2017-05-10T15:29:20-07:00 2016-06-30 990 2015-07-01 251818793 GOOD SAMARITAN HOSPICE of PITTSBURGH GOOD 7249338888 3500 Brooktree Road Suite 320 Wexford PA 150909277 Tammy Young CFO 7249338888 2017-05-10 2015 2021-01-29 14:40:06Z Judy Connelly 3500 Brooktree Road Suite 320 Wexford PA 15090 12891948 0 X www.good-samaritanhospice.org X 1998 PA Home Hospice/Nursing: Establish and maintain programs which provide supportive care for terminally ill patients and their families; and to provide associated services including, but not limited to, operation of a Non-Profit Hospice. X 9 6 145 173 0 0 265392 180720 11465814 12700192 -351 -2553 -3969 8051 11726886 12886410 0 0 0 0 5650401 5948849 0 0 21834 3514686 3822979 9165087 9771828 2561799 3114582 4920876 5404246 836678 723939 4084198 4680307 The mission is to establish and maintain programs which provide supportive care for terminally ill patients and their families; and to provide associated services including, but not limited to, operations of a non-profit hospice. The goal is to empower the community to understand the blessings of hospice and how the service can help those in an extremely difficult time in their lives. For fiscal year ending 06/30/2016 a total of $10,470 in services was rendered as benevolent care. 0 0 7227465 0 12700192 Good Samaritan Hospice (GSH) program service activities focus on educating individuals and organizations to hospice care, insurance coverage, advocacy, advance directives, coordination of care, patient, rights, pain and symptom management and to clarify confusion related to hospice care. In addition, GSH provides support to those facing serious illness through individual Reflections of Care meeting to listen to patient/family concerns, goals and wishes and facilitate problem-solving and decision making related to health care needs and desires. Family and community support is provided through Grief Support groups and other community activities. All these efforts occur to improve and enhance end of life care in our communities. Good Samaritan Hospice (GSH) offered education at no cost to members of the community in order to provide knowledge and comfort to patients, families, healthcare workers and future healthcare workers. Topics of education included Changes in Medicare Benefit, Advanced Directives, Changes in Hospice Regulation, Understanding of Today's Hospice (Values and Benefits), Overview of Facts and Myths in Hospice Care, and Hospice Care at End of Life, Pain and Symptom Management, the role of Palliative Care, Spirituality, Grief and Bereavement. Hospice staff members provided information to over 224 individuals and their family members regarding their disease state, concerns, healthcare wishes and hospice and palliative care insurance options within the counties served, prior to their decision regarding care. Each encounter occurs in a location of the patients' choice and takes from 60 to 90 minutes. Often times, families request a follow-up visit to gain a greater understanding or involve additional family members. Students preparing to become Registered Nurses and Licensed Practical Nurses were also offered educational opportunities. Education was provided by offering nursing program students rotations at one of our 3-inpatient facility locations or with a nurse in the community setting. This education was provided to nursing students from Chatham University, Citizen's School of Nursing, Duquesne University, Beaver Valley Community College School of Nursing, University of Maryville, Indiana (CRNP) and Lenape Technical School of Nursing. A total of 1121.50 hours of professional training was offered to a total of 139 students free of charge. End of Life symptom management and psycho-social care training was provided to 32 Registered Nurses at Heritage Valley Health System and 16 at Butler Memorial Hospital, providing an additional 384 hours of free education. Grief support groups were offered in 3 counties and were open to the community at no charge. In addition to phone contacts and mailings for bereavement education to 1,540 hospice family members, a total of 38 grief support group sessions provided support and encouragement to 215 participants. Special Holiday Group Support sessions were also provided to 26 people. 