2012-10-29T10:53:56-05:00 2011-12-31 HOWARD WERSHBALE & CO 23240 CHAGRIN BLVD CLEVELAND OH 441225450 990 2011-01-01 341256377 HOSPICE OF THE WESTERN RESERVE INC % JOHN E HARVAN JR HOSP 2163832222 17876 ST CLAIR AVENUE CLEVELAND OH 44110 JOHN HARVAN 2012-10-18 true Joseph C Sbrocco CPA 2168311200 2011 2016-02-24 21:20:13Z WILLIAM E FINN 17876 ST CLAIR CLEVELAND OH 44110 92642544 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. 28 27 1021 2000 0 5927849 3336021 87328489 86180366 258808 759642 385388 392944 93900534 90668973 0 0 0 0 52602441 54513206 7500 0 1158954 36423576 36412212 89033517 90925418 4867017 -256445 67821107 75254029 15501550 25690999 52319557 49563030 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 76698968 86573310 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 THE 42-BED RESIDENTIAL FACILITY HOSPICE HOUSE. IN 2011, HOSPICE OF WESTERN RESERVE PROVIDED 453,854 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. 76698968 true true false false false false false false true true false false false true false true false false false false false false false false false false false false true true false false false false false false false true false true false false false false false false false false false false true 136 0 1021 true false false false false false false false false false false X 28 27 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 H CLARK HARVEY JR 1.0 X 0 0 0 PEG MILBOURN 3.0 X X 0 0 0 RICHARD B WHITNEY 1.0 X 0 0 0 CARL BALDASSARRE 3.0 X X 0 0 0 JOSEPH CARSON 3.0 X X 0 0 0 REV NEROY CARTER 1.0 X 0 0 0 DAVID G COLE 1.0 X 0 0 0 MARGIT DALEY 1.0 X 0 0 0 CYNTHIA HUNDORFEAN 1.0 X 0 0 0 JEAN E KILGORE 1.0 X 0 0 0 HILARY MASON KING 1.0 X 0 0 0 MARY ANN KOCURKO 3.0 X X 0 0 0 CAROL G MANNING 3.0 X X 0 0 WENDY MIANO 1.0 X VIRGINIA A MOONEY 1.0 X 0 0 0 DAVID MORDARSKI 1.0 X 0 0 0 JANICE MURPHY 1.0 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 BRET WILLIAMS 1.0 X 0 0 0 ELIZABETH PITORAK 1.0 X 145878 0 18922 RICHARD A BARONE 1.0 X 0 0 0 JAMES W ROGERSON 1.0 X 0 0 0 TRACY K STRATFORD 1.0 X 0 0 0 JAMES L HAMBRICK 3.0 X X 0 0 0 DAVID SIMPSON 40.0 X 467699 0 28015 BRIDGET J MONTANA 40.0 X 171687 0 15333 JOHN E HARVAN JR 40.0 X 194134 0 20934 WILLIAM FINN 40.0 X 226338 0 18898 CHARLES V WELLMAN 40.0 X 312682 0 24643 STEPHEN RYDER 40.0 X 153007 0 5866 DANN GANZHORN 40.0 X 193273 0 18672 JEFFREY SPIESS 40.0 X 181263 0 20203 JOHN WALTERS 40.0 X 159565 0 6126 SUSAN M FIGULA 40.0 X 162113 0 20924 2367639 0 198536 22 false true false VOCON PARTNERS OF OHIO LLC 3142 PROSPECT AVENUE CLEVELAND OH 44115 ARCHITECTURAL 196448 DONLEY'S INC 5430 WARNER ROAD CLEVELAND OH 44125 BUILDING CONTRACTOR 7985651 SUBURBAN MAINTENANCE CONSTRUCTION PO BOX 33009 NORTH ROYALTON OH 44133 CONTRACTOR-BLDG 269278 ACE DEMO INC 2111 CENTER STREET CLEVELAND OH 44113 DEMOLITION 189380 COMFORT SYSTEMS USA 7401 FIRST PLACE OAKWOOD VILLAGE OH 44146 CONTRACTOR-HVAC 187327 10 422325 2913696 21803 3336021 HOSPICE CARE SERVICES 623000 86144688 86144688 GRIEF COUNSELING 624100 35678 35678 86180366 578773 578773 0 0 2154440 0 1892353 81218 262087 -81218 180869 180869 0 0 0 RESALE SHOP 900099 314156 314156 MISCELLANEOUS REVENUE 900099 78788 78788 392944 90668973 86573310 759642 0 0 0 0 2265071 2265071 0 38250756 33600682 4054850 595224 1248421 1035343 194737 18341 8252323 6820946 1308707 122670 4496635 3729160 701414 66061 0 172580 172580 0 0 0 0 2258737 1068116 1120514 70107 632534 179873 421781 30880 2820451 1348216 1361470 110765 0 0 1973214 1340186 573834 59194 93845 77827 14639 1379 0 178662 80305 91482 6875 71232 48379 20715 2138 0 1071957 781400 269981 20576 286624 194672 83354 8598 BAD DEBT 294550 278129 16421 MEDICAL SUPPLIES 4711559 4693630 17419 510 PATIENT SERVICES 2029207 2021484 7502 221 NURSING FACILITIES 17931174 17862942 66292 1940 1885886 1537678 321154 27054 90925418 76698968 13067496 1158954 1416 4421020 8126279 3740000 5001959 3049220 9719391 9193753 0 0 0 0 0 0 0 0 669582 465320 36073731 5464587 19367899 30609144 23267535 22163774 1234391 1199903 0 0 396345 383789 36310 28106 67821107 75254029 10006771 10714795 0 0 0 0 3938170 12659754 0 0 0 0 0 0 0 0 1556609 2316450 15501550 25690999 X 45114011 42312875 6740644 6785253 