755284 400796 18235 651734 422227 219314 10193 11925 11925 72395 72395 27435 27435 695869 217705 478164 246641 216059 30582 248456 248456 98053 2304 95749 268188 257365 10823 9647 9647 129867 16997 112870 54704 54704 PATIENT COSTS 1387583 1387583 14216454 9076705 4977604 162145 4673409 1759973 452705 681591 2055616 3181903 177047 153737 5511543 3257367 2316733 2254176 3959569 5843150 31249 41336 13666328 13915866 984207 1018141 1920594 10298 2904801 1028439 X 10428509 12422804 333018 464623 10761527 12887427 13666328 13915866 1603951 249095 272854 0 X X 0 0 0 X 1006334 466800 147830 610463 2058457 4289884 10267041 10259559 12965142 16157495 13548004 63197241 11273375 10726359 13112972 16767958 15606461 67487125 0 0 0 67487125 110843 98517 75625 59692 78817 423494 110843 98517 75625 59692 78817 423494 55399 91954 9345 599 157297 11439617 10916830 13197942 16828249 15685278 68067916 0.99150 0.98910 0.00620 0.00770 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FUNDRAISING EVENT REVENUES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1292797 196332 8688 1480441 1081200 218906 7309 1292797 883484 204117 6401 1081200 596790 425000 -132693 5613 883484 263964 318176 16733 2083 596790 1.00000 0.00000 0.00000 1 0 416150 416150 3509558 1673965 1835593 1585835 1583402 2433 2254176 PART V, LINE 4: BOARD-DESIGNATED ENDOWMENTS PROVIDE FOR UNFUNDED HOSPICE CARE FOR THE COMMUNITY AND PROVIDE FOR UNCOMPENSATED CARE. X X X X 0 0 0 0 0 0 0 0 0 CHERYL MACDONALD MEDICAL DIRECTOR 283107 0 14451 0 0 0 0 0 7077 0 304635 0 0 0 NANCY BOUTIN HOSPICE PHYSICIAN 238164 0 3563 0 0 0 24986 0 0 0 266713 0 0 0 IRIA NISHIMURA EXECUTIVE DIRECTOR 183100 0 5500 0 0 0 8522 0 7822 0 204944 0 0 0 BARB FARMER CLINICAL MANAGER 147312 0 12046 0 0 0 10061 0 6935 0 176354 0 0 0 X 46 10411 ESTIMATED FMV X 15 3600 ESTIMATED FMV X 25 10320 ESTIMATED FMV X SUPPLIES 54 11109 ESTIMATED FMV 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. THE EXCUTIVE COMMITTEE HAS THE POWER OF THE BOARD TO AUTHORIZE EXPENDITURES AND AMENDMENTS TO BUDGETS, SET POLICIES, AND AUTHORIZE PROGRAMS OR ACTIVITIES. THE EXECUTIVE COMMITTE MAKES REASONABLE EFFORTS TO COMMUNICATE WITH THE FULL BOARD IN ADVANCE REGARDING THE ISSUES AND DECISIONS THAT WILL BE CONSIDERED OR VOTED ON AT EXECUTIVE COMMITTEE MEETINGS. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR FINANCIAL OVERSIGHT OF THE ORGANIZATION'S INCOME AND EXPENSES. THE COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE ORGANIZATION'S FINANCIAL TRANSACTIONS AND THE IMPLEMENTATION OF THE ORGANIZATION'S FINANCIAL POLICIES. THE COMMITTEE REVIEWS ON A MONTHLY BASIS, OR OVERSEE A MONTHLY REVIEW OF, THE ORGANIZATION'S EXPENDITURES, FINANCIAL TRANSACTIONS, BANK STATEMENTS, RETURNED CHECKS, AND CREDIT CARD STATEMENTS. THE COMMITTEE ALSO MAKES THE NECESSARY ARRANGEMENTS FOR AND OVERSEES THE ORGANIZATION'S ANNUAL AUDIT OR ANNUAL FINANCIAL REVIEW. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE FINANCE MANAGER, THE EXECUTIVE DIRECTOR AND THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND EMPLOYEES. ALL BOARD MEMBERS, VOLUNTEERS AND STAFF SIGN A CONFLICT OF INTEREST STATEMENT UPON JOINING THE ORGANIZATION. BOARD MEMBERS AND EXECUTIVE STAFF ANNUALLY PROVIDE WRITTEN DISCLOSURE OF ALL PROFESSIONAL AND PERSONAL RELATIONSHIPS OR INTERESTS, DIRECT OR INDIRECT, THAT MIGHT PRESENT A CONFLICT OF INTEREST. IF A MATTER ARISES IN WHICH A BOARD MEMBER HAS AN ACTUAL OR POTENTIAL CONFLICT, THAT CONFLICT IS IMMEDIATELY DISCLOSED TO THE BOARD. IF THE MATTER INVOLVES A VOTE, THE CONFLICTED INDIVIDUAL ABSTAINS FROM VOTING. IF A MATTER ARISES IN WHICH A VOLUNTEER OR EMPLOYEE HAS AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICT IS IMMEDIATELY DISCLOSED TO THE EXECUTIVE DIRECTOR WHO INVESTIGATES IT. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND IS SUMMARIZED IN AN EMPLOYMENT CONTRACT. ALL OTHER EMPLOYEES' COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE DIRECTOR. COMPARABLE COMPENSATION WAS DETERMINED BY USING MARKET RESEARCH WITH ASSISTANCE FROM A COMPENSATION CONSULTING FIRM. MARKET SURVEYS ARE DONE ON ALL EMPLOYEES EACH YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.