Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2050 Claire Court
 
Room/suite
City or town, state or country, and ZIP + 4
Glenview, IL60025
D Employer identification number

36-2996608
E Telephone number

G Gross receipts $ 31,773,234
F Name and address of principal officer:
JAMIE O'MALLEY
2050 Claire Court
Glenview,IL60025
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CARECENTER.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1978
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROMOTE INDEPENDENCE, WELLNESS, COMFORT AND QUALITY OF LIFE FOR THE CHRONICALLY AND SERIOUSLY ILL, AGING AND DYING IN OUR REGION THROUGH THE DELIVERY OF A COMPASSIONATE MEDICALLY EXCELLENT CONTINUUM OF PALLIATIVE AND HOSPICE CARE AND SUPPORTIVE SERVICES. CHARITY CARE AND UNCOMPENSATED CARE = $3,033,000.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 18
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 17
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 346
6 Total number of volunteers (estimate if necessary) .... 6 318
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,214,126 3,051,922
9 Program service revenue (Part VIII, line 2g) ......... 23,809,355 24,273,061
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 110,298 215,948
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -29,865 -42,060
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 28,103,914 27,498,871
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 17,616,781 17,339,121
16a Professional fundraising fees (Part IX, column (A), line 11e).... 100,318 77,667
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet743,300    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 7,726,116 8,062,858
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 25,443,215 25,479,646
19 Revenue less expenses. Subtract line 18 from line 12...... 2,660,699 2,019,225
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 26,087,853 29,278,907
21 Total liabilities (Part X, line 26)............ 3,214,068 4,097,684
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 22,873,785 25,181,223
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: TO PROMOTE INDEPENDENCE, WELLNESS, COMFORT AND QUALITY OF LIFE FOR THE CHRONICALLY AND SERIOUSLY ILL, AGING AND DYING IN OUR REGION THROUGH THE DELIVERY OF A COMPASSIONATE MEDICALLY EXCELLENT CONTINUUM OF PALLIATIVE AND HOSPICE CARE, HOME HEALTH AND SUPPORTIVE SERVICES. CHARITY CARE AND UNCOMPENSATED CARE = $3,033,000.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 18,531,150 including grants of $ 0 ) (Revenue $ 23,245,127 )
MIDWEST CARECENTER SERVES PATIENTS AND FAMILY MEMBERS IN 150 COMMUNITIES IN COOK AND LAKE COUNTIES THROUGH COMPREHENSIVE, COMPASSIONATE HOSPICE, PALLIATIVE CARE AND GRIEF SUPPORT SERVICES. IN 2010, 1,942 PATIENTS FACING THE END OF LIFE RECEIVED HOSPICE CARE, WHICH INVOLVES NURSING, MEDICAL MANAGEMENT, SOCIAL WORK, CHAPLAINCY AND VOLUNTEER SERVICES. BEREAVEMENT COUNSELING, IN THE FORM OF INDIVIDUALIZED AND GROUP SUPPORT, WAS PROVIDED TO APPROXIMATELY 300 ADULTS AND 100 YOUTH WHO WERE GRIEVING THE DEATH OF A LOVED ONE. TO SUPPORT THESE PROGRAMS, OVER 300 INDIVIDUALS PROVIDED 17,400 HOURS OF VOLUNTEER SERVICE THROUGH MIDWEST CARECENTER PATIENT CARE, OFFICE SUPPORT, FUNDRAISING, GOVERNANCE AND YOUTH OUTREACH SERVICES. (SEE SCHEDULE O)
4b (Code:   ) (Expenses $ 1,809,641 including grants of $ 0 ) (Revenue $ 1,027,934 )
PALLIATIVE CARE SERVICES PROVIDED MEDICAL CONSULTATIONS IN THE PALLIATION OF PAIN AND OTHER SYMPTOMS TO 1,416 PATIENTS.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 20,340,791
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part I.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
Yes
 
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II...........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III...............
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
Yes
 
