2011-11-03T13:43:01-05:00 2010-12-31 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-01-01 431209344 KANSAS CITY HOSPICE INC KANS 8163632600 9221 WARD PARKWAY NO 100 KANSAS CITY MO 64114 ELAINE MCINTOSH 8163632600 2011-11-01 1 AMY BIBBY 8282542254 2010 2016-03-07 17:11:31Z ELAINE MCINTOSH 9221 WARD PARKWAY NO 100 KANSAS CITY MO 64114 22647756 0 X WWW.KANSASCITYHOSPICE.ORG X 1980 MO SEE PART III, LINE I 18 17 369 522 0 0 3468275 1935780 19794945 20637001 1607 445 28556 74530 23293383 22647756 0 0 0 0 13438001 14408487 0 0 0 7636155 8194269 21074156 22602756 2219227 45000 18686877 19374598 7219628 7764571 11467249 11610027 TO BRING EXPERT CARE, PEACE OF MIND, COMFORT, GUIDANCE, AND HOPE TO PEOPLE WHO ARE AFFECTED BY LIFE-THREATENING AND LIFE-LIMITING ILLNESS. 0 0 19389616 20637001 KANSAS CITY HOSPICE, INC. IS A NONPROFIT ORGANIZATION OFFERING A RANGE OF SERVICES FOR PEOPLE OF ALL AGES AND AT ANY STAGE OF SERIOUS ILLNESS. WE'VE BEEN PROVIDING COMFORT AND CARE TO THE SERIOUSLY ILL AND THEIR FAMILIES IN THE GREATER KANSAS CITY AREA SINCE 1980. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS. VISIT US ON THE WEB AT WWW.KANSASCITYHOSPICE.ORG. 19389616 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 82 0 1 369 1 0 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X RAY LETOURNEAU 8162762611 9221 WARD PARKWAY SUITE 100 KANSAS CITY MO 64114 ALFRED BIGGS 1.00 X X 0 0 0 MICHELLE STARK KAUFMAN 1.00 X X 0 0 0 ROBERT HILL 1.00 X X 0 0 0 ELAINE MCINTOSH 40.00 X X 241479 0 32209 NANCY DEBASIO 1.00 X 0 0 0 STEVE JONES 1.00 X 0 0 0 LYNNE BROWN 1.00 X X 0 0 0 KEITH ASHCRAFT 1.00 X 0 0 0 SHERRY AINSWORTH 1.00 X 0 0 0 FRAN MARTINSEN 1.00 X 0 0 0 FREDA MENDEZ-SMITH 1.00 X 0 0 0 MIKE O'FLAHERTY 1.00 X 0 0 0 LEE STANFORD 1.00 X 0 0 0 SHERMAN STEINZEIG 1.00 X 0 0 0 WILLIAM TAMMEUS 1.00 X 0 0 0 MARGE SIRRIDGE 1.00 X 0 0 0 ROBERT WOOD 1.00 X 0 0 0 GRACIELA COUCHONNAL 1.00 X 0 0 0 DAVID SMALL 1.00 X 0 0 0 MELISSA EDMAN 1.00 X 0 0 0 BARRETT HATCHES 1.00 X 0 0 0 RAY LETOURNEAU JR 40.00 X 98867 0 4567 ANN ALLEGRE 39.40 X 145199 0 7895 CHRISTIAN SINCLAIR 34.00 X 111077 0 18723 TERRIE MYERS 40.00 X 95690 0 8835 DEANNA HAFER 40.00 X 101130 0 14807 LESLIE MCGREW-KAUFMAN 40.00 X 91743 0 12141 697752 0 78201 4 0 1 0 BLUE CROSS BLUE SHIELD PO BOX 419016 KANSAS CITY MO 64141 EMPLOYEE HEALTH CARE BENEFIT 1286819 UVANTA PHARMACY 9204 BOND STREET OVERLAND PARK MO 66214 PATIENT CARE MEDICATIONS 1001899 TRUMAN MEDICAL CENTER EAST LTC 7900 LEES SUMMIT ROAD KANSAS CITY MO 64112 NURSING HOME-ROOM AND BOARD 336254 WARD PARKWAY CS LLC 700 W 47TH STREET STE 200 KANSAS CITY MO 64112 OFFICE RENTAL 287492 HMP 400 SE