2013-08-12T09:36:41-05:00 2012-12-31 Howard Wershbale & Co 23240 Chagrin Blvd Suite 700 Cleveland OH 441225450 990 2012-01-01 341256377 Hospice of The Western Reserve Inc % JOHN E HARVAN JR HOSP 2163832222 17876 St Clair Avenue Suite Cleveland OH 44110 John Harvan 2163832222 2013-08-09 true Joseph C Sbrocco CPA 2168311200 2012 2016-02-24 21:20:13Z WILLIAM E FINN 17876 ST CLAIR CLEVELAND OH 44110 98537946 false X WWW.HOSPICEWR.ORG X 1978 OH HOSPICE OF THE WESTERN RESERVE PROVIDES PALLIATIVE END-OF-LIFE CARE, CAREGIVER SUPPORT, AND BEREAVEMENT SERVICES THROUGHOUT NORTHERN OHIO. We strive to relieve suffering & enhance comfort in end of life care. 25 23 1074 2500 0 3336021 3910402 86180366 90576989 759642 693930 392944 1323436 90668973 96504757 0 0 0 0 54513206 58348701 0 0 1313261 36412212 36595249 90925418 94943950 -256445 1560807 75254029 87551848 25690999 34316578 49563030 53235270 HOSPICE OF THE WESTERN RESERVE PROVIDES PALLIATIVE END-OF-LIFE CARE, CAREGIVER SUPPORT, AND BEREAVEMENT SERVICES THROUGHOUT NORTHERN OHIO. IN CELEBRATION OF THE INDIVIDUAL WORTH OF EACH LIFE, WE STRIVE TO RELIEVE SUFFERING, ENHANCE COMFORT, PROMOTE QUALITY LIFE, FOSTER CHOICE IN END-OF-LIFE CARE AND SUPPORT EFFECTIVE GRIEVING. false false 78614731 91808840 HOSPICE CARE SERVICES ARE ABOUT PROVIDING PEOPLE (ADULTS AND CHILDREN) WITH A LIFE-LIMITING ILLNESS, AND THEIR FAMILIES WITH CHOICES AND DIGNITY. CARE IS PROVIDED WHEREVER THE PATIENTS LIVE; IN THEIR HOME, IN A HOSPITAL, ASSISTED LIVING/LONG-TERM CARE FACILITY OR at two HOSPICE HOUSE residential facilities. IN 2012, HOSPICE OF WESTERN RESERVE PROVIDED 459,612 PATIENT DAYS. CARE IS PROVIDED BY A TEAM OF PAID AND NON-PAID STAFF WHO ARE AVAILABLE 24-HOURS A-DAY, SEVEN DAYS A WEEK. ADDITIONALLY, BEREAVEMENT SERVICES ARE PROVIDED FOR FAMILIES FOR MORE THAN A YEAR FOLLOWING THE LOSS OF A LOVED ONE. 78614731 true true false false false false false false false true true false false false true false true false false false false false false false true false false false false true true false false false false false false false true false true true false false false false false false false false true 121 0 true 1074 true false false false false false false false false false false X 25 23 true false false false false false false true true false false true true true true true true true false false OH X JOHN E HARVAN JR 2163832222 17876 ST CLAIR CLEVELAND OH 44110 PEG MILBOURN 3.0 X X 0 0 0 JOSEPH CARSON 3.0 X X 0 0 0 MARGIT DALEY 1.0 X 0 0 0 CYNTHIA HUNDORFEAN 1.0 X 0 0 0 MARY ANN KOCURKO 3.0 X X 0 0 0 CAROL G MANNING 1.0 X 0 0 0 WENDY MIANO 1.0 X 0 0 0 VIRGINIA A MOONEY 1.0 X 0 0 0 DAVID MORDARSKI 1.0 X 0 0 0 JANICE MURPHY 3.0 X X 0 0 0 LAURA NAVIN 1.0 X 0 0 0 MARY L OGRINC 1.0 X 0 0 0 SARAH ROBERTSON 1.0 X 0 0 0 RICHARD T SPOTZ JR 1.0 X 0 0 0 WILLIAM SPRINGER 1.0 X 0 0 0 ELIZABETH PITORAK 1.0 X 206737 0 24392 RICHARD A BARONE 1.0 X 0 0 0 JAMES W ROGERSON 1.0 X 0 0 0 Stephen P Kresnye 1.0 X 0 0 0 H Clark Harvey Jr 1.0 X 0 0 0 Paula Ames Redman 1.0 X 0 0 0 Rev Neroy Carter 1.0 X 0 0 0 Alfred F Connors Jr MD 1.0 X 0 0 0 Amelia V Llerena MD 1.0 X 0 0 0 Hilary Mason King 3.0 X X 0 0 0 DAVID SIMPSON 40.0 X 389225 0 2601 William Finn 40.0 X 335613 0 33436 John E Harvan Jr 40.0 X 194184 0 25872 CHARLES V WELLMAN 40.0 X 246088 0 26428 Dann Ganzhorn 40.0 X 201617 0 24526 Jeffrey Spiess 40.0 X 184483 0 25156 John Walters 40.0 X 177211 