HOSPICE SAVANNAH INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- HOSPICE SAVANNAH INC (EIN 58-1393820)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-09-03
- IRS object ID
- 201512469349300326
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-09-03T09:46:14-05:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 581941470 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLLAND HENRY & BROMLEY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8878 | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31412 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581393820 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE SAVANNAH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOSP | BusinessNameControlTxt |
| Phone | 9123552289 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 13190 | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31416 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHAD CARNELL | PersonNm |
| Person Title | CHIEF OPERATING OFFICER | PersonTitleTxt |
| Phone | 9123552289 | PhoneNum |
| Signature | 2015-09-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHANNON L BRETT | PreparerPersonNm |
| PTIN | P00558136 | PTIN |
| Phone | 9122353410 | PhoneNum |
| Preparation | 2015-09-03 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHAD CARNELL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 13190 | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31416 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,985,430 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HOSPICESAVANNAH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE MEDICAL SERVICES TO PATIENTS WITH TERMINAL ILLNESSES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 22 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 22 | VotingMembersIndependentCnt |
| Total Employee | 241 | TotalEmployeeCnt |
| Total Volunteers | 201 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $392,739 | PYContributionsGrantsAmt |
| CY Contributions Grants | $477,682 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,467,601 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,407,518 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,396 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,151 | CYInvestmentIncomeAmt |
| PY Other Revenue | $83,919 | PYOtherRevenueAmt |
| CY Other Revenue | $98,079 | CYOtherRevenueAmt |
| PY Total Revenue | $13,950,655 | PYTotalRevenueAmt |
| CY Total Revenue | $12,985,430 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,479,552 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,285,371 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,354,774 | PYOtherExpensesAmt |
| CY Other Expenses | $4,228,110 | CYOtherExpensesAmt |
| PY Total Expenses | $13,834,326 | PYTotalExpensesAmt |
| CY Total Expenses | $13,513,481 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $116,329 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$528,051 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,025,423 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,603,459 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,336,127 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,442,214 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,689,296 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,161,245 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE BEST SERVICES AND RESOURCES FOR THE COMMUNITY ON DYING, DEATH, GRIEF AND LOSS | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $10,994,436 | ExpenseAmt |
| Revenue | $12,451,341 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDED CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES THROUGH HOSPICE HOUSE AND HOME CARE PROGRAMS AND PROVIDED EDUCATIONAL OPPORTUNITIES ON DEATH AND DYING, GRIEF AND LOSS. GRIEF AND LOSS PROGRAM FOR PATIENTS, FAMILY MEMBERS AND THE COMMUNITY AT LARGE. | Desc |
| Total Program Service Expenses | $10,994,436 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 83 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 241 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 22 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 22 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAD CARNELL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9123552289 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 13190 | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31416 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOSEPH ROBERTS | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MYRA HILL | |||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROSS KAMINSKY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL MEYER | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PHILIP SOLOMONS JR | |||||||