400 individuals attended Memorial Services as well. Good Samaritan Hospice also participated in Community Health and Wellness Fairs by sharing information on hospice care, coping, grief, insurance benefits and general Q&A sessions. A total of 15 hours were dedicated to serving approximately150 people at these events. The Community Educators of GSH also offered free education at contracted facilities in our service areas of Allegheny, Beaver and Butler Counties. Education was provided to 26 members of Butler County Leadership class during their HealthCare Day experience. A tour of the Inpatient unit with education related to Hospice care, Hospice insurance opportunities (levels of care) and the benefits of Hospice care was provided and questions were answered throughout the training session. Hospice education was provided at no charge to the physical therapy class Slippery Rock University. Approximately 80 students attended a two hour class regarding their role in hospice care. Community education in the Beaver Valley area consisted of sessions every second Wednesday of the month for 11 months. Topics included questions asked regarding hospice by the participants, disease states, hospice insurance coverage, myths and facts, care of those with serious illnesses, etc. A total of 100 participants and 37 hours of training were completed. There was also an educational presentation at Concordia of the South Hills in Allegheny County. The topic was Palliative Care & Hospice and more than 25 independent living community residents attended. GSH also offered support to local chambers, local high schools, churches and community events. These services were all offered at no cost and often during weekends and evening hours. Camp Erin is a summer weekend bereavement camp for children and teens serving the needs of families in our Western Pennsylvania service area. This summer camp was a partnership of GSH, The Moyer Foundation (a national foundation dedicated to children in crisis), and Camp Kon-O-Kwee Spencer (our local YMCA camp). A total of 83 children ages 6-17 enjoyed this tuition-free overnight camp from Friday, June 17 through Sunday June 19. Camp was again a great success due to those who generously donated their time: 92 volunteers, of which 67 were the cabin Big Buddies. Volunteers donated over 4,000 hours of their time to train and make this three-day event a success. Family members and guardians joined the campers for the closing memorial service. The combined total budget for the camp for 2015 was $53,168.52. An annual camp reunion and community open house was provided in honor of Children's Grief Awareness Day in order to spread the word about child and adolescent grief within the community and in Western Pennsylvania. Approximately 70 people attended and 20 volunteers participated in the program, which was 2 hours in length. Our second largest community-centered activity was our Annual GSH 5KRun/Walk at North Park in Allegheny County, held in 2015 on Saturday, October 10th. A total of 32 volunteers dedicated their time from 1-7 hours of community service hours to the 5 K event. Volunteers assisted in both administrative preparations for the day's events and also man-power on the day of the race/walk. This event utilized approximately 155 hours of volunteer service to provide a positive, helpful way for patient families and community members to memorialize their loved ones, spend a healthy day outdoors with others in a beautiful county park location and promote hospice services among all ages. Our final community event involving educational opportunities and volunteers dedicated to hospice care in 2015 was the Second Annual Purse Gala, November 5, at the Lexus Club at PNC Park, Pittsburgh. New York Life co-hosted the event with Good Samaritan Hospice. This event drew 150 participants, with the assistance of 5 GSH volunteers. 0 0 0 7227465 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 28 0 1 145 1 0 0 0 0 0 0 0 0 0 0 X 9 6 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 PA X Tammy S Young 7243526200 613 North Pike Road Cabot PA 160232215 X Keith Frndak Board Chairman/President 5 45 X X 0 630065 70313 Norm Mitry Vice Chairman 1 1 X X 0 0 0 Ruth Redenbaugh Board Member 1 4 X 0 0 0 Dr Ross Betts Board Member 1 0 X 0 0 0 W Scott Hardy Board Member 1 0 X 0 0 0 Bryan Randall Board Member 1 1 X X 0 0 0 Paul Rehkopf Board Member 1 2 X 0 0 0 Christie Scott Board Member 1 2 X 0 0 0 Martin J Trettel Board Member 1 44 X 0 173460 30218 Tammy Young Board Member 1 44 X 0 86555 5696 Dr John Reefer Board Member 1 1 X 0 0 0 Ken DeFurio Board Member 1 1 X 0 0 0 Rev Barry Keurulainen Board Member 1 1 X 0 0 0 Judy Connelly Executive Director 45 0 X 106062 0 6921 Anzie Kelley Former Executive Director 0 0 X 45221 0 4174 151283 890080 117322 1 1 1 0 Concordia Medical Equipment 615 N Pike Road Cabot PA 16023 Durable Medical Equipment 713634 Procare BPM 1267 