2020-07-14T15:02:16-05:00 2019-06-30 946214841 ARMANINO LLP 50 W SAN FERNANDO ST STE 500 SAN JOSE CA 95113 990 2018-07-01 942497618 HOSPICE OF SANTA CRUZ COUNTY HOSP 8314303000 940 DISC DRIVE SCOTTS VALLEY CA 95066 CATHERINE CONWAY CHIEF EXECUTIVE OFFICER 8314303000 2020-07-13 1 MATTHEW PETROSKI P00853132 4082006400 2020-07-09 34.104.1.97 2020-07-13 16:45:18 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 5DA78C49DE750741151D309A842E38370EA81981 2018 2021-01-29 14:40:06Z CATHERINE CONWAY 940 DISC DRIVE SCOTTS VALLEY CA 95066 23594751 0 X HOSPICESANTACRUZ.ORG X 1978 CA HOSPICE SERVICE AND SUPPORT FOR TERMINAL PATIENTS AND THEIR FAMILIES. 12 12 210 303 0 0 1405711 1808791 20867289 21640922 9432 49840 51811 57437 22334243 23556990 0 18434 0 0 15524930 16263089 0 0 485865 6818550 7274886 22343480 23556409 -9237 581 13738786 13857637 2586618 2654964 11152168 11202673 HOSPICE OF SANTA CRUZ COUNTY HONORS THE CHOICES OF INDIVIDUALS AND FAMILIES BY PROVIDING EXEMPLARY END-OF-LIFE CARE AND GRIEF SUPPORT TO OUR COMMUNITY. 0 0 19196465 18434 21640922 1,042 PATIENTS AND FAMILIES RECEIVED 73,459 DAYS OF EXPERT END-OF-LIFE CARE FROM HOSPICE TEAMS OF MEDICAL DIRECTORS, NURSES, SOCIAL WORKERS, CHAPLAINS, HOSPICE AIDES, AND VOLUNTEERS. ADDITIONALLY, 2,526 INDIVIDIAL GRIEF SUPPORT SESSIONS WERE PROVIDED TO HOSPICE FAMILIES AND GRIEVING COMMUNITY MEMBERS OF ALL AGES. 19196465 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 82 0 1 210 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X THE ORGANIZATION 8314303000 940 DISC DRIVE SCOTTS VALLEY CA 95066 KATHLEEN GRAVE PRESIDENT TO 12/2018 6.00 X X 0 0 0 BOB KASWEN PRESIDENT (FORMER VP) 6.00 X X 0 0 0 RENEE MELLO TREASURER TO 1/2019 4.00 X X 0 0 0 CARA DISIMONE TREASURER 4.00 X X 0 0 0 MARGARET GORDON SECRETARY 3.00 X X 0 0 0 DAVID KLUGER VICE PRESIDENT 4.00 X X 0 0 0 BETH HANSMAN DIRECTOR 1.00 X 0 0 0 CAROLYN MECOZZI DIRECTOR TO 12/2018 1.00 X 0 0 0 CHARLOTTE KIM DIRECTOR TO 12/2018 1.00 X 0 0 0 DAVID DOOLIN DIRECTOR 1.00 X 0 0 0 ALICIA FLORES DIRECTOR 1.00 X 0 0 0 DICK CLARK DIRECTOR 1.00 X 0 0 0 HOLLY ALEXANDER DIRECTOR 1.00 X 0 0 0 KUNTAL THAKER DIRECTOR 1.00 X 0 0 0 RACHEL WEDEEN DIRECTOR 1.00 X 0 0 0 RUTH MEHR DIRECTOR 1.00 X 0 0 0 MICHAEL MILWARD CEO 40.00 X 338593 0 29712 ADAM SHORE CFO 40.00 X 214979 0 25193 CHARLEA TARMAS MASSION CHIEF MEDICAL & PALLIATIVE 40.00 X 238965 0 28955 KIERAN SHAH CHIEF STRATEGY OFFICER 40.00 X 212688 0 9827 JUDITH HUMBLE CHIEF COMPLIANCE OFFICER 40.00 X 189949 0 11007 CATHERINE CONWAY CHIEF MISSION OFFICER 40.00 X 186364 0 29637 SALLY ANN ADELUS CHIEF CLINICAL OFFICER 40.00 X 166282 0 7720 GLORIA REED DIRECTOR OF PATIENT SERVIC 40.00 X 157711 0 18461 HEATHER SVERSON-TANEZ CLINICAL NURSE MANAGER 40.00 X 149461 0 9298 LISA M FLORES SR. DIRECTOR OF IT 40.00 X 137963 0 7847 AMY HARTE NURSE, VARIABLE STAFFING N 32.00 X 132417 0 11658 EMILIA SCHAMBECK PATIENT CARE MANAGER 40.00 X 130629 0 11290 SHARON ANNE SHULMAN NURSE, VARIABLE STAFFING, FLOAT 40.00 X 126862 0 8232 2382863 0 208837 28 0 1 0 NETWORK MANAGEMENT SOLUTIONS INC 1574-F SOQUEL DRIVE SANTA CRUZ CA 95065 INFORMATION TECHNOLOGY SERVICE 249811 NETSMART TECHNOLOGIES INC PO BOX 823519 PHILADELPHIA PA 19182 SOFTWARE SOLOUTIONS 192306 JANIE KEESLING VESTAL GLEGHORN 330 PENNSYLVANIA AVE SANTA CRUZ CA 95062 PHYSICIAN 171292 PALO ALTO MEDICAL FOUNDATION PO BOX 3757 SUNNYVALE CA 94086 CONTRACTED PHYSICIANS 141188 DAN J RIORDAN PO BOX 1026 SUTTER CREEK CA 95685 PROJECT CONSULTANT 136158 6 116565 1692226 1808791 PATIENT FEES 