0 25423 John Lim 40.0 X 157039 0 23876 Julia A Bartel 40.0 X 150409 0 13017 Shareefah T Sabur 40.0 X 285528 0 23415 Wayne Grant 40.0 X 106134 0 22781 Patricia A Kilfoyle 40.0 X 110900 0 23023 Janice M Scheufler 40.0 X 119826 0 3584 Robert Phillips-Plona 40.0 X 122158 0 11767 Clement Heary 40.0 X 120462 0 22207 3107614 0 331504 21 false true false VOCON PARTNERS OF OHIO LLC 3142 PROSPECT AVENUE CLEVELAND OH 44115 ARCHITECTURAL 149899 DONLEY'S INC 5430 WARNER ROAD CLEVELAND OH 44125 BUILDING CONTRACTOR 5809232 LONDON ROAD ELECTRIC CO 16109 SAINT CLAIR AVE CLEVELAND OH 44110 CONTRACTOR 185302 DR CARLA BASTER 16920 CHARDON-WINDSOR ROAD HUNSTBURG OH 44046 CONTRACTOR-PHYSICIAN 179201 COMFORT SYSTEMS USA 7401 FIRST PLACE OAKWOOD VILLAGE OH 44146 CONTRACTOR-HVAC 150102 8 394595 3515807 127636 3910402 HOSPICE CARE SERVICES 623000 90539164 90539164 GRIEF COUNSELING 624100 37825 37825 90576989 851175 851175 0 0 0 0 0 1814423 1947635 24033 -133212 -24033 -157245 -24033 -133212 129073 61521 67552 0 0 RESALE SHOP 900099 284980 284980 MISCELLANEOUS REVENUE 900099 539804 539804 REBATES AND REFUNDS 900099 431100 431100 1255884 96504757 91808840 717963 0 0 0 0 2302283 2302283 0 40768607 33524458 6584664 659485 2247958 1869871 343667 34420 8858173 7358447 1363436 136290 4171680 3470040 637765 63875 0 390463 390463 0 0 0 0 2241434 1289143 878150 74141 240798 60168 167505 13125 2749800 1429882 1207268 112650 0 0 1615107 1234851 330500 49756 93508 77781 14295 1432 0 183589 83986 92163 7440 273887 209403 56046 8438 0 1512753 1280482 213694 18577 309325 236499 63297 9529 BAD DEBT 369169 342350 26819 MEDICAL SUPPLIES 4755409 4730565 12547 12297 PATIENT SERVICES 2059910 2049148 5435 5327 NURSING FACILITIES 17708578 17616060 46724 45794 2091519 1751597 306056 33866 94943950 78614731 15015958 1313261 4421020 4478649 3740000 5555000 3049220 2743700 9193753 9459091 0 0 0 0 0 0 0 0 465320 628948 42759120 6303766 30609144 36455354 22163774 26278248 1199903 1562122 0 0 383789 370555 28106 20181 75254029 87551848 10714795 10504785 0 0 0 0 12659754 21440000 0 0 0 0 0 0 0 0 2316450 2371793 25690999 34316578 X 42312875 49168920 6785253 3601448 464902 464902 49563030 53235270 75254029 87551848 X 1560807 2463013 -351580 X false true X true false X false false false 8829804 8526768 5927849 3336021 3910402 30530844 73369832 82077261 87368989 86180366 90576989 419573437 0 0 0 82199636 90604029 93296838 89516387 94487391 450104281 0 0 0 450104281 801992 760658 578480 578773 851175 3571078 0 801992 760658 578480 578773 851175 3571078 0 326388 357582 344887 392944 1231851 2653652 83328016 91722269 94220205 90488104 96570417 456329011 0.98636 0.98804 0.00783 0.00815 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 829943 131205 961148 852162 -22219 829943 774691 77471 852162 790588 -15897 774691 464902 37729 37729 464902 0.48369 0.51631 false false 8045374 8045374 26469883 3623636 22846247 71945 47608 24337 3171811 1335474 1836337 5000107 1297048 3703059 36455354 0 ANNUITY OBLIGATIONS 78562 DEFERRED COMPENSATION OBLIGATION 832609 INTEREST RATE SWAP 1460622 2371793 100490562 2463013 1522792 3985805 96504757 96504757 96818322 1522792 351580 1874372 94943950 94943950 OTHER EXPENSES SCHEDULE D, PART XIII, #2D Change in Split Value Interest Agreements - $9,930 Change in Value of Interest Rate Swap - $ 341,650 Total Other Expenses = $ 351,580 INTENDED USES OF ENDOWMENT FUNDS SCHEDULE