2015-09-03T09:46:14-05:00 2014-12-31 581941470 HOLLAND HENRY & BROMLEY LLP PO BOX 8878 SAVANNAH GA 31412 990 2014-01-01 581393820 HOSPICE SAVANNAH INC HOSP 9123552289 PO BOX 13190 SAVANNAH GA 31416 CHAD CARNELL CHIEF OPERATING OFFICER 9123552289 2015-09-03 1 SHANNON L BRETT P00558136 9122353410 2015-09-03 X 2014 2016-02-25 16:41:14Z CHAD CARNELL PO BOX 13190 SAVANNAH GA 31416 12985430 0 X WWW.HOSPICESAVANNAH.ORG X 1979 GA TO PROVIDE MEDICAL SERVICES TO PATIENTS WITH TERMINAL ILLNESSES. 22 22 241 201 0 0 392739 477682 13467601 12407518 6396 2151 83919 98079 13950655 12985430 0 0 0 0 9479552 9285371 0 0 0 4354774 4228110 13834326 13513481 116329 -528051 10025423 9603459 1336127 1442214 8689296 8161245 TO PROVIDE THE BEST SERVICES AND RESOURCES FOR THE COMMUNITY ON DYING, DEATH, GRIEF AND LOSS 0 0 10994436 12451341 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. 10994436 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 83 0 1 241 1 0 0 0 0 0 0 0 0 X 22 22 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 1 0 GA X CHAD CARNELL 9123552289 PO BOX 13190 SAVANNAH GA 31416 JOSEPH ROBERTS BOARD MEMBER 1.00 X 0 0 0 MYRA HILL CHAIRMAN 1.00 X 0 0 0 ROSS KAMINSKY BOARD MEMBER 1.00 X 0 0 0 PAUL MEYER TREASURER 1.00 X 0 0 0 PHILIP SOLOMONS JR MEMBER-AT-LARGE 1.00 X 0 0 0 EULA PARKER BOARD MEMBER 1.00 X 0 0 0 KATHY MCCURRY BOARD MEMBER 1.00 X 0 0 0 BRUCE BARRAGAN VICE CHAIRMAN 1.00 X 0 0 0 ROENIA DELOACH BOARD MEMBER 1.00 X 0 0 0 BO RUSSOM BOARD MEMBER 1.00 X 0 0 0 EB GAINES III SECRETARY 1.00 X 0 0 0 RICHARD LEIGHTON MD BOARD MEMBER 1.00 X 0 0 0 CONNIE DARBYSHIRE BOARD MEMBER 1.00 X 0 0 0 RABBI RUVEN BARKAN BOARD MEMBER 1.00 X 0 0 0 WILLIAM BILL KEIGHTLEY BOARD MEMBER 1.00 X 0 0 0 LE BUD ROBERTSON MD BOARD MEMBER 1.00 X 0 0 0 WILLIAM BILL H ROELLE JR BOARD MEMBER 1.00 X 0 0 0 MAURA SOVCHEN BOARD MEMBER 1.00 X 0 0 0 MARJORIE YOUNG BOARD MEMBER 1.00 X 0 0 0 DEREK ZIMMERMAN BOARD MEMBER 1.00 X 0 0 0 DEBRA LARSON CEO 40.00 X 118825 0 0 ARTHUR GNANN CHIEF FINANCIAL OFFICER 40.00 X 116247 0 0 MONICA ANDERSON CHIEF CLINICAL OFFICER 40.00 X 105237 0 0 JAMEY ESPINA VP OF SERVICE EXCELLENCE 40.00 X 81656 0 0 MEGAN KERLEY VP OF FOUNDATION 40.00 X 85437 0 0 LAURA WIGGINS SCPC DIRECTOR 40.00 X 109468 0 0 DR KELLY EROLA CHIEF MEDICAL OFFICER 40.00 X 215676 0 0 DEBORAH KEMP NURSE 40.00 X 102333 0 0 LATOYA WILLIAMS PHARMACIST 40.00 X 104055 0 0 JULIA JOHNSON PHYSICIAN 40.00 X 147301 0 0 1186235 0 0 8 0 1 0 BCBS PO BOX 100376 ATLANTA GA 30384 EMPLOYEE HEALTH INSURANCE 1044474 HOSPICE PHARMACIA LLC PO BOX 510818 PHILADELPHIA PA 191750818 PATIENT MEDICATIONS 621638 EDM ENTERPRISES INC BLDG 6 2600 CHAMBLEE ROAD SUITE 2 ATLANTA GA 30341 DURABLE MEDICAL EQUIPMENT 442128 RIVERVIEW HEALTH & REHAB 