464902 464902 52319557 49563030 67821107 75254029 X -256445 -2500082 X false true true X false X false false false 4254990 8829804 8526768 5927849 3336021 30875432 72018845 73369832 82077261 87368989 86180366 401015293 76273835 82199636 90604029 93296838 89516387 431890725 431890725 842135 801992 760658 578480 578773 3562038 842135 801992 760658 578480 578773 3562038 241893 326388 357582 344887 392944 1663694 77357863 83328016 91722269 94220205 90488104 437116457 0.98804 0.98668 0.00815 0.00956 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 852162 -22219 829943 774691 77471 852162 790588 -15897 774691 464902 37729 37729 464902 0.56016 0.43984 false false 8045374 8045374 9015944 3047534 5968410 73090 36772 36318 2889940 1161156 1728784 16049383 1219124 14830258 30609144 0 ANNUITY OBLIGATIONS 81382 DEFERRED COMPENSATION OBLIGATION 1116096 INTEREST RATE SWAP 1118972 2316450 90668973 90925418 -256445 -1371218 -1128864 -2500082 -2756527 92042245 1373272 1373272 90668973 90668973 94798772 1373272 1371218 1128864 3873354 90925418 90925418 CHANGES IN NET ASSETS SCHEDULE D, PART XI, #8 Change in Split Value Interest Agreements - $ (9,892) Change in Value of Interest Rate Swap - $ (1,118,972) Total Other Change in Net Assets = $ (1,128,864) OTHER EXPENSES SCHEDULE D, PART XIII, #2D Change in Split Value Interest Agreements - $9,892 Change in Value of Interest Rate Swap - $ 1,118,972 Total Other Expenses = $ 1,128,864 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. X X X false true false false false false false false false ELIZABETH PITORAK 145678 0 200 0 0 0 5607 0 13315 0 164800 0 0 0 CHARLES V WELLMAN 239564 0 600 0 72518 0 11328 0 13315 0 337325 0 0 0 STEPHEN RYDER 152807 0 200 0 0 0 5866 0 0 0 158873 0 0 0 DANN GANZHORN 192673 0 600 0 0 0 5357 0 13315 0 211945 0 0 0 JEFFREY SPIESS 180663 0 600 0 0 0 6732 0 13471 0 201466 0 0 0 JOHN WALTERS 159365 0 200 0 0 0 6126 0 0 0 165691 0 0 0 DAVID SIMPSON 300000 0 123700 0 43999 0 14700 0 13315 0 495714 0 0 0 BRIDGET J MONTANA 171687 0 0 0 0 0 5338 0 9995 0 187020 0 0 0 JOHN E HARVAN JR 193934 0 200 0 0 0 7463 0 13471 0 215068 0 0 0 SUSAN M FIGULA 96853 0 600 0 64660 0 7609 0 13315 0 183037 0 0 0 WILLIAM FINN 225014 0 200 0 1124 0 7804 0 11094 0 245236 0 0 0 Participate in, receive payment from, supplemental nonqualified retirement schedule J, part I, #4B DAVID SIMPSON, CEO, EMERITUS - $43,279 BRIDGET MONTANA, CHIEF OPERATING OFFICER - $79,586 CHARLES WELLMAN, CHIEF MEDICAL OFFICER - $72,518 SUSAN FIGULA, CHIEF MARKETING & COMMUNICATIONS OFFICER - $64,660 CLEVELAND-CUYAHOGA COUNTY PORT AUTHORITY 341029691 2010-12-30 21565000 RETIRE 1999 BONDS AND CONSTRUCT FA true false false 0 0 12659574 0 41572 0 397023 0 0 8282809 3938170 8905426 2012 true false true true false false false false 0.00000 0.00000 0.00000 true false true false 0 false 0 false true X schedule k, part II, line 3 0 difference in proceeds and issue price is due to construction period draws on bond financing. RICHARD SPOTZ JR DIRECTOR 45029 PROVIDED LEGAL SERVICES false JOHN E HARVAN JR CFO 1800 ANNUAL ORGANIZATION DUES false WILLIAM F FINN CEO 13600 ANNUAL ORGANIZATION DUES 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 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 2011.) 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. 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 2011, THAT FIRM PROVIDED LEGAL ADVICE AND SERVICES TO HOSPICE OF THE WESTERN RESERVE AND WAS PAID $45,029. HOSPICE OF THE WESTERN RESERVE IS A MEMBER OF THE HOSPICE ALLIANCE OF OHIO (ANNUAL DUES PAID IN 2011 OF $1,800). HOSPICE ALLIANCE OF OHIO, AN OHIO 501(C)(6) ORGANIZATION, IS A GROUP OF NINETEEN HOSPICES THROUGHOUT THE STATE THAT COLLECTIVELY NEGOTIATE CONTRACTS WITH HEALTHCARE INSURANCES FOR HOSPICE SERVICES AND NETWORKS WITH EACH OTHER. MR. JOHN E. HARVAN, JR., CFO OF HOSPICE OF THE WESTERN RESERVE, IS A BOARD MEMBER OF THE HOSPICE ALLIANCE OF OHIO AND SERVES IN THE ROLE AS ITS TREASURER. 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 $13,600 in 2011. 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 - $ (1,118,972) UNREALIZED LOSS ON INVESTMENTS - $ (1,371,218) CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS - $ (9,892)