D, PART V, #4 DONOR-IMPOSED STIPULATIONS INDICATING THAT THE FUNDS BE MAINTAINED PERMANENTLY BY THE ORGANIZATION AND THAT ALLOW THE INCOME EARNED ON ANY RELATED INVESTMENT TO BE USED FOR GENERAL PURPOSES. Walk to Remembe 112332 112332 4720 5523 9848 3199 29063 Jaguar Raffle 16741 16741 7225 1943 0 0 0 0 0 0 0 0 0 0 129073 0 129073 0 11945 5523 9848 3199 31006 61521 67552 X X X false true false false false false false false false ELIZABETH PITORAK 145678 0 250 0 60809 0 5943 0 18449 0 231129 0 0 0 DAVID SIMPSON 89135 0 300000 0 90 0 1065 0 1536 0 391826 0 0 0 CHARLES V WELLMAN 245438 0 650 0 0 0 7979 0 18449 0 272516 0 0 0 William Finn 258978 0 75250 0 1385 0 14987 0 18449 0 369049 0 0 0 John E Harvan Jr 193934 0 250 0 0 0 7610 0 18262 0 220056 0 0 0 Dann Ganzhorn 201367 0 250 0 0 0 6077 0 18449 0 226143 0 0 0 Jeffrey Spiess 183833 0 650 0 0 0 6894 0 18262 0 209639 0 0 0 John Walters 176561 0 650 0 0 0 6974 0 18449 0 202634 0 0 0 John Lim 156789 0 250 0 0 0 5467 0 18409 0 180915 0 0 0 Julia A Bartel 149759 0 650 0 0 0 5592 0 7425 0 163426 0 0 0 Shareefah T Sabur 121711 0 250 0 163567 0 4966 0 18449 0 308943 0 0 0 Participate in, receive payment from, supplemental nonqualified retirement schedule J, part I, #4B David Simpson, CEO, Emeritus - 98,432 Shareefah T. Sabur, Chief Quality & Education Officer - $163,567 Elizabeth Pitorak, Director of Hospice Institute - $60,809 Clem Hearey, Director of Human Resources - $9,563 A CLEVELAND-CUYAHOGA COUNTY PORT AUTHORITY 341029691 2010-12-30 21565000 RETIRE 1999 BONDS AND CONSTRUCT FA false false false A 125000 0 21565000 0 120302 0 397023 0 0 17480849 3566826 0 2012 true false true true A false false false false 0 false false false true A false true true false 0 0 A RICHARD SPOTZ JR DIRECTOR 66239 PROVIDED LEGAL SERVICES false WILLIAM F FINN CEO 21641 ANNUAL ORGANIZATION DUES false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV MR. RICHARD T. SPOTZ, JR. IS AN ATTORNEY AND LONG STANDING MEMBER OF THE BOARD OF DIRECTORS. MR. SPOTZ IS A PARTNER AT THE LAW FIRM, ZIEGLER, METZER, MILLER, LLP, IN CLEVELAND, OHIO. IN 2012, THAT FIRM PROVIDED LEGAL ADVICE AND SERVICES TO HOSPICE OF THE WESTERN RESERVE AND WAS PAID $66,239. William Finn serves as the chair of the National Hospice Work Group board of directors. This role is voluntary and receives no compensation. The National Hospice Work Group is a Not for Profit, 501(c)(3) organization. The organization's mission is to stimulate new ideas, share best practices and emerging models, stay informed of key issues and to build a strong network among hospice leaders who aspire to excellence. Hospice of the Western Reserve is a member of the National Hospice Work Group, and paid dues of $21,641 in 2012. X 3 18000 fmv X 5000 fmv X 1 6750 fmv X 10 97886 FMV false true false DOCUMENTS AVAILABLE TO PUBLIC PAGE 6, PART VI, SECTION C, #19 HOSPICE OF THE WESTERN RESERVE DOES MAKE ITS FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC BY PROVIDING COPIES UPON REQUEST, INSPECTION AT THE HEADQUARTERS OFFICE AND BY PROVIDING FINANCIAL DATA IN ANNUAL REPORTS WHICH ARE AVAILABLE ON HOSPICE OF THE WESTERN RESERVE'S WEBSITE. HOSPICE OF THE WESTERN RESERVE DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. PROCESS FOR DETERMINING COMPENSATION PAGE 6, PART VI, SECTION B, #15A THE COMPENSATION OF THE CEO IS BASED ON ANNUAL LABOR MARKET DATA FROM BOTH LOCAL AND NATIONAL