Professional Parkway Gainesville GA 30507 Pharmaceuticals 631717 Concordia Visiting Nurses 613 N Pike Road Cabot PA 16023 Management Services Agreement 162094 Dina C Dosch 1712 Holmes Drive Sewickley PA 15143 Physician Advisory Services 137354 McKesson Technologies Inc PO Box 98347 Chicago IL 606938347 Point of Care Software 115805 5 19611 0 0 34590 0 126519 0 180720 Hospice Care Services in the Community 621610 9446690 9446690 0 0 Hospice Inpatient Care Services 623000 3253502 3253502 0 0 0 0 0 0 12700192 376 376 0 0 0 0 0 0 0 0 0 0 0 0 0 2609 0 5538 0 -2929 -2929 -2929 0 0 0 Miscellaneous Income 621610 8051 8051 0 0 0 0 0 0 8051 12886410 12705690 0 0 305805 305805 4495288 3837401 657887 232651 189907 42744 514496 416145 98351 400609 322282 78327 254004 254004 285 285 18239 18239 676496 129820 526269 20407 85686 160 85526 153254 52186 99641 1427 77367 60621 16746 391062 327905 63157 203125 185214 17911 10208 2033 8175 122921 24065 98856 34306 34306 Food Service Costs 25332 25332 0 0 Pharmacy & Medical Supplies 1511455 1511455 0 0 Dues & Subscriptions 26379 340 26039 0 Outside Transportation 110226 110226 0 0 122634 32373 90261 0 9771828 7227465 2522529 21834 1592837 2585613 2144863 1698481 92839 62910 2123322 1066080 1090337 1057242 4920876 5404246 648622 506941 188056 216998 836678 723939 X 4050312 4649918 33886 30389 0 0 4084198 4680307 4920876 5404246 X 3114582 0 0 0 0 -2518473 X 0 1 X 1 0 X 149092 181665 227179 270012 180720 1008668 6723913 9065066 10079181 11465814 12700191 50034165 6873005 9246731 10306360 11735826 12880911 51042833 0 0 0 0 0 0 51042833 21 61 34 18 376 510 21 61 34 18 376 510 7290 5345 8793 12524 8051 42003 6880316 9252137 10315187 11748368 12889338 51085346 0.99917 0.99873 0.00001 0.00001 X Schedule A, Part III, Line 12 The other income received in each of the five years presented was miscellaneous income. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 104279 104279 0 1188449 505798 682651 0 0 0 0 0 830594 560282 270312 0 0 0 0 1057242 0 Due to Affiliates 216998 216998 X 12920296 0 0 0 33886 33886 12886410 0 0 0 12886410 9771828 0 0 0 0 0 9771828 0 0 0 9771828 Schedule D, Part X, Line 2 The organization is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and has been recognized as tax exempt under Section 501(a) of the Code. Accordingly, no provision for income taxes has been provided. The Organization follows the guidance for accounting for uncertainty in income taxes recognized in an organization's consolidated financial statements that prescribes a recognition threshold of more-likely-than-not to be sustained upon examination by the appropriate taxing authority. Measurement of the tax uncertainty occurs if the recognition threshold has been met. The guidance also addresses derecognition, classification, interest and penalties, accounting in interim periods, and disclosure. Management has determined that this guidance had no material effect on the consolidated financial statements. The Organization's policy is to recognize interest related to unrecognized tax benefits in interest expense and penalties in general and administrative expenses. There were no interest or penalties recognized on the consolidated statements of operations and changes in net assets as a result of this guidance. Generally, tax returns for years ended June 30, 2013, and thereafter remain subject to examination by federal and state tax authorities. Schedule D, Part XI, Line 2d Net Assets Released from Restriction in the amount of $33,886. X X 0 1 0 0 0 0 0 0 0 Keith Frndak Board Chairman 0 502721 0 75100 0 52244 0 64787 0 5526 0 700378 0 0 Martin J Trettel Board Member 0 153237 0 3100 0 17123 0 22608 0 7610 0 203678 0 0 Schedule J, Part I All board members of Good Samaritan Hospice of Pittsburgh serve on a purely volunteer basis. Any compensation to a board member by a related organization, reported on Part VII and Schedule J, is for his/her service as an employee of that organization and not for his/her service as a board member. Schedule J, Part I, Line 3 The organization reviews national and state salary surveys for various non-profit organizations. Compensation is then appropriately determined based upon experience and comparing to the benchmarks. Schedule J, Part I, Line 4 Keith Frndak and Martin Trettel participate in a supplemental non qualified 457 plan. The Boards of Directors of Concordia Lutheran Health and Human Care, Heritage Valley Health System and Good Samaritan Hospice of Pittsburgh have determined that it would be in their best interests for Butler Healthcare Providers dba Butler Memorial Hospital to become a member of Good Samaritan Hospice of Pittsburgh; and Butler Healthcare Providers dba Butler Memorial Hospital desires to become a member of Good Samaritan in furtherance of its charitable purposes. 