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
63
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
346
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
18
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
17
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
IL
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
David Bruce
2050 Claire Court
Glenview,IL60025
(847) 467-7423
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) DAVID M TINGUE
DIRECTOR
 2 X           0 0 0
(2) KEVIN J SHRIER
DIRECTOR
 1 X           0 0 0
(3) WILLIAM E RACINE
DIRECTOR
 2 X           0 0 0
(4) DARLENE LANDSITTEL
DIRECTOR
 1 X           0 0 0
(5) ELAINE R KURCZEWSKI
DIRECTOR
 1 X           0 0 0
(6) HARRY JAFFE MD FACP
DIRECTOR
 1 X           0 0 0
(7) ELIZABETH S FOLEY
DIRECTOR
 2 X           0 0 0
(8) FRANK D CELLA
DIRECTOR
 1 X           0 0 0
(9) DIANE M BLAKE
DIRECTOR
 1 X           0 0 0
(10) SAMUEL KATZ MD
ASSOCIATE MEDICAL DIRECTOR
 40         X   134,642 0 13,858
(11) JAMIE M O'MALLEY
PRESIDENT & CEO - CURRENT YEAR
 40 X   X       52,185 0 1,917
(12) NANCY L O'MALLEY MD
ASSOCIATE MEDICAL DIRECTOR
 40         X   151,755 0 15,535
(13) LYNN KATTEN MD
ASSOCIATE MEDICAL DIRECTOR
 40         X   154,661 0 17,909
(14) JASON SOBEL MD
ASSOCIATE MEDICAL DIRECTOR
 40         X   152,091 0 24,463
(15) MAUREEN MCGILLY MD
ASSOCIATE MEDICAL DIRECTOR
 40         X   151,918 0 20,839
(16) ALAN M SMOOKLER MD
ASSISTANT MEDICAL DIRECTOR
 40       X     205,677 0 31,079
(17) DAVID C BRUCE
CHIEF FINANCIAL OFFICER
 40     X       167,337 0 18,423
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MARTHA L TWADDLE MD
CHIEF MEDICAL OFFICER
 40     X       252,420 0 18,776
(19) E DENNIS MURPHY MD FACP
DIRECTOR
 2 X           0 0 0
(20) M MEAD MONTGOMERY
CHAIRMAN
 7 X   X       0 0 0
(21) WILLIAM GRAHAM
DIRECTOR
 1 X           0 0 0
(22) THOMAS W HODSON
DIRECTOR
 1 X           0 0 0
(23) WILLIAM A GIFFORD JR
DIRECTOR
 2 X           0 0 0
(24) PETER D MORRIS
VICE CHAIRMAN & TREASURER
 3 X   X       0 0 0
(25) SCOTT F VENDER
SECRETARY
 3 X   X       0 0 0
(26) TODD R MILLER
DIRECTOR
 1 X           0 0 0
(27) MARY K SHEEHAN
PRESIDENT & CEO - PART YEAR
 40 X   X       172,585 0 7,558