SOURCES. WITH THE HELP OF THE HUMAN RESOURCES TEAM, THE ORGANIZATION PARTICIPATES IN ANNUAL AND SPECIAL COMPENSATION SURVEYS AND THE RESULTING DATA IS SHARED WITH THE BOARD OF DIRECTORS. COMPENSATION INFORMATION IS ALSO OBTAINED FROM FORM 990'S FROM OTHER COMPARABLE NOT-FOR-PROFIT HOSPICES. IN ADDITION, EACH BOARD DIRECTOR IS ASKED TO RESPOND TO A QUESTIONNAIRE EVALUATING THE CEO'S PERFORMANCE COMPARED TO GOALS ESTABLISHED DURING THE PREVIOUS YEAR'S EVALUATION. THE RESULTS OF THE QUESTIONNAIRES ARE TABULATED AND SHARED WITH THE BOARD'S EXECUTIVE COMMITTEE. BASED ON THE THE LABOR MARKET DATA AND ANNUAL PERFORMANCE EVALUATION PROCESS, THE EXECUTIVE COMMITTEE THEN ESTABLISHES THE CEO'S COMPENSATION LEVEL AS WELL AS ANY PERFORMANCE BONUS THAT MAY BE PROVIDED. FOR OTHER KEY OFFICERS, THE PROCESS IS SIMILAR TO THE PROCESS NOTED ABOVE. THE ORGANIZATION OBTAINS ANNUAL LABOR MARKET DATA FROM BOTH LOCAL AND NATIONAL SOURCES. THE ORGANIZATION PARTICIPATES IN ANNUAL AND SPECIAL COMPENSATION SURVEYS AND THE RESULTING DATA IS SHARED WITH THE CEO. IN ADDITION, THE INTERNAL ALIGNMENT OF OUR POSITIONS IS PERIODICALLY REVIEWED. RATES OF PAY ARE REVIEWED AND ESTABLISHED FOR INTERNAL POSITIONS BASED ON EQUITABLE RELATIONSHIPS AND THE DIFFICULTY AND RESPONSIBILITY OF WORK PERFORMED. RECOMMENDATIONS FOR REQUISITE CHANGES ARE DISCUSSED WITH THE CEO. THE OFFICER'S PERFORMANCE IS REVIEWED ON AN ANNUAL BASIS BY THE CEO. BASED ON THE INDIVIDUAL'S ANNUAL PERFORMANCE AND GOALS ACHIEVED, AND THE INTERNAL AND EXTERNAL DATA, THE CEO WILL ESTABLISH THE COMPENSATION LEVEL FOR HIS OFFICERS. THIS PROCESS HELPS US MAINTAIN THE ORGANIZATION'S INTERNAL ALIGNMENT AND EXTERNAL COMPETITIVENESS. THE ABOVE PROCESSES ARE DOCUMENTED AT THE TIME THE DECISIONS ARE MADE. FAMILY OR BUSINESS RELATIONSHIPS PAGE 6, PART VI, SECTION A, #2 MRS. MARGARET MENDENHALL SIMPSON, THE WIFE OF HOSPICE OF THE WESTERN RESERVE'S emeritus CEO, MR. DAVID A. SIMPSON, IS AN EMPLOYEE OF ZIEGLER, METZER, MILLER, LLP. (THE LAW FIRM PROVIDED LEGAL ADVICE AND SERVICES TO THE ORGANIZATION DURING 2012.) MR. RICHARD T. SPOTZ, JR. IS A BOARD MEMBER OF HOSPICE OF THE WESTERN RESERVE AND THE MANAGING PARTNER AT ZIEGLER, METZER & MILLER, LLP. FORM 990 REVIEW PROCESS PAGE 6, PART VI, SECTION A, #11B Initially the Form 990 is sent to the Finance Committee of the Board for their review and approval before it is finalized. Then, it is made available to the full Board for their review, prior to filing the form with the IRS. MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY PAGE 6, PART VI, SECTION B, #12C All Board members and employees are required to submit a disclosure statement at the beginning of employment and annually thereafter. If a matter arises which a Board member or employee has a conflict of interest, it shall be promptly disclosed to the Board or Chief Executive Officer as appropriate. Staff may initiate disclosure through their supervisor. However, the Board member or employee shall not participate in the discussion or vote to determine whether a conflict exists unless requested to do so. The Human Resources Committee shall be available to the Chief Executive Officer for review of conflict situations. RECONCILIATION OF NET ASSETS PAGE 12, PART XI, #5 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP - $ (341,650) CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS - $ (9,930) ------------- $ (351,580)