2015-09-01 480000 At Closing, Good Samaritan Hospice of Pittsburgh (GSH) used its best efforts based on the information available at that time to determine GSH's current Book Value. As of Closing (9/1/2015), GSH's Book Value was calculated to be $4.0 Million. Butler Healthcare Providers dba Butler Memorial Hospital bought into membership at 12% or $480,000. 250965274 Butler Healthcare Providers dba Butler Memorial Hospital One Hospital Way Butler PA 16001 501(c)(3) 0 0 0 0 Form 990, Part VI, Section A, Line 1b The independent board members are independent due to the definition of control. These members are employed by the minority members i.e. two (2) member hospitals. They serve purely on a volunteer basis. They are not compensated for their participation on the board of directors. Form 990, Part VI, Section A, Line 3 Good Samaritan Hospice (GSH) entered into a management services agreement with Concordia Community Support Services (CCSS) on 9/1/15. CCSS will perform management and policy functions and is committed to developing strong leadership so that GSH can assure efficient and competent operations of the Hospice Program for the benefit of GSH's members and the patients served. CCSS will be responsible for appointment of the administrator for the agency and supervise all aspects of the operations of the home health program. Form 990, Part VI, Section A, Line 4 The Articles of Incorporation and Bylaws were amended to address that there are three (3) members of Good Samaritan Hospice effective 9/1/2015. The three members include Concordia Lutheran Health and Human Care, Heritage Valley Health System, and Butler Healthcare Providers dba Butler Memorial Hospital all of which are Pennsylvania nonprofit corporations and public charities exempt from taxation under section 501(c)(3). Form 990, Part VI, Section A, Line 6 Concordia Lutheran Health and Human Care is a 66% member of Good Samaritan Hospice of Pittsburgh. Heritage Valley Health System is a 22% member of Good Samaritan Hospice of Pittsburgh. Butler Healthcare Providers dba Butler Memorial Hospital is a 12% member of Good Samaritan Hospice of Pittsburgh. Form 990, Part VI, Section A, Line 7a Concordia Lutheran Health & Human Care appoints/assigns 5 (five) members of the Good Samaritan Hospice of Pittsburgh board of directors. Heritage Valley Health System appoints/assigns 2 (two) members of the Good Samaritan Hospice of Pittsburgh board of directors. Butler Healthcare Providers dba Butler Memorial Hospital appoints/assigns 2 (two) members of the Good Samaritan Hospice of Pittsburgh board of directors. The Good Samaritan Hospice of Pittsburgh board of directors consists of a total of 9 members. Form 990, Part VI, Section A, Line 7b The three (3) members have reserved powers, the exercise of which shall require the affirmative vote or consent of at least 80% of the membership voting interest of the Corporation. Form 990, Part VI, Section B, Line 11b The Form 990 is prepared and reviewed by the CFO for Concordia Community Support Services. The return is reviewed by the CEO and CFO for Concordia Lutheran Health & Human Care, the majority member. The board is sent draft copies of the 990 prior to filing, in order to provide questions, comments, and feedback. Questions and comments are addressed accordingly. Upon board approval the final 990 is submitted to the taxing authorities. A copy of the final 990 is made available to all board members. Form 990, Part VI, Section B, Line 12c The corporate compliance officer attends at least 1 (one) board meeting a year. All officers, directors or trustees, and key employees are educated on compliance policies and procedures with the corporate compliance officer. Updates on corporate compliance are addressed in scheduled meetings during the year with all staff (including management). Specific corporate compliance goals and objectives are reviewed and evaluated on an ongoing basis during the year with the corporate compliance officer. Additionally, board members are required to disclose any potential conflict of interest prior to discussion on a topic where a conflict may exist. The Board will determine if a conflict exists and act accordingly, which may include the conflicted board member recusing himself/herself from discussion and any votes related to the matter. Form 990, Part VI, Section B, Line 15 The organization reviews national