| MEMBER-AT-LARGE | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| EULA PARKER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHY MCCURRY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRUCE BARRAGAN | |||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROENIA DELOACH | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BO RUSSOM | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| EB GAINES III | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD LEIGHTON MD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CONNIE DARBYSHIRE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RABBI RUVEN BARKAN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM BILL KEIGHTLEY | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LE BUD ROBERTSON MD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM BILL H ROELLE JR | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MAURA SOVCHEN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARJORIE YOUNG | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEREK ZIMMERMAN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEBRA LARSON | |||||||
| CEO | 40.00 | $118,825 | $0 | $0 | Yes (X) | ||
| ARTHUR GNANN | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | $116,247 | $0 | $0 | Yes (X) | ||
| MONICA ANDERSON | |||||||
| CHIEF CLINICAL OFFICER | 40.00 | $105,237 | $0 | $0 | Yes (X) | ||
| JAMEY ESPINA | |||||||
| VP OF SERVICE EXCELLENCE | 40.00 | $81,656 | $0 | $0 | Yes (X) | ||
| MEGAN KERLEY | |||||||
| VP OF FOUNDATION | 40.00 | $85,437 | $0 | $0 | Yes (X) | ||
| LAURA WIGGINS | |||||||
| SCPC DIRECTOR | 40.00 | $109,468 | $0 | $0 | Yes (X) | ||
| DR KELLY EROLA | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | $215,676 | $0 | $0 | Yes (X) | ||
| DEBORAH KEMP | |||||||
| NURSE | 40.00 | $102,333 | $0 | $0 | Yes (X) | ||
| LATOYA WILLIAMS | |||||||
| PHARMACIST | 40.00 | $104,055 | $0 | $0 | Yes (X) | ||
| JULIA JOHNSON | |||||||
| PHYSICIAN | 40.00 | $147,301 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,186,235 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BCBS | |||||
| PO BOX 100376 | ATLANTA | GA | 30384 | EMPLOYEE HEALTH INSURANCE | $1,044,474 |
| HOSPICE PHARMACIA LLC | |||||
| PO BOX 510818 | PHILADELPHIA | PA | 191750818 | PATIENT MEDICATIONS | $621,638 |
| EDM ENTERPRISES INC | |||||
| BLDG 6 2600 CHAMBLEE ROAD SUITE 2 | ATLANTA | GA | 30341 | DURABLE MEDICAL EQUIPMENT | $442,128 |
| RIVERVIEW HEALTH & REHAB | |||||
| 6711 LAROCHE AVENUE | SAVANNAH | GA | 31406 | NURSING HOME | $349,200 |
| BRYAN COUNTY HEALTH & REHAB | |||||
| 127 CARTER STREET | RICHMOND HILL | GA | 31324 | NURSING HOME | $280,055 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $320,950 | RelatedOrganizationsAmt |
| All Other Contributions | $156,732 | AllOtherContributionsAmt |
| Total Contributions | $477,682 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621610 | $15,897,138 | $15,897,138 |
| CHARITY CARE | 621610 | -$597,515 | -$597,515 |
| CONTRACTUAL ADJUSTMENTS AND ALLOW | 621610 | -$2,892,105 | -$2,892,105 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,407,518 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,151 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,151 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $56,407 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $56,407 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,407 | TotalRevenueColumnAmt |
| Exclusion | $56,407 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MANAGEMENT FEES | 561000 | $36,000 | $36,000 |
| SPECIAL EVENTS | 621610 | $5,672 | $5,672 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $41,672 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,985,430 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,451,341 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $56,407 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,576,907 | TotalAmt |
| Program Services | $6,386,905 | ProgramServicesAmt |
| Management And General | $1,190,002 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,708,464 | TotalAmt |
| Program Services | $1,440,138 | ProgramServicesAmt |
| Management And General | $268,326 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,252 | TotalAmt |
| Management And General | $23,252 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,927 | TotalAmt |
| Management And General | $32,927 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,122 | TotalAmt |
| Management And General | $57,122 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,398 | TotalAmt |
| Management And General | $78,398 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,058 | TotalAmt |
| Program Services | $1,527 | ProgramServicesAmt |
| Management And General | $34,531 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,006 | TotalAmt |
| Program Services | $49,191 | ProgramServicesAmt |
| Management And General | $7,815 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,903 | TotalAmt |
| Management And General | $7,903 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $394,952 | TotalAmt |
| Program Services | $394,952 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,764 | TotalAmt |
| Management And General | $134,764 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICATIONS | $627,863 | $627,863 | |
| DME | $544,903 | $544,903 | |
| MILEAGE, MEETINGS, CELL | $329,921 | $268,989 | $60,932 |
| BAD DEBT | $295,311 | $295,311 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,607,730 | TotalAmt |
| Program Services | $984,657 | ProgramServicesAmt |
| Management And General | $623,073 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,513,481 | TotalAmt |
