2014-03-12T11:42:08-05:00 2013-09-30 581729751 Metcalf Davis CPAs 3340 Peachtree Road NE Suite 2600 Atlanta GA 303261089 990 2012-10-01 582051326 Georgia Mountains Hospice Inc GEOR 8006927199 70 Caring Way Jasper GA 30143 Mary Anne Bramlett 7062534100 2014-03-12 1 Susan Hill P00846200 4042641700 2014-03-11 2012 2015-11-30 17:44:51Z Gina Pendley 70 Caring Way Jasper GA 30143 2410284 0 X www.georgiamountainhospice.org X 1993 GA Georgia Mountains Hospice's mission is to provide excellent hospice care utilizing the interdisciplinary team model. 10 10 37 38 0 0 82206 98656 1963377 2211926 7254 3247 -3838 9667 2048999 2323496 5643 7603 0 0 1315265 1382385 0 0 37481 669805 727837 1990713 2117825 58286 205671 1778766 1891528 478869 391666 1299897 1499862 X To offer hope to a patient for whom all hope for cure has been exhausted; hope for maximum alertness,hope for independence and control over one's life. To offer support to families by allowing terminal patients to live at home pain free and with dignity. To offer the opportunity to tie up loose ends, make reconciliations, to know "good" goodbyes. To offer spiritual guidance and answers to one's search for meaning in one's life and death. To offer relief from financial strain. To offer care and support to family members and significant others through the bereavment period. To offer support to the community through education on death and dying. 0 0 1544146 7603 2211926 Hospice Program: See schedule OWe provide access to the highest quality hospice program for the people of North Georgia we care for through comprehensive approaches to palliative care, pain management, and compassionate customer services while developing exceptional professional skills regarding hospice care for a rural community.Our goals are 1: To provide service excellence in nursing care, emotional support, spiritual guidance, and bereavement services to terminally ill patients and their families. 2: To provide a spirit of acceptance and mutual respect, quality and compassionate care to all patients requesting services. 3: To promote independence, comfort, and dignity surrounding death in one's chosen environment. 4: To serve as a facilitator of education and community resources for patients with limited life expectancy, their families, and community physicians. 1544146 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 37 1 0 0 0 0 0 1 1 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 GA X The Organization 8006927199 70 Caring Way Jasper GA 30143 Mark Atkins 1.00 X 0 0 0 Jerry Tyson 0.50 X 0 0 0 Betty Francis 0.50 X X 0 0 0 Paul Nealey 0.50 X 0 0 0 Steve Purvis 0.00 X 0 0 0 Marie Lindsey 0.00 X 0 0 0 Caroline Carder 0.00 X 0 0 0 Samantha Callihan 0.00 X 0 0 0 Patricia Roberts 0.00 X 0 0 0 Honorable Brenda Weaver 0.00 X 0 0 0 Bill Bapst 0.00 X 0 0 0 Gina Pendley 36.00 X 52377 0 0 Mary Anne Bramlett 40.00 X 48476 0 1667 100853 0 1667 0 0 0 0 Blue Cross Blue Shield PO Box 100376 Atlanta GA 303840376 Health insurance 206308 HospiScript Services LLC PO Box 933273 Atlanta GA 311933273 Medications 147211 Union County Nursing Home 550 Nursing Home Circle Blairsville GA 30514 Patient care 115000 3 45480 53176 98656 Medicare revenue 621610 1927234 1927234 Medicaid revenue 621610 208361 208361 Commercial benefits re 621610 76331 76331 2211926 3618 3618 19945 20316 -371 -371 -371 75733 45480 66472 9261 9261 Other revenue 900099 406 406 406 2323496 2211926 0 12914 7603 7603 118132 101630 16502 1027216 752255 258185 16776 154536 146324 8212 82501 63476 19025 18600 18600 10168 10168 26387 2215 23753 419 19445 8499 10381 565 29409 8275 20388 746 29649 8896 19271 1482 14098 6912 6641 545 Direct medical expense 393443 393443 0 0 Mileage reimbursements 142957 138425 4226 306 Communication 16552 17 16535 0 Community Education 5966 0 5966 0 21163 7806 13217 140 2117825 1544146 536198 37481 769593 784157 354634 392055 189375 244843 10517 15424 790302 382040 403976 408262 50671 46787 1778766 1891528 138151 163972 340718 227694 478869 391666 X 1247973 1460940 51924 38922 1299897 1499862 1778766 1891528 205671 -5706 0 X 0 1 X 1 0 X 57110 58919 51244 80057 98656 345986 2514008 1961653 1890593 1967200 2211763 10545217 2571118 2020572 1941837 2047257 2310419 10891203 0 0 0 10891203 5541 8782 6357 6461 3618 30759 5541 8782 6357 6461 3618 30759 987 618 1275 17347 406 20633 2577646 2029972 1949469 2071065 2314443 10942595 0.99530 0.00280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 125233 125233 425000 201603 223397 11425 4455 6970 228644 175982 52662 408262 Medicaid overpayment liability 227694 227694 X 2330792 -5706 -5706 2336498 -13002 -13002 2323496 2117825 0 2117825 0 2117825 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Organization's policy is to record a liability for any tax