1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,595,271 0 170,357
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet12
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
ADVACARE SYSTEMS
23838 NETWORK PLACE
CHICAGO,IL60673 		MEDICAL SERVICES 561,226
NORTH SHORE UNIV HEALTH SYSTEM
1301 CENTRAL STREET
EVANSTON,IL60202 		MEDICAL SERVICES 548,382
AMERICAN HOSPICE EQUIPMENT
2900 CHAMBLEE-TUCKER ROAD BLD 6 200
ATLANTA,GA30341 		MEDICAL EQUIPMENT SERVICES 297,024
NORTH SHORE UNIV HEALTH SYSTEM
9730 EAGLE WAY
CHICAGO,IL60678 		MEDICAL SERVICES 276,185
NORTHWESTERN LAKE FOREST HOSPITAL
75 REMITTANCE DRIVE 1951
CHICAGO,IL60675 		MEDICAL SERVICES 221,209
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet5
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 216,216
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		2,835,706
g Noncash contributions included in lines 1a-1f:$ 164,587
h Total. Add lines 1a-1f.......MediumBullet 3,051,922
Program Service Revenue Business Code
2a HOSPICE SERVICES PATIENT REVENUE   23,245,127 23,245,127    
b PALLIATIVE CARE SVCS PATIENT REVENUE   1,027,934 1,027,934    
c
d
e
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 24,273,061
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 220,677     220,677
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 4,184,546  
b Less: cost or other basis and sales expenses 4,189,275  
c Gain or (loss) -4,729 0
d Net gain or (loss)..........MediumBullet -4,729     -4,729
8a Gross income from fundraising events (not including
$ 216,216
of contributions reported on line 1c). See Part IV, line 18 ...
a 40,238
b Less: direct expenses ...b 82,138
c Net income or (loss) from fundraising events..MediumBullet -41,900   -41,900
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 2,790
b Less: direct expenses ...b 2,950
c Net income or (loss) from gaming activities...MediumBullet -160     -160
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 27,498,871 24,273,061 0 173,888
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 965,107 579,064 386,043  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 85,000   85,000  
7 Other salaries and wages 13,586,140 11,993,202 1,120,604 472,334
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 327,291 251,676 61,032 14,583
9 Other employee benefits ....... 1,244,762 945,309 274,016 25,437
10 Payroll taxes ........... 1,130,821 884,126 210,410 36,285
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 56,004   56,004  
c Accounting ........... 64,644 1,020 63,624  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 77,667 77,667
f Investment management fees ...... 7,470   7,470  
g Other .......... 2,248,138 1,981,572 253,981 12,585
12 Advertising and promotion .... 148,281 1,348 142,283 4,650
13 Office expenses ....... 2,655,524 2,369,733 242,332 43,459
14 Information technology ...... 300,138 54,822 221,369 23,947
15 Royalties .. 0      
16 Occupancy ........... 965,712 643,792 321,920  
17 Travel ............ 249,686 234,610 11,258 3,818
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 14,777 6,327 7,215 1,235
20 Interest ........... 1,299 649 650  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 866,849 23,790 843,059  
23 Insurance .............. 407,999 340,760 67,239  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a BAD DEBT 23,445 23,445    
b OTHER 52,892 5,546 20,046 27,300
c
d
e
f All other expenses 0 0 0 0
25 Total functional expenses. Add lines 1 through 24f 25,479,646 20,340,791 4,395,555 743,300
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		0      
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 90 1 90
2 Savings and temporary cash investments ....... 1,898,097 2 2,725,229
3 Pledges and grants receivable, net ......... 3,323,733 3 3,495,179
4 Accounts receivable, net ......... 3,230,276 4 2,767,796
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 142,060 7 45,300
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ............ 227,003 9 308,138
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 18,132,040
b Less: accumulated depreciation. ..... 10b 5,467,936 12,426,195 10c 12,664,104
11 Investments—publicly traded securities .......... 4,825,083 11 7,273,071
12 Investments—other securities. See Part IV, line 11 ......   12 0
13 Investments—program-related. See Part IV, line 11 ..   13 0
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 15,316 15 0
16 Total assets. Add lines 1 through 15 (must equal line 34)... 26,087,853 16 29,278,907
Liabilities 17 Accounts payable and accrued expenses . 2,712,909 17 3,337,196
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24 320,664
25 Other liabilities. Complete Part X of Schedule D..... 501,159 25 439,824
26 Total liabilities. Add lines 17 through 25..... 3,214,068 26 4,097,684
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 17,036,596 27 17,486,791
28 Temporarily restricted net assets ..... 2,943,221 28 4,779,384
29 Permanently restricted net assets ..... 2,893,968 29 2,915,048
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 22,873,785 33 25,181,223
34 Total liabilities and net assets/fund balances ..... 26,087,853 34 29,278,907
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
27,498,871
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
25,479,646
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
2,019,225
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
22,873,785
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
288,213
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
25,181,223
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID: 10000128
Software Version: v2010.1.0
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 2,899,102 3,292,235 2,745,944 4,214,126 3,051,922 16,203,329
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 27,703,774 29,244,924 25,855,676 23,809,355 24,273,061 130,886,790
3 Gross receipts from activities that are not an unrelated trade or business under section 513..           0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
6 Total. Add lines 1 through 5. 30,602,876 32,537,159 28,601,620 28,023,481 27,324,983 147,090,119
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           0
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.           0
c Add lines 7a and 7b.. 0 0 0 0 0 0
8 Public Support (Subtract line 7c from line 6.)           147,090,119
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6... 30,602,876 32,537,159 28,601,620 28,023,481 27,324,983 147,090,119
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 76,071 184,336 173,773 110,298 220,677 765,155
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 76,071 184,336 173,773 110,298 220,677 765,155
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.           0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)   20,513 56,245 57,580 43,028 177,366
13 Total support (Add lines 9, 10c, 11 and 12.). 30,678,947 32,742,008 28,831,638 28,191,359 27,588,688 148,032,640
14
Section C. Computation of Public Support Percentage
15
15
99.36 %
16
16
99.62 %
Section D. Computation of Investment Income Percentage
17
17
0.52 %
18
18
0.366 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
OTHER INCOME, SCHEDULE A, PART III, LINE 12, OTHER INCOME - 2006=NONE, 2007=$20,513, 2008=NONE, 2009=NONE, 2010=NONE, TOTAL=$20,513 GROSS INCOME FROM FUNDRAISING - 2006=NONE, 2007=NONE, 2008=$56,245, 2009=$57,580, 2010=$40,238, TOTAL=$154,063 GROSS INCOME FROM GAMING - 2006=NONE, 2007=NONE, 2008=NONE, 2009=NONE, 2010=$2,790, TOTAL=$2,790,
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
  		Employer identification number