| Program Services | $10,994,436 | ProgramServicesAmt |
| Management And General | $2,519,045 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,851,065 | BOYAmt |
| EOY | $1,197,923 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,565,094 | BOYAmt |
| EOY | $2,052,360 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $366,249 | BOYAmt |
| EOY | $354,709 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,171,492 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,295,059 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,047,435 | BOYAmt |
| EOY | $5,876,433 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $195,580 | BOYAmt |
| EOY | $122,034 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,025,423 | BOYAmt |
| EOY | $9,603,459 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,335,627 | BOYAmt |
| EOY | $1,441,714 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500 | BOYAmt |
| EOY | $500 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,336,127 | BOYAmt |
| EOY | $1,442,214 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,682,247 | BOYAmt |
| EOY | $8,157,480 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,049 | BOYAmt |
| EOY | $3,765 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,689,296 | BOYAmt |
| EOY | $8,161,245 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,025,423 | BOYAmt |
| EOY | $9,603,459 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$528,051 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $7,049 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Other Expenditures | $3,284 | OtherExpendituresAmt |
| End Year Balance | $3,765 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,125 | BeginningYearBalanceAmt |
| Contributions | $6,000 | ContributionsAmt |
| Other Expenditures | $7,076 | OtherExpendituresAmt |
| End Year Balance | $7,049 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $10,000 | ContributionsAmt |
| Other Expenditures | $1,875 | OtherExpendituresAmt |
| End Year Balance | $8,125 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $9,125,872 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $3,556,266 | DepreciationAmt |
| Book Value | $5,569,606 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,999,128 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,738,793 | DepreciationAmt |
| Book Value | $260,335 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $46,492 | InvestmentCostOrOtherBasisAmt |
| Book Value | $46,492 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,876,433 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTIES | Desc |
| Amt | $500 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $500 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $12,985,430 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,985,430 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,985,430 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $13,513,481 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $13,513,481 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,513,481 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | 0 | FPGReferenceFreeCareInd |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $322,834 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $322,834 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02400 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $492,414 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $492,414 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03600 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $815,248 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $815,248 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06000 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $178,157 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $178,157 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $178,157 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $178,157 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01300 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $993,405 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $993,405 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07300 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $482,389 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $322,834 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,155,858 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,354,244 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$198,386 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE SAVANNAH INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1352 EISENHOWER DRIVE | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31406 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | HOSPICE CARE INPATIENT UNIT | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE SAVANNAH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | 0 | CHNAConductedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | 0 | IncludesPublicityMeasuresInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | 0 | NondisEmergencyCarePolicyInd |