6711 LAROCHE AVENUE SAVANNAH GA 31406 NURSING HOME 349200 BRYAN COUNTY HEALTH & REHAB 127 CARTER STREET RICHMOND HILL GA 31324 NURSING HOME 280055 5 320950 156732 477682 PATIENT SERVICE REVENUE 621610 15897138 15897138 CHARITY CARE 621610 -597515 -597515 CONTRACTUAL ADJUSTMENTS AND ALLOW 621610 -2892105 -2892105 12407518 2151 2151 56407 0 56407 56407 56407 MANAGEMENT FEES 561000 36000 36000 SPECIAL EVENTS 621610 5672 5672 41672 12985430 12451341 0 56407 X 7576907 6386905 1190002 1708464 1440138 268326 23252 23252 32927 32927 57122 57122 78398 78398 36058 1527 34531 57006 49191 7815 7903 7903 394952 394952 134764 134764 MEDICATIONS 627863 627863 DME 544903 544903 MILEAGE, MEETINGS, CELL 329921 268989 60932 BAD DEBT 295311 295311 1607730 984657 623073 13513481 10994436 2519045 0 1851065 1197923 1565094 2052360 366249 354709 11171492 5295059 6047435 5876433 195580 122034 10025423 9603459 1335627 1441714 500 500 1336127 1442214 X 8682247 8157480 7049 3765 8689296 8161245 10025423 9603459 -528051 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7049 0 3284 3765 8125 6000 7076 7049 10000 1875 8125 0 0 9125872 3556266 5569606 1999128 1738793 260335 46492 46492 5876433 DUE TO RELATED PARTIES 500 500 12985430 0 12985430 0 12985430 13513481 0 13513481 0 13513481 1 1 X 0 0 1 1 1 0 0 322834 322834 0.02400 492414 492414 0.03600 815248 815248 0.06000 178157 178157 0.01300 178157 178157 0.01300 993405 993405 0.07300 1 482389 322834 10155858 10354244 -198386 X 1 1 1 1 HOSPICE SAVANNAH INC 1352 EISENHOWER DRIVE SAVANNAH GA 31406 HOSPICE CARE INPATIENT UNIT HOSPICE SAVANNAH INC 1 0 0 0 0 1 X X 1 1 X X X 0 1 X 0 0 X X 0 1 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. 2 HOSPICE SAVANNAH INC 1674 CHATHAM PARKWAY SAVANNAH GA 31405 ADMINISTRATIVE OFFICES HOSPICE SAVANNAH INC 450 MALL BLVD SUITE H SAVANNAH GA 31416 BEREAVEMENT CENTER 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 X 0 0 0 0 0 0 0 0 0 DR KELLY EROLA CHIEF MEDICAL OFFICER 215676 0 0 0 0 0 0 0 0 0 215676 0 0 0 HOLDEN HAYES BOARD MEMBER- HOSPICE FOUNDATION PRES OF BANK WHERE CASH ACCOUNTS ARE HELD EMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICEEMPLOYED BY BANK AND VOLUNTEERS AS BOARD MEMBER FOR HOSPICE 0 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. OLD RIVER HOSPICE PROPERTIES LLC 24 DRAYTON STREET SUITE 712 SAVANNAH GA 31410 270888923 PROPERTY MANAGEMENT GA 832721 1317524 HOSPICE SAVANNAH INC 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 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 HOSPICE SAVANNAH FOUNDATION INC C 320950 FMV HOSPICE SAVANNAH FOUNDATION INC C 832721 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 36000 FMV THE STEWARD CENTER FOR PALLIATIVE CARE INC N