36-2996608
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
  		Employer identification number

36-2996608
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
  		Employer identification number

36-2996608
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID: 10000128
Software Version: v2010.1.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$ 0
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? If "Yes," describe in Part IV ..........................
 
 
 
j
Total. lines 1c through 1i ...................................
0
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
0
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 3,188,719 2,727,523 2,154,865
b Contributions ........ 21,997 216,410 708,159
c Investment earnings or losses ... 289,373 271,623 -90,133
d Grants or scholarships ..... 0 0 0
e Other expenditures for facilities
and programs ........ 		55,564 26,837 45,368
f Administrative expenses .... 0 0 0
g End of year balance ...... 3,444,525 3,188,719 2,727,523
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet6.46 %
b
Permanent endowment: SchDMd Bullet84.63 %
c
Term endowment: SchDMd Bullet8.91 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,754,517 1,754,517
b Buildings ................   8,864,950 1,192,471 7,672,479
c Leasehold improvements ............   506,472 502,150 4,322
d Equipment ................   5,422,877 3,773,315 1,649,562
e Other .................   1,583,224   1,583,224
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 12,664,104
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
SUPPLEMENTAL RETIREMENT LIABILITY 439,824








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 439,824
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 27,498,871
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 25,479,646
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 2,019,225
4 Net unrealized gains (losses) on investments .......................... 4 288,213
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 25,486
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 313,699
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 2,332,924
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 28,007,936
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 288,213
b Donated services and use of facilities ......... 2b 143,028
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 85,294
e Add lines 2a through 2d ..................... 2e 516,535
3 Subtract line 2e from line 1..................... 3 27,491,401
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a 7,470
b Other (Describe in Part XIV): ........... 4b 0
c Add lines 4a and 4b....................... 4c 7,470
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 27,498,871
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 25,675,012
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a 143,028
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 59,808
e Add lines 2a through 2d...................... 2e 202,836
3 Subtract line 2e from line 1..................... 3 25,472,176
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 7,470
b Other (Describe in Part XIV): ............ 4b 0
c Add lines 4a and 4b....................... 4c 7,470
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 25,479,646
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Intended uses of endowment funds Schedule D, Part V, Line 4 THE ORGANIZATION USES THE ENDOWMENT FUNDS TO FUND A PORTION OF THE CHIEF MEDICAL DIRECTOR'S SALARY (ALLOWING TIME TO BE SPENT ON EDUCATIONAL PROGRAMS), FUND PALLIATIVE CARE EDUCATION PROGRAMS, FUND THE DEVELOPMENT AND BUILDING OF A HOSPICE INPATIENT PAVILION AND FUND VARIOUS OTHER PROGRAMS DESIGNATED BY THE DONORS (CHILDREN'S PROGRAMS, MUSIC THERAPY, MASSAGE THERAPY, ETC.)
FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 CARECENTER HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501 (A) OF THE IRC. THE ORGANIZATION HAS ADOPTED U.S. GAAP WITH RESPECT TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES AS OF JANUARY 1, 2009. A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAN NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. THE ADOPTION HAD NO EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. DUE TO ITS TAX-EXEMPT STATUS, THE ORGANIZATION IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE ORGANIZATION'S FORM 990 HAS NOT BEEN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE OR THE STATE OF ILLINOIS FOR THE LAST THREE YEARS. THE ORGANIZATION DOES NOT EXPECT THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE ORGANIZATION RECOGNIZES INTEREST AND/OR PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE. THE ORGANIZATION DID NOT HAVE ANY AMOUNTS ACCRUED FOR INTEREST AND PENALTIES AT DECEMBER 31, 2010 OR 2009.
Schedule D (Form 990) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
 