| Other Reason | Yes (X) | OtherReasonInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HOSPICE SAVANNAH, INC. | PART V, SECTION B, LINE 18D: HOSPICE'S COLLECTION POLICY IS TO SEND THREE STATEMENTS AND PAST DUE LETTERS ONCE AN ACCOUNT IS DEEMED PAST DUE. IF NO PAYMENT IS RECEIVED AFTER STATEMENTS AND LETTERS ARE SENT, THE ACCOUNT IS WRITTEN OFF. |
| HOSPICE SAVANNAH, INC. | PART V, SECTION B, LINE 21D: HOSPICE SAVANNAH IS NOT A HOSPITAL AND PROVIDES HOSPICE SERVICES, NOT EMERGENCY CARE SERVICES. |
| HOSPICE SAVANNAH, INC. | PART V, SECTION B, LINE 22D: HOSPICE SAVANNAH USES A FINANCIAL ASSESSMENT FORM TO DETERMINE THE AMOUNT OWED. |
| HOSPICE SAVANNAH, INC. | PART V, SECTION B, LINE 24: ALL SELF PAY PATIENTS THAT DO NOT QUALIFY FOR A REDUCED RATE AFTER COMPLETING THE FINANCIAL ASSESSMENT FORM ARE CHARGED FULL PRICE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| HOSPICE SAVANNAH INC | ||||
| 1674 CHATHAM PARKWAY | SAVANNAH | GA | 31405 | ADMINISTRATIVE OFFICES |
| HOSPICE SAVANNAH INC | ||||
| 450 MALL BLVD SUITE H | SAVANNAH | GA | 31416 | BEREAVEMENT CENTER |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE FOLLOWING POLICY IS USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. A FINANCE REPRESENTATIVE OR SOCIAL WORKER WILL MEET WITH THE PATIENT AND/OR RESPONSIBLE PARTY PRIOR TO PATIENT BEING ADMITTED TO COMPLETE A FINANCIAL ASSESSMENT FORM. THIS FORM DETERMINES THE LEVEL OF PAY THAT IS REQUIRED PER DAY FROM THE PATIENT OR FAMILY, DEPENDING ON THE FINANCIAL RESOURCES AVAILABLE. THE PATIENT/FAMILY WILL PROVIDE VERIFICATION AND APPROPRIATE PROOF OF RESOURCES AND COMMITMENTS.THE FINANCIAL ASSESSMENT FORM IS SIGNED BY THE PATIENT OR RESPONSIBLE PARTY AND A HOSPICE SAVANNAH REPRESENTATIVE. SIGNING THE FORM IS AN AGREEMENT TO PAY THE AMOUNT DETERMINED. REFUSAL TO PAY THE AGREED TO AMOUNT WILL RESULT IN APPROPRIATE MEASURES BEING TAKEN TO COLLECT THE FUNDS.REFUSAL TO COMPLETE AND SIGN THE FORM WILL RESULT IN THE PATIENT BEING CHARGED THE FULL RATE PER DAY.THE ORIGNIAL AGREEMENT WILL BE PLACED IN THE PATIENT'S FINANICAL CHART. THE PATIENT OR RESPONSIBLE PARTY WILL BE BILLED MONTHLY BASED ON THE PER DIEM RATE ESTABLISHED USING THE FINANCIAL ASSESSMENT FORM. |
| PART I, LINE 7: | WORKSHEET 2 FROM FORM 990 INSTRUCTIONS IS USED AS COSTING METHODOLOGY. THERE WERE NO SUBSIDIZED HEALTH SERVICES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THERE WERE NO COMMUNITY BUILDING ACTIVITIES HELD IN 2014. |
| PART III, LINE 4: | WORKSHEET 2 IN THE FORM 990 INSTRUCTIONS WAS USED AS THE COSTING METHODOLOGY FOR PART III, LINE 4. |
| PART III, LINE 8: | THERE WAS NO SHORTFALL ON PART III, LINE 7. THE MEDICARE ALLOWABLE COSTS OF CARE WERE DERIVED FROM THE CMS PUBLISHED PER DIEM RATE. |
| PART III, LINE 9B: | HOSPICE'S COLLECTION POLICY IS TO SEND THREE STATEMENTS AND PAST DUE LETTERS. IF NO PAYMENT IS RECEIVED AFTER STATEMENTS AND LETTERS ARE SENT, THE ACCOUNT IS WRITTEN OFF. |
| PART VI, LINE 2: | HOSPICE SAVANNAH PREPARES AN ANNUAL MARKET ANALYSIS ON DEMOGRAPHICS IN THE REGION. CUSTOMER SATISFACTION SURVEYS ARE USED TO PROVIDE FEEDBACK ON EFFECTIVITY OF SERVICES PROVIDED. NHPCO AND GHPCO RESOURCES ARE USED TO TRACK TRENDS IN HOSPICE CARE AND BEST PRACTICES. |
| PART VI, LINE 3: | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE IS DONE THROUGH THE ADMISSIONS PROCESS. THEY RECEIVE A FAMILY RESOURCE GUIDE EXPLAINING FINANCIAL OPTIONS. HOSPICE SAVANNAH ALSO ASSISTS PATIENTS WITH COMPLETING MEDICAID APPLICATIONS. |
| PART VI, LINE 4: | HOSPICE SAVANNAH SERVES A 5 COUNTY AREA IN SOUTHEAST GEORGIA. CHATHAM, BRYAN, EFFINGHAM, LIBERTY AND LONG COUNTIES ARE ALL SERVED BY HOSPICE SAVANNAH. MOST OF THE POPULATION IS IN CHATHAM COUNTY IN AN URBAN SETTING. |
| PART VI, LINE 5: | HOSPICE SAVANNAH OFFERS GRIEF AND LOSS SERVICES TO NOT ONLY HOSPICE SAVANNAH PATIENTS AND THEIR FAMILIES BUT THE COMMUNITY AT LARGE AT NO COST TO THE PARTICIPANTS. THESE SERVICES INCLUDE, BUT ARE NOT LIMITED TO, INDIVIDUAL AND GROUP COUNSELING, MASSAGE THERAPY, MUSIC THERAPY, STORYTELLING, ETC. SCHOOLS, HOSPITALS, NURSING HOMES AND WORD OF MOUTH ARE USED TO INFORM THE COMMUNITY OF THESE SERVICES. |
| PART VI, LINE 6: | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR KELLY EROLA | PersonNm |
| Title | CHIEF MEDICAL OFFICER | TitleTxt |
| Base Compensation Filing Org | $215,676 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $215,676 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLDEN HAYES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER- HOSPICE FOUNDATION PRES OF BANK WHERE CASH ACCOUNTS ARE HELD | RelationshipDescriptionTxt |
| Transaction | EMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICEEMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICE | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE REVIEWED AND APPROVED BY CEO, COO, AND EXECUTIVE/FINANCE COMMITTEE OF BOARD OF DIRECTORS VIA EMAIL PRIOR TO SUBMISSION TO IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | AN ACKNOWLEDGEMENT IS SIGNED BY ALL EMPLOYEES AND BOARD MEMBERS. THIS FORM IS MAINTAINED IN THE HUMAN RESOURCES DEPARTMENT. |