BRIZENDINE RD BLUE SPRINGS MO 64017 PROVIDER OF DURABLE MEDICAL EQUIPMENT 252308 5 1890781 44999 1935780 PATIENT SERVICE REVENU 621300 19591376 19591376 NURSING HOME SUPPORT 621300 1045625 1045625 20637001 445 445 MISCELLANEOUS REVENUE 900099 74530 74530 74530 22647756 20637001 0 74975 398421 398421 11789381 10113738 1675643 130411 128419 1992 1228453 1082211 146242 861821 739790 122031 26830 26830 86779 86779 138526 138526 902833 651149 251684 78257 78257 2885152 2695067 190085 142279 142279 711295 711295 415215 381943 33272 48178 14901 33277 108358 108358 737889 737889 325742 325742 MEDICARE ROOM & BOARD 1103142 1103142 BAD DEBT EXPENSE 340540 340540 PATIENT TRANSPORTATION 143254 143254 22602756 19389616 3213140 0 1406096 1260051 265469 2422315 2792035 36478 36481 196634 200887 18667817 4364487 14371942 14303330 122657 169102 276800 201198 18686877 19374598 994704 1280075 6200000 6000000 451353 24924 33143 7219628 7764571 X 11467249 11579266 30761 11467249 11610027 18686877 19374598 X 45000 97778 X X 0 1 1 X 0 X 23689 1761814 3468275 1905018 7158796 15974449 18164547 18293261 19794945 20637001 92864203 15998138 18164547 20055075 23263220 22542019 100022999 90237 90237 0 90237 90237 99932762 253975 41143 10158 1607 445 307328 253975 41143 10158 1607 445 307328 1897475 60129 111125 28556 74530 2171815 18149588 18265819 20176358 23293383 22616994 102502142 0.97490 0.96300 0.00300 0.00360 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME INCREASE IN BENEFICIAL INTEREST IN FOUNDATION RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1112921 9000 7001 1128922 1049519 45667 17735 1112921 1064013 -14494 1049519 1.00000 0 1 1 1571077 1571077 12932225 1850731 11081494 16689 15607 1082 1242368 536054 706314 2905458 1962095 943363 14303330 DEPOSITS 37706 DEFERRED BOND COSTS 163492 201198 CAPITAL ACCUMULATION LIABILITY 33143 33143 22647756 22602756 45000 97778 97778 142778 24247681 1599925 1599925 22647756 0 22647756 22602756 0 22602756 0 22602756 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE REPORTED AS PERMANENTLY RESTRICTED NET ASSETS ON THE FINANCIAL STATEMENTS OF KANSAS CITY HOSPICE FOUNDATION. THE ENDOWMENT CONSISTS OF 2 DONOR-RESTRICTED FUNDS. NET ASSETS ASSOCIATED WITH ENDOWMENT FUND ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. DONOR RESTRICTIONS CONFORM TO THE ORGANIZATION'S MISSION. THE POLSKY FAMILY SUPPORTING FOUNDATION ENDOWMENT, A DONOR RESTRICTED ENDOWMENT, OPERATES UNDER THE FOLLOWING GUIDELINES. THE PURPOSE OF THE ENDOWMENT IS TO PROVIDE FUNDS TO: I. TEACH MEMBERS/OFFICERS/TRUSTEES/STAFF PRINCIPLES OF PRUDENT INVESTING BY USING THE POLSKY LESSONS FOR LIFE MODEL AS A PASS OUT AND PRESENTATION (WWW.POLSKY-LESSONS-FOR-LIFE.COM ) AND BY RECEIVING AND CONSIDERING PERIODIC INVESTMENT RECOMMENDATIONS FROM NORMAN POLSKY OR HIS SUCCESSOR; AND / OR 2. FOSTER STAFF DEVELOPMENT THROUGH: FORMAL EDUCATION; REGULAR TRAINING; ATTENDANCE AT INDUSTRY CONFERENCES AND EVENTS; AND WHATEVER OTHER STAFF PROGRAMS THE KCHF BOARD DETERMINES TO BE APPROPRIATE; AND/OR 3. FOSTER AND ENCOURAGE FUND RAISING BY HIRING A SUCCESSFUL PROFESSIONAL FUND RAISER CAPABLE OF TEACHING THE STAFF AND THE PROFESSIONAL VOLUNTEER OFFICERS OF KCH; AND/OR 4. FOSTER IMPROVED PUBLIC RELATIONS FOR KCH BY HIRING A PROFESSIONAL TO TEACH THE STAFF AND OFFICERS AND/OR 5. ENCOURAGE RESEARCH AND EDUCATION, EDUCATIONAL ACCREDITATION AND OTHER SIMILAR ACTIVITIES; AND/OR 6. ESTABLISH AN ARCHIVE OF KCHF TO PRESERVE THE HISTORY; AND/OR 7. ESTABLISH A PROGRAM RECOGNIZING AND UTILIZING MORE OF THE PAST OFFICERS, BOARD MEMBERS AND STAFF; AND/OR 8. CARRY ON ANY OTHER ACTIVITIES CONSISTENT WITH KCH TAX-EXEMPT STATUS AND AS DETERMINED BY KCH BOARD OF DIRECTORS, EXCEPT THAT NO PART OF THE ENDOWMENT PRINCIPAL MAY BE USED TO DEFRAY OPERATING EXPENSES SUCH AS, WITHOUT LIMITATION, RENT, PAYROLL, EMPLOYEE BENEFIT PROGRAMS, EQUIPMENT PURCHASES, LEASES, AND SUPPLIES -- UNLESS SPECIFICALLY APPROVED IN WRITING IN ADVANCE BY PFSF. THE SECOND ENDOWMENT, THE COMMUNITY HEALTH GROUP ENDOWMENT, OPERATES UNDER THE FOLLOWING GUIDELINES: (A) TO ESTABLISH, OPERATE, SUPPORT, PROVIDE THE CAPITAL REQUIREMENTS OF, AND MAINTAIN HOSPITALS, INPATIENT FACILITIES, CLINICS, LABORATORIES, OFFICE BUILDINGS, PHARMACIES, AND ALL MEASURE OF FACILITIES AND PROGRAMS FOR OR RELATING TO, THE STUDY OR CARE OF THE HUMAN MIND AND BODY OR ANY PART THEREOF, AND (B) TO FOSTER THE HEALTH OF THE COMMUNITY AND TO ENGAGE IN EDUCATIONAL ACTIVITIES, RESEARCH AND OPERATIONS RELATED THERETO. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPICE IS A NOT-FOR-PROFIT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPICE HAS ADOPTED THE FINANCIAL ACCOUNTING STANDARDS BOARDS (FASB) AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THAT ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT FOR THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE HOSPICES FINANCIAL STATEMENTS. THE HOSPICE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2010 AND THE ADOPTION OF THE GUIDANCE DID NOT HAVE A MATERIAL EFFECT ON THE HOSPICES FINANCIAL POSITION OR RESULTS OF OPERATIONS. FISCAL YEARS ENDING ON OR AFTER DECEMBER 31, 2007 REMAIN SUBJECT TO EXAMINATION BY FEDERAL TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: ASSET TRANSFERS BETWEEN ENTITIES 97,778. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ELIMINATED FOUNDATION ACTIVITY 1,502,147. ASSET TRANSFERS BETWEEN ENTITIES 97,778. X X X 0 1 0 0 0 0 0 0 0 ELAINE MCINTOSH 230062 0 11417 0 0 0 9083 0 23126 0 273688 0 11417 0 ANN ALLEGRE 145199 0 0 0 0 0 4256 0 3639 0 153094 0 0 0 PART I, LINE 4B ELAINE MCINTOSH, CEO, IS AWARDED BENEFITS INCLUDING THE CHOICE OF MUTUAL FUNDS, LIFE INSURANCE, AND OTHER SIMILAR ASSETS. FOR 2010, AMOUNTS RELATING TO THIS PLAN WERE: DEPOSITS TO A CAPITAL ACCUMULATION ACCOUNT WITH 2-YEAR VESTING PERIOD: $ 15,832 THE INDUSTRIAL DEVELOPMENT AUTHORITY OF JACKSON COUNTY MISSOURI 521375404 46737CAR7 2005-08-17 7200000 SERIES 2005, BUILDING CONSTRUCTION FINANCE 0 0 0 1200000 7321474 254872 172855 7148619 2006 0 0 1 1 0 0 0 0 0 1 1 1 0 1 TRANSAMERICA OCCIDENTAL LIFE INS 1.080000000000 1 0 1 SCHEDULE K SUPPLENTAL INFORMATION THE PROJECT CONSISTS OF THE CONSTRUCTION, FURNISHING, AND EQUIPPING OF A HOSPICE INPATIENT FACILITY, WHICH IS A FREESTANDING CARE FACILITY FOR INDIVIDUALS WHO HAVE A LIMITED LIFE EXPECTANCY. CARE WILL BE PALLIATIVE AND WILL FOCUS ON ADDRESSING THE COMFORT NEEDS OF THE PATIENT, RATHER THAN CURATIVE. THE FACILITY IS DESIGNED TO PROVIDE MEDICAL AND NURSING CARE TO THE PATIENT, AS WELL AS EMOTIONAL SUPPORT OF THE PATIENT'S LOVED ONES. THE SITE IS LOCATED IN SOUTH CENTRAL KANSAS CITY, MISSOURI ON A 12-ACRE SITE, WHICH WAS PREVIOUSLY OCCUPIED BY AN ABANDONED NURSING HOME AND A RESIDENTIAL HOME. CONSTRUCTION OF THE PROJECT BEGAN IN 2005 AND WAS COMPLETED IN 2006. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT OF KANSAS CITY HOSPICE, INC. THE KANSAS CITY HOSPICE BOARD EXECUTIVE COMMITTEE REVIEWED THE 990 IN DETAIL ON OCTOBER 17, 2011, WITH THE PREPARER PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UPON ELECTION TO THE BOARD, MEMBERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST FORM. THE KCH BOARD EXECUTIVE COMMITTEE REVIEWS ALL FORMS WITH CONFLICTS. BOARD MEMBERS WILL ABSTAIN FROM PARTICIPATION IN PERTINENT DISCUSSION IF APPLICABLE WHEN CONFLICT OF INTEREST SITUATIONS ARISE. THE CONFLICT OF INTEREST FORM IS COMPLETED ANNUALLY BY ALL ONGOING BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S SALARY IS REVIEWED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS USING AN OUTSIDE COMPENSATION CONSULTANT. THE CEO AND DIRECTOR OF HUMAN RESOURCES DETERMINE THE COMPENSATION FOR OFFICERS AND KEY MANAGEMENT PERSONNEL (WITH THE EXCEPTION OF THE CEO POSITION ITSELF). THREE SOURCES OF MARKET DATA ARE USED WHICH SPECIALIZE IN THE HOSPICE AND HEALTCARE INDUSTRY. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 REQUESTS FOR INFORMATION ON FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE EVALUATED ON A CASE BY CASE BASIS BY THE ORGANIZATION'S MANAGEMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: ASSET TRANSFERS BETWEEN ENTITIES 97,778. TOTAL TO FORM 990, PART XI, LINE 5: 97,778. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: FORM 990, PART III, LINE 4A: KANSAS CITY HOSPICE HOMECARE PROGRAM: KANSAS CITY HOSPICE PROVIDES IN HOME (WHETHER IT BE A HOME, LONG TERM CARE FACILITY, ASSISTED LIVING FACILITY OR OTHER TYPE OF HOME) TO PATIENTS RESIDING IN 9 COUNTIES IN THE KANSAS CITY METROPOLITAN AREA. SPECIALLY TRAINED STAFF, OF MULTIPLE DISCIPLINES, HELPS PATIENTS AND THEIR LOVED ONES WITH THE CHALLENGES OF LIFE-THREATENING ILLNESSES. INPATIENT FACILITY HOSPICE HOUSE: IN APRIL OF 2006, KANSAS CITY HOSPICE OPENED THE FIRST INPATIENT HOSPICE FACILITY IN THE KANSAS CITY METROPOLITAN AREA. THE KANSAS CITY HOSPICE HOUSE PROVIDES THE COMFORTS OF HOME COUPLED WITH THE ADDITION OF EXPERTS AT THE PATIENT'S SIDE. THE 32-BED FACILITY ADDRESSES NOT ONLY MEDICAL AND NURSING CARE FOR PATIENTS FACING ADVANCED ILLNESSES, BUT ALSO EMOTIONAL AND SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES. THIS PROGRAM IS A SUPPLEMENT TO OUR HOMECARE PROGRAM IN THAT IT IS USED WHEN MEDICAL PROBLEMS ARE TOO SERIOUS TO MANAGE IN THE HOME SETTING. KANSAS CITY HOSPICE PALLIATIVE CARE PROGRAM: THE PALLIATIVE CARE PROGRAM IS LIKE OUR HOSPICE PROGRAM. AN INTERDISCIPLINARY TEAM FOCUSES ON SPECIALIZED MANAGEMENT OF PAIN AND OTHER SYMPTOMS. THE TEAM ADDRESSES EMOTIONAL NEEDS OF THE PATIENT AND FAMILY. ITS GOAL IS TO MAKE THE MOST OF THE REMAINING LIFE OF THE PATIENT. THE PROGRAM SERVES PEOPLE WHO HAVE LIFE-THREATENING ILLNESSES, BUT WHO WANT TO CONTINUE SEEKING CURATIVE TREATMENT OR WHO DO NOT WISH TO ELECT HOSPICE CARE. KANSAS CITY HOSPICE ALSO HAS A PALLIATIVE MEDICINE PROGRAM WHICH IS A PHYSICIAN SERVICE FOCUSING ON IMPROVING THE QUALITY OF LIFE FOR PATIENTS FACING LIFE-LIMITING ILLNESSES. THE PROGRAM ALSO ASSISTS PATIENTS' FAMILIES. CARE IS CONCENTRATED ON PREVENTING AND RELIEVING SUFFERING THROUGH TREATING PAIN AND SYMPTOMS AS WELL AS BY PROVIDING EMOTIONAL AND SPIRITUAL SUPPORT. ADDITIONAL SERVICES: IN 2009, SERVICES TO CHILDREN WERE EXPANDED THROUGH THE ADDITION OF GRIEF SUPPORT GROUP AND INDIVIDUAL COUNSELING PROGRAMS CALLED SOLACE HOUSE. KANSAS CITY HOSPICE FOUNDATION 9221 WARD PARKWAY SUITE 100 KANSAS CITY MO 64114 431724085 SUPPORT/FUNDRAISING MO 501(C)(3) LINE 11A, I N/A 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 KANSAS CITY HOSPICE FOUNDATION C 1890781 KANSAS CITY HOSPICE FOUNDATION R 97778