position taken that is beneficial to the Organization, including any related interest and penalties, when it is more likely than not the position taken by management with respect to a transaction or class of transactions will be overturned by a taxing authority upon examination. Management believes there are no such positions as of September 30, 2013 and 2012, and, accordingly, no liability has been accrued. Accordingly, the Organization is not required to pay federal taxes on income. Generally the Internal Revenue Service (the "IRS") may examine a tax return for three years from the date it is filed. At September 30, 2013, tax years ended September 30, 2010, 2011 and 2012 remain open for possible examination by the IRS. Part XI, Line 4b - Other Adjustments: Contributions to temporarily restricted net assets 20,700. Temporarily restricted net assets released from restriction -33,702. Golf Tournament 44520 21627 22893 8977 892 1544 Mardi Gras Gala 57679 22628 35051 1900 9705 1500 30725 1 12510 1225 11285 3347 1000 4701 114709 45480 69229 10877 13944 2500 36970 64291 4938 1 Wishes and Dreams 7603 Form 990, Part VI, Section A, line 8b During the year, minutes of the Executive Committee Meetings were not maintained due to the fact that any decisions arrived at during the Executive Committe Meetings were still subject to full board approval. As such, these motions were documented in the minutes of the full Board meetings. Form 990, Part VI, Section B, line 11 Prior to the filing of the Form 990 the Organization's management performed a formal review of a draft copy of the Form 990 as provided by the CPA firm that prepared the return. Management directed any questions and concerns that arose during their review to the CPA firm for further understanding and/or corrections. Once Management was comfortable with the contents of the Form 990, an updated draft of the Form 990 was presented to the Executive Committee of the Board of Directors for their review and approval and then to the full Board. Once the draft was approved by the Board, a final copy of Form 990 was filed with the IRS. Form 990, Part VI, Section B, line 12c All members of the Board of Directors, contractors, and agency employees must disclose actual and potential conflicts of interest to the Organization via a "Potential Conflict of Interest Declaration." This declaration must be completed prior to the individual serving the Organization and and must be updated when changes occur. The Executive Director reviews all declarations and reports a summary of declarations to the Board of Directors as requested. The Board of Directors conducts an annual review of performance for the Executive Director utilizing the position's job description as a guide for evaluating performance. Additionally, the Board uses historical compensation data of the Organization's Executive Director in order to determine an appropriate compensation for this position. The Executive Director conducts performance reviews for other members of management on an annual basis. Form 990, Part VI, Section C, line 18 Any information related to the tax exempt status is available upon request from the Organization. Form 990, Part VI, Section C, line 19 Governing documents are available via the Georgia Secretary of State website at https://sos.georgia.gov. All other governing documents, the Organization's conflict of interest policy and latest financial statements are available upon request during business hours. Executive Committee Part VI, Section A Line 1a The Organization is governed by a Board of Directors, which is elected in a manner consistent with the state corporate law. The Board of Directors has chosen to delegate certain authority to an Executive Committee consisting of a chairperson, vice chair, treasurer, and secretary. Authority delegated to the Executive Committee includes but is not limited to oversight and involvement in the design and implementation of the Organization' internal control procedures, monitoring of mangement's activity, financial oversight, and committee appointment. However, powers of the Executive Committee are not such as to materially impact the Board's governance responsibilites. Medicaid Overpayment Liability Schedule D, Part X Other Liabilities The Organization has received overpayments over a period of time from Medicaid on the patient liability portion of room and board claims for patients residing in nursing homes. The Organization has made many attempts to resolve this problem with Medicaid to no avail. Therfore, the Organization maintains these overpayments in a separate board designated non-interest bearing bank account. The corresponding liability is recorded as Medicaid Overpayments and the balance as of September 30, 2013 was $227,694.