RONALD G SPAETH 		FUNDRAISING   No 250,000 77,667 172,333
Total .................right arrow 250,000 77,667 172,333
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
IL
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

COMFORT ZONE
(event type) 		(b) Event #2

GOLF OUTING
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 165,654 90,800   256,454
2 Less: Charitable
contributions . . . 		155,626 60,590   216,216
3 Gross income (line 1
minus line 2) . . . 		10,028 30,210 0 40,238
VerticalDirectExpenses 4 Cash prizes . . .       0
5 Non-cash prizes . .       0
6 Rent/facility costs . . 6,050 25,000   31,050
7 Food and beverages . . 33,027 4,967   37,994
8 Entertainment . . . 1,175     1,175
9 Other direct expenses . 6,734 5,185   11,919
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 82,138
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -41,900
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID: 10000128
Software Version: v2010.1.0
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) NANCY L O'MALLEY MD (i)
(ii)		 147,007
0 		4,748
0 		0
0 		4,686
0 		10,849
0 		167,290
0 		0
0
(2) LYNN KATTEN MD (i)
(ii)		 149,947
0 		4,714
0 		0
0 		6,170
0 		11,739
0 		172,570
0 		0
0
(3) JASON SOBEL MD (i)
(ii)		 147,158
0 		4,933
0 		0
0 		709
0 		23,754
0 		176,554
0 		0
0
(4) MAUREEN MCGILLY MD (i)
(ii)		 146,844
0 		5,074
0 		0
0 		6,324
0 		14,515
0 		172,757
0 		0
0
(5) ALAN M SMOOKLER MD (i)
(ii)		 199,342
0 		6,335
0 		0
0 		7,350
0 		23,729
0 		236,756
0 		0
0
(6) DAVID C BRUCE (i)
(ii)		 161,334
0 		6,003
0 		0
0 		6,955
0 		11,468
0 		185,760
0 		0
0
(7) MARTHA L TWADDLE MD (i)
(ii)		 252,420
0 		0
0 		0
0 		7,350
0 		11,426
0 		271,196
0 		0
0
(8) MARY K SHEEHAN (i)
(ii)		 122,585
0 		50,000
0 		0
0 		6,903
0 		655
0 		180,143
0 		0
0








Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Non-fixed payments Schedule J, Part I, Line 7 DURING 2010 THE ORGANIZATION PAID THREE TYPES OF BONUSES. THE FIRST WAS PAID TO MARY SHEEHAN, CEO FOR HER PERFORMANCE DURING 2009. THIS PAYMENT WAS MADE AFTER REVIEW BY THE CHAIRMAN AND OTHER MEMBERS OF THE BOARD OF DIRECTORS. THE SECOND PAYMENT WAS MADE TO DAVID BRUCE, CFO, FOR TAKING ON ADDITIONAL RESPONSIBILITIES WHILE THE ROLE OF THE CEO WAS VACANT. THIS PAYMENT WAS MADE WAS DETERMINED BY MARY SHEEHAN, CEO, THE CHAIRMAN, AND VICE-CHAIRMAN OF THE BOARD OF DIRECTORS. THE THIRD PAYMENTS WERE MADE TO THE ORGANIZATION'S SALARIED PHYSICIANS AND ADVANCED PRACTICE NURSES IN RECOGNITION OF THE INCREASED WORKLOAD THEY HAD OVER A SIGNIFICANT PERIOD OF TIME. THESE PAYMENTS WERE MADE AT THE RECOMMENDATION OF MANAGEMENT AND APPROVED BY THE INTERIM CEO.
QUESTIONS REGARDING COMPENSATION SCHEDULE J, PART I, LINES 1-2 THE ORGANIZATION DID NOT PROVIDE ANY OF THE BENEFITS LISTED ON LINE 1. THEREFORE, LINES 1-2 ARE NOT APPLICABLE AND HAVE BEEN INTENTIONALLY LEFT BLANK.
Schedule J (Form 990) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0
SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art .... X 3 8,100 OPINIONS OF EXPERTS
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		X 5,975 SELLING COST
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 12 136,362 MARKET VALUE
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ... X 2 1,239 SELLING COST
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( EVENT SUPPLIES ) X 11 3,363 COST
26 Other Right pointing arrow large image ( GIFT CERTIFICATES ) X 2