and state salary surveys for various non-profit organizations. Compensation is then appropriately determined based upon experience and comparing to the benchmarks. The Executive Director, Director of Operations and Clinical Director was reviewed during the fiscal year associated with this return. Form 990, Part VI, Section C, Line 19 Good Samaritan Hospice of Pittsburgh publishes an annual report that summarizes the financial and operational accomplishments of the organization, which is forwarded to Good Samaritan Hospice constituents and is available to the public upon request. The final Form 990 is available to the public upon request. A copy of the final 990 is made available to all board members. Form 990, Part VII, Section A, Line 1a All board members of Good Samaritan Hospice of Pittsburgh serve on a purely volunteer basis. Any compensation to a board member by a related organization, reported on Part VII and Schedule J, is for his/her service as an employee of that organization and not for his/her service as a board member. Form 990, Part XI, Line 9 Net Value of Distribution to members during current fiscal year ($2,548,862) and changes in temporarily restricted fund in the current fiscal year $30,389. Concordia Lutheran Health & Human Care 134 Marwood Road Cabot PA 16023 250969458 Provide skilled nursing, personal care, independent living and rehabilitation services PA 501(c)(3) 509(a)(2) Concordia Lutheran Ministries 0 Rebecca Residence dba Concordia at Rebecca Residence 3746 Cedar Ridge Road Allison Park PA 15101 250974311 Provide skilled nursing, personal care, and rehabilitation services. PA 501(c)(3) 509(a)(2) Concordia Lutheran Health & Human Care 0 Concordia Lutheran Ministries 134 Marwood Road Cabot PA 16023 205138278 Manage, oversee, and carry out the purpose of the affiliated 501(c)(3) organizations PA 501(c)(3) 509(a)(3) N/A 0 Concordia Community Support Services 613 North Pike Road Suite B Cabot PA 16023 473508524 Provide oversight, management and strategic planning PA 501(c)(3) 509(a)(3) Concordia Lutheran Ministries 0 Concordia Visiting Nurses 613 North Pike Road Cabot PA 16023 421704067 Provide home health care services PA 501(c)(3) 509(a)(2) Concordia Community Support Services 0 Concordia Tele-CareGivers 613 North Pike Road Suite A Cabot PA 16023 251881783 Provide private dute non-medical services PA 501(c)(3) 509(a)(1) Concordia Community Support Services 0 Concordia of Ohio 970 Sumner Parkway Copley OH 44321 611682165 Provide healthcare and retirement services in Ohio OH 501(c)(3) 509(a)(2) Concordia Lutheran Ministries 0 Concordia Lutheran Ministries Foundation 134 Marwood Road Cabot PA 16023 205138266 Raise and receive funds in futherance of the corporate mission and purposes of the affiliated org PA 501(c)(3) 509(a)(3) Concordia Lutheran Ministries 0 Concordia Visiting Nurses of Ohio 613 North Pike Road Cabot PA 16023 463845269 Home Health Services OH 501(c)(3) 509(a)(2) Concordia Community Support Services 0 Concordia of Monroeville 4363 Northern Pike Monroeville PA 15146 251475192 To provide skilled nursing, personal care, independent living and rehabilitation services PA 501(c)(3) 509(a)(2) Concordia Lutheran Ministries of Pittsburgh 0 Cedars Home Health Care Services 4363 Northern Pike Monroeville PA 15146 251875508 Home Health Services PA 501(c)(3) 509(a)(2) Concordia Tele-CareGivers 0 Concordia Lutheran Ministries of Pittsburgh dba Concordia of the South Hills 1300 Bower Hill Road Pittsburgh PA 15243 270209886 Provide skilled nursing, personal care, independent living , and rehabilitative services. PA 501(c)(3) 509(a)(2) Concordia Lutheran Ministries 0 Concordia Physician Practice 134 Marwood Road Cabot PA 16023 473951584 To provide primary physician services PA 501(c)(3) 509(a)(2) Concordia Lutheran Ministries 0 Concordia Hospice of Washington 613 North Pike Road Suite B Cabot PA 16023 812448411 Provide inpatient and community hospice patient care PA 501(c)(3) PENDING 509(a)(2) PENDING Concordia Community Support Services 0 Providence Pharmacy Services 615 North Pike Road Cabot PA 16023 223885810 Provides institutional pharmacy services and consulting to the limited partnership PA Concordia Providence LLC Concordia Medical Equipment 615 North Pike Road Cabot PA 16023 204386767 rental/sales of medical equipment and supplies PA Concordia Lutheran Ministries C 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 Additional time was needed to gather information and complete the Form 990. Extension was approved by the Department of the Treasury per correspondence received on January 30, 2017.