2014-11-12T07:59:15-06:00 2013-12-31 581941470 HOLLAND HENRY & BROMLEY LLP PO BOX 8878 SAVANNAH GA 31412 990 2013-01-01 581393820 HOSPICE SAVANNAH INC HOSP 9123552289 PO BOX 13190 SAVANNAH GA 31416 ARTHUR GNANN VP OF FINANCE 9123552289 2014-11-10 1 SHANNON L BRETT P00558136 9122353410 2014-11-10 X 2013 2015-11-30 17:44:51Z ARTHUR GNANN PO BOX 13190 SAVANNAH GA 31416 13950655 0 X WWW.HOSPICESAVANNAH.ORG X 1979 GA TO PROVIDE MEDICAL SERVICES TO PATIENTS WITH TERMINAL ILLNESSES. 22 22 255 0 0 0 257890 392739 14191160 13467601 4945 6396 85937 83919 14539932 13950655 0 0 0 0 9685573 9479552 0 0 0 4897498 4354774 14583071 13834326 -43139 116329 10568847 10025423 1995880 1336127 8572967 8689296 TO PROVIDE THE BEST SERVICES AND RESOURCES FOR THE COMMUNITY ON DYING, DEATH, GRIEF AND LOSS 0 0 11145174 13503102 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. 11145174 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 1 0 0 0 0 1 1 0 0 0 1 92 0 1 255 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 ARTHUR GNANN 9123552289 PO BOX 13190 SAVANNAH GA 31416 NITA ANN KLEIN BOARD MEMBER 1.00 X 0 0 0 JOSEPH ROBERTS BOARD MEMBER 1.00 X 0 0 0 KACEY RATTERREE PAST CHAIRMAN 1.00 X 0 0 0 MYRA HILL VICE CHAIRMAN 1.00 X 0 0 0 ROSS KAMINSKY BOARD MEMBER 1.00 X 0 0 0 LYNN WIRTH BOARD MEMBER 1.00 X 0 0 0 PAUL MEYER TREASURER 1.00 X 0 0 0 PHILLIPS SOLOMONS JR BOARD MEMBER 1.00 X 0 0 0 EULA PARKER BOARD MEMBER 1.00 X 0 0 0 RAMON V MEGUIAR MD MEMBER-AT-LARGE 1.00 X 0 0 0 KATHY MCCURRY BOARD MEMBER 1.00 X 0 0 0 MARK BURNS BOARD MEMBER 1.00 X 0 0 0 WILLIAM A BAKER CHAIRMAN 1.00 X 0 0 0 BRUCE BARRAGAN BOARD MEMBER 1.00 X 0 0 0 KATHLEEN DELOACH BENTON BOARD MEMBER 1.00 X 0 0 0 ROENIA DELOACH BOARD MEMBER 1.00 X 0 0 0 HOLDEN HAYES BOARD MEMBER 1.00 X 0 0 0 CONNIE DARBYSHIRE BOARD MEMBER 1.00 X 0 0 0 BO RUSSOM BOARD MEMBER 1.00 X 0 0 0 JUDGE HARRIS LEWIS 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 KELLY EROLA CHIEF MEDICAL OFFICER 40.00 X 196978 0 0 DEBRA LARSON CEO 40.00 X 112083 0 0 ARTHUR GNANN CHIEF FINANCIAL OFFICER 40.00 X 111663 0 0 MONICA ANDERSON CHIEF CLINICAL OFFICER 40.00 X 96027 0 0 JAMEY ESPINA VP OF SERVICE EXCELLENCE 40.00 X 78778 0 0 MEGAN KERLEY VP OF FOUNDATION 40.00 X 61334 0 0 LAURA WIGGINS SCPC DIRECTOR 40.00 X 102469 0 0 JULIA JOHNSON PHYSICIAN 40.00 X 114483 0 0 873815 0 0 5 0 1 0 BCBS PO BOX 100376 ATLANTA GA 30384 EMPLOYEE HEALTH INSURANCE 971972 HOSPICE PHARMACIA LLC PO BOX 510818 PHILADELPHIA PA 191750818 PATIENT MEDICATIONS 725888 MUTUAL OF AMERICA ROCKEFELLER CTR UNIT PO BOX 2493 NEW YORK NY 101850049 403B 710014 EDM ENTERPRISES INC BLDG 6 2600 CHAMBLEE ROAD SUITE 2 ATLANTA GA 30341 DURABLE MEDICAL EQUIPMENT 497349 BOAEN MECHANICAL PO BOX 22054 SAVANNAH GA 31403 AIR CONDITIONING 343800 5 164787 227952 392739 PATIENT SERVICE REVENUE 621610 16994431 16994431 CHARITY CARE 621610 -535452 -535452 CONTRACTUAL ADJUSTMENTS AND ALLOW 621610 -2991378 -2991378 13467601 6396 6396 54814 0 54814 54814 54814 MANAGEMENT FEES 561000 24000 24000 SPECIAL EVENTS 621610 5105 5105 29105 13950655 13503102 0 54814 X 7776958 6601586 1175372 1702594 1445272 257322 21870 21870 3962 3962 55584 55584 98766 98766 45516 2671 42845 48271 45146 3125 374744 208048 166696 138143 138143 MEDICATIONS 760355 760355 DME 534627 534627 MILEAGE, MEETINGS, CELL 360211 289212 70999 MEDICAL SUPPLIES 266178 266178 1646547 992079 654468 13834326 11145174 2689152 0 2627479 1851065 1796934 1565094 40867 366249 10947543 4900108 5932855 6047435 170712 195580 10568847 10025423 1995380 1335627 500 500 1995880 1336127 X 8564842 8682247 8125 7049 8572967 8689296 10568847 10025423 116329 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8125 6000 7353 6772 10000 1875 8125 1.00000 0 0 8836305 3238857 5597448 1952125 1661251 290874 159113 159113 6047435 DUE TO RELATED PARTIES 500 500 13950655 0 13950655 0 13950655 13834326 0 13834326 0 13834326 PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO FOUNDATION PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO FOUNDATION 1 1 X 0 0 1 1 1 0 0 280782 280782 0.02000 561939 561939 0.04100 842721 842721 0.06100 165484 165484 0.01200 165484 165484 0.01200 1008205 1008205 0.07300 1 382197 280577 11604346 11753141 -148795 X 1 1 1 1 HOSPICE SAVANNAH INC 1352 EISENHOWER DRIVE SAVANNAH GA 31406 HOSPICE CARE INPATIENT UNIT HOSPICE SAVANNAH INC 1 0 1 0 0 1 X X 1 1 X 1 X 0 0 X X 0 1 HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 16E: 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 19D: HOSPICE SAVANNAH IS NOT A HOSPITAL AND PROVIDES HOSPICE SERVICES, NOT EMERGENCY CARE SERVICES. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 20D: HOSPICE SAVANNAH USES A FINANCIAL ASSESSMENT FORM TO DETERMINE THE AMOUNT OWED. SEE EXPLANATION ABOVE UNDER PART I, LINE 3C FOR ADDITIONAL DETAIL. HOSPICE SAVANNAH, INC. PART V, SECTION B, LINE 22: 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 2012. 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 KELLY EROLA CHIEF MEDICAL OFFICER 196978 0 0 0 0 0 0 0 0 0 196978 0 0 0 HOLDEN HAYES BOARD MEMBER OF HOSPICE AND PRESIDENT 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, VP OF FINANCE 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 BAD DEBT: PROGRAM SERVICE EXPENSES 193,931. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 193,931. CLEANING AND EXTERMINATING: PROGRAM SERVICE EXPENSES 123,401. MANAGEMENT AND GENERAL EXPENSES 29,371. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 152,772. UTILITIES: PROGRAM SERVICE EXPENSES 73,862. MANAGEMENT AND GENERAL EXPENSES 65,789. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 139,651. TELEPHONE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 125,458. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 125,458. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,750. MANAGEMENT AND GENERAL EXPENSES 97,379. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,129. CABLE AND LINEN: PROGRAM SERVICE EXPENSES 101,389. MANAGEMENT AND GENERAL EXPENSES 624. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 102,013. COMPUTER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 94,190. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,190. EQUIPMENT: PROGRAM SERVICE EXPENSES 67,180. MANAGEMENT AND GENERAL EXPENSES 23,980. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 91,160. FACILITY RELATED CONTRACTS: PROGRAM SERVICE EXPENSES 40,667. MANAGEMENT AND GENERAL EXPENSES 25,465. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,132. CONSULTING AND SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 6,815. MANAGEMENT AND GENERAL EXPENSES 57,679. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,494. THERAPIES: PROGRAM SERVICE EXPENSES 62,917. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,917. AMBULANCE: PROGRAM SERVICE EXPENSES 61,868. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,868. DIETARY AND FOOD: PROGRAM SERVICE EXPENSES 58,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,278. SECURITY EXPENSE: PROGRAM SERVICE EXPENSES 36,064. MANAGEMENT AND GENERAL EXPENSES 18,565. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,629. DUES AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 10,854. MANAGEMENT AND GENERAL EXPENSES 43,725. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,579. CONTINUING EDUCATION: PROGRAM SERVICE EXPENSES 37,299. MANAGEMENT AND GENERAL EXPENSES 13,380. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,679. LAB AND IMAGING: PROGRAM SERVICE EXPENSES 49,463. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,463. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 25,004. MANAGEMENT AND GENERAL EXPENSES 14,160. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,164. POSTAGE AND PRINTING: PROGRAM SERVICE EXPENSES 2,921. MANAGEMENT AND GENERAL EXPENSES 20,936. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,857. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 2,375. MANAGEMENT AND GENERAL EXPENSES 19,290. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,665. PASS THROUGHS: PROGRAM SERVICE EXPENSES 16,277. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,277. WASTE DISPOSAL: PROGRAM SERVICE EXPENSES 6,095. MANAGEMENT AND GENERAL EXPENSES 4,477. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,572. OUTPATIENT: PROGRAM SERVICE EXPENSES 7,469. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,469. PATIENT RELATED PROGRAMS: PROGRAM SERVICE EXPENSES 3,200. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,200. OLD RIVER HOSPICE PROPERTIES LLC 24 DRAYTON STREET SUITE 712 SAVANNAH GA 31410 270888923 PROPERTY MANAGEMENT GA 3125 484803 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 ASSISTANCE FOR HOSPICE SAVANNAH, INC. AND THE 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 22954 FMV HOSPICE SAVANNAH FOUNDATION INC N THE STEWARD CENTER FOR PALLIATIVE CARE INC N HOSPICE SAVANNAH FOUNDATION INC O THE STEWARD CENTER FOR PALLIATIVE CARE INC O THE STEWARD CENTER FOR PALLIATIVE CARE INC Q 172621 FMV P