621610 20989283 20989283 PRIVATE INSURANCE 621610 599652 599652 SELF PAY PATIENT FEES 621610 37989 37989 BEREAVEMENT INCOME 621610 13998 13998 21640922 49840 49840 47721 47721 35641 116565 34074 1567 1567 11836 3687 8149 8149 23556990 21640922 0 107277 18434 18434 1767342 505909 1261433 12039818 10330980 1401200 307638 110345 100147 7056 3142 1332427 1124924 173102 34401 1013157 798514 191911 22732 12964 10754 2210 73260 73260 32368 32368 506164 170263 330383 5518 8671 8671 372672 279732 68647 24293 587763 486834 85662 15267 302592 250799 43917 7876 237652 226795 9098 1759 183724 125215 55376 3133 17103 14187 2470 446 273885 226833 39941 7111 376955 313913 53075 9967 ROOM & BOARD 1848556 1848556 PATIENT CARE SERVICES A 982544 970471 12073 MEDICATIONS 661069 661069 BAD DEBT 460707 460707 336237 271429 34299 30509 23556409 19196465 3874079 485865 2994067 3230425 1291385 1044719 401689 546481 2343020 2274630 72045 223264 4859926 1779867 3324488 3080059 2861400 2911323 450692 546736 13738786 13857637 1855809 1856557 299421 276845 431388 521562 2586618 2654964 X 10494146 10331847 220953 433757 437069 437069 11152168 11202673 13738786 13857637 581 49924 0 X X 0 1 X 1 0 X 1034196 2767070 958027 1405711 1808791 7973795 1034196 2767070 958027 1405711 1808791 7973795 526204 7447591 45701 94242 54691 62977 147485 405096 194098 48824 55517 31122 47477 377038 8755929 98262757 0.85060 0.88300 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GROSS INCOME SPECIAL EVENTS GROSS INCOME SPECIAL EVENTS GAMING RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 212 212 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION, WHICH PERFORMS LIMITED LOBBYING ACTIVITIES. BASED ON THAT ORGANIZATIONS TAX RETURN THE AMOUNT OF ALLOCATED LOBBYING EXPENSES IS DE MINIMIS ($212) 530022 15146 9188 535980 517009 13013 530022 470969 100 45940 517009 482392 75 -11423 75 470969 488670 100 -6378 482392 0.00000 0.81550 0.18450 0 0 558850 558850 1441150 567429 873721 1758881 561444 1197437 1094700 647328 447372 6345 3666 2679 3080059 ENDOWED AGENCY FUND HELD AT COMMUNITY FOUNDATION OF SCC 535880 F NON ENDOWED AGENCY FUND HELD AT COMMUNITY FOUNDATION OF SCC 2375443 F 2911323 DEFERRED COMPENSATION LIABILITIES 325147 SELF-INSURANCE LIABILITY 196415 521562 X 23623115 49924 10808 37761 98493 23524622 32368 32368 23556990 23572610 10808 37761 48569 23524041 32368 32368 23556409 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS CONSISTS OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES TO SUPPORT THE ORGANIZATIONS PROGRAMS. THE ORGANIZATION HAS A POLICY OF CLASSIFYING INVESTMENT INCOME ON ENDOWMENT FUNDS AS TEMPORARILY RESTRICTED UNTIL SUCH TIME AS SPECIFICALLY BUDGETED FOR SPENDING AND APPROVED BY THE BOARD. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND FROM STATE FRANCHISE TAX UNDER REVENUE AND TAXATION CODE SECTION 23701(D), BUT IS SUBJECT TO TAXES ON UNRELATED BUSINESS INCOME WHEN EARNED. FOR THE YEAR ENDING JUNE 30, 2019, NO PROVISION FOR INCOME TAXES HAVE BEEN RECORDED ON THE FINANCIAL STATEMENTS. AS OF THE YEAR ENDED JUNE 30, 2019, THE ORGANIZATION IS CURRENT IN ALL FEDERAL AND STATE TAX FILING OBLIGATIONS AND THE RETURNS ARE SUBJECT TO STANDARD STATUTE OF LIMITATIONS APPLICABLE UNDER THE GOVERNING FEDERAL AND STATE TAX STATUTES. THE ORGANIZATION HAS EVALUATED ITS CURRENT TAX POSITION AND HAS CONCLUDED THAT AS JUNE 30, 2019 IT DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS FOR WHICH A RESERVE WOULD BE NECESSARY. THE ORGANIZATION FILES U.S. FEDERAL AND CALIFORNIA STATE INFORMATION RETURNS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING DIRECT EXPENSES 34,074. GAMING DIRECT EXPENSES 3,687. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING DIRECT EXPENSES 34,074. GAMING DIRECT EXPENSES 3,687. FAIRWAYS FOR KIDS (GOLF) 69542 56000 13542 1075 7530 4160 AN EVENING WITH FRIENDS 52738 40000 12738 1166 4474 700 4161 2 29926 20565 9361 137 196 1605 8870 152206 116565 35641 1075 8833 8830 2305 13031 34074 1567 1 HOUSING MATTERS (FORMERLY HOMELESS SERVICES CENTER) 115 B CORAL STREET SANTA CRUZ CA 95060 770126783 501(C)(3) 13434 RECUPERATIVE CARE CENTER HOSPICE SERVICES OF LAKE COUNTY 1862 PARALLEL DR LAKEPORT CA 95453 942678796 501(C)(3) 5000 GENERAL OPERATIONS - DISASTER RECOVERY 2 0 PART I, LINE 2: STAFF REVIEWS ALL REQUESTS TO ENSURE APPLICANT ORGANIZATION IS ELIGIBLE TO RECEIVE A GRANT UNDER IRS GUIDELINES. ORGANIZATION REQUIRES PERIODIC WRITTEN OR ORAL REPORTS. X X X 0 0 0 0 0 0 0 1 0 MICHAEL MILWARD CEO 297788 0 40805 0 0 0 21025 0 8687 0 368305 0 0 0 ADAM SHORE CFO 195279 0 19700 0 0 0 1979 0 23214 0 240172 0 0 0 CHARLEA TARMAS MASSION CHIEF MEDICAL & PALLIATIVE 235734 0 3231 0 0 0 21108 0 7847 0 267920 0 0 0 KIERAN SHAH CHIEF STRATEGY OFFICER 203307 0 9381 0 0 0 1979 0 7848 0 222515 0 0 0 JUDITH HUMBLE CHIEF COMPLIANCE OFFICER 181553 0 8396 0 0 0 2320 0 8687 0 200956 0 0 0 CATHERINE CONWAY CHIEF MISSION OFFICER 178155 0 8209 0 0 0 20950 0 8687 0 216001 0 0 0 SALLY ANN ADELUS CHIEF CLINICAL OFFICER 157171 0 9111 0 0 0 1850 0 5870 0 174002 0 0 0 GLORIA REED DIRECTOR OF PATIENT SERVIC 150676 0 7035 0 0 0 840 0 17621 0 176172 0 0 0 HEATHER SVERSON-TANEZ CLINICAL NURSE MANAGER 146309 0 3152 0 0 0 1450 0 7848 0 158759 0 0 0 PART I, LINE 7 INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED NONFIXED PAYMENTS IN THE FORM OF A BONUS, AMOUNTS WERE INCLUDED IN COLUMN B(II) AND IN THE EMPLOYEE W-2. BONUS AMOUNTS ARE BASED ON PERFORMANCE MEASURED AGAINST METRICS WHICH ARE REVIEWED AND APPROVED ANNUALLY BY THE COMPENSATION COMMITTEE. KATHERYNE ROBINSON DAUGHTER OF BOARD MEMBER 48616 EMPLOYMENT (NURSE) AMOUNT OF TRANSACTION INCLUDES WAGES OF $45,168, $265 EMPLOYER CONTRIBUTION TO 403(B) PLAN, AND $3,183 IN HEALTH CARE BENEFITS. 0 FORM 990, PART VI, SECTION B, LINE 11B CFO AND CEO REVIEW 990 WHEN COMPLETED BY CPA FIRM. A COPY OF THE 990 IS FURNISHED TO THE FINANCE COMMITTEE AND TO THE BOARD MEMBERS BEFORE THE 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT HSCC'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE ORGANIZATION. OFFICERS AND DIRECTORS REVIEW AND SIGN AN ANNUAL STATEMENT INDICATING UNDERSTANDING AND ADHERENCE TO THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 MARKET DATA ON SALARIES FOR CEO AND CFO POSITIONS IN THE HEALTHCARE AND HOSPICE FIELD IS COMPILED AND REVIEWED ANNUALLY BY HR DIRECTOR. A REPORT CONSIDERING MARKET AND GEOGRAPHIC FACTORS, WAS PRESENTED TO THE ORGANIZATION'S COMPENSATION COMMITTEE, WHICH REVIEWS AND RECOMMENDS ANY SALARY ADJUSTMENT TO FULL BOARD OF DIRECTORS. BOARD OF DIRECTORS REVIEW AND VOTE ON PROPOSED SALARY CHANGES. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, AND ANNUAL 990 INFORMATION RETURNS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL RESULTS ARE PUBLISHED IN THE ORGANIZATION'S ANNUAL REPORT. FORM 990, PART XI, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BETTY L LEONARD TRUST 15 JINGLE LANE APTOS CA 95003 826889620 DECEDENTS ESTATE TRUST CA N/A T 130478 0.68000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0