| FORM 990, PART VI, SECTION B, LINE 15B | HOSPICE SAVANNAH TYPICALLY UTILIZES AN OUTSIDE AGENCY TO PERFORM A COMPENSATION SURVEY. THIS SURVEY ENSURES THAT ALL SALARIES ARE COMPARABLE WITH AVERAGE GOING RATES FOR ORGANIZATIONS OF SIMILAR SIZE AND IN THE SAME INDUSTRY. ALL SALARIES ARE BASED ON RELEVANT EXPERIENCE AND EDUCATION WITHIN COMPENSATION STRUCTURE. THE COMPENSATION SURVEY IS PERFORMED EVERY TWO YEARS. |
| 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 FROM THE ADMINSTRATIVE OFFICE. |
| FORM 990, PART IX, LINE 24E | MEDICAL SUPPLIES: PROGRAM SERVICE EXPENSES 252,687. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 252,687. UTILITIES: PROGRAM SERVICE EXPENSES 78,427. MANAGEMENT AND GENERAL EXPENSES 56,399. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,826. CLEANING AND EXTERMINATING: PROGRAM SERVICE EXPENSES 111,278. MANAGEMENT AND GENERAL EXPENSES 23,135. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,413. TELEPHONE: PROGRAM SERVICE EXPENSES 149. MANAGEMENT AND GENERAL EXPENSES 128,341. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 128,490. COMPUTER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 109,989. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 109,989. PASS THROUGHS: PROGRAM SERVICE EXPENSES 100,822. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,822. CABLE AND LINEN: PROGRAM SERVICE EXPENSES 93,214. MANAGEMENT AND GENERAL EXPENSES 610. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,824. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 20,769. MANAGEMENT AND GENERAL EXPENSES 72,893. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,662. EQUIPMENT: PROGRAM SERVICE EXPENSES 54,790. MANAGEMENT AND GENERAL EXPENSES 23,659. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,449. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 46,505. MANAGEMENT AND GENERAL EXPENSES 25,879. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,384. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 2,951. MANAGEMENT AND GENERAL EXPENSES 54,620. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,571. AMBULANCE: PROGRAM SERVICE EXPENSES 55,335. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,335. FACILITY RELATED CONTRACTS: PROGRAM SERVICE EXPENSES 36,396. MANAGEMENT AND GENERAL EXPENSES 16,838. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,234. CONSULTING AND SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 6,522. MANAGEMENT AND GENERAL EXPENSES 38,575. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,097. DIETARY AND FOOD: PROGRAM SERVICE EXPENSES 44,121. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,121. CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 26,231. MANAGEMENT AND GENERAL EXPENSES 11,403. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,634. SECURITY EXPENSE: PROGRAM SERVICE EXPENSES 11,376. MANAGEMENT AND GENERAL EXPENSES 17,761. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,137. POSTAGE AND PRINTING: PROGRAM SERVICE EXPENSES 4,157. MANAGEMENT AND GENERAL EXPENSES 21,361. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,518. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 4,806. MANAGEMENT AND GENERAL EXPENSES 17,024. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,830. THERAPIES: PROGRAM SERVICE EXPENSES 21,023. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,023. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 5,399. MANAGEMENT AND GENERAL EXPENSES 4,586. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,985. LAB AND IMAGING: PROGRAM SERVICE EXPENSES 9,865. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,865. OUTPATIENT: PROGRAM SERVICE EXPENSES 534. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 534. PATIENT RELATED PROGRAMS: PROGRAM SERVICE EXPENSES -2,700. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -2,700. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OLD RIVER HOSPICE PROPERTIES LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24 DRAYTON STREET SUITE 712 | AddressLine1Txt |
| City | SAVANNAH | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31410 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270888923 | EIN |
| Primary Activities | PROPERTY MANAGEMENT | PrimaryActivitiesTxt |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Total Income | $832,721 | TotalIncomeAmt |
| End Of Year Assets | $1,317,524 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE SAVANNAH INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THE STEWARD CENTER FOR PALLIATIVE CARE INC | |||||||||||
| POST OFFICE BOX 13190 | SAVANNAH | GA | 31416 | 510545338 | COUNSELING | GA | 501(C)(3) | LINE 9 | HOSPICE SAVANNAH INC | 0 | |
| HOSPICE SAVANNAH FOUNDATION INC | |||||||||||
| POST OFFICE BOX 13190 | SAVANNAH | GA | 31416 | 582215819 | FUNDING ASSIST FOR HOSPICE SAVANNAH, OLD RIVER PROPERTIES & STEWARD CENTER | GA | 501(C)(3) | LINE 11A, I | 0 | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| HOSPICE SAVANNAH FOUNDATION INC | ||
| C | $320,950 | FMV |
| HOSPICE SAVANNAH FOUNDATION INC | ||
| C | $832,721 | FMV TO OLD RIVER HOSPICE PROPERTI |
| HOSPICE SAVANNAH FOUNDATION INC | ||
| N | ||
| HOSPICE SAVANNAH FOUNDATION INC | ||
| O | ||
| THE STEWARD CENTER FOR PALLIATIVE CARE INC | ||
| O | ||
| THE STEWARD CENTER FOR PALLIATIVE CARE INC | ||
| Q | $36,000 | FMV |
| THE STEWARD CENTER FOR PALLIATIVE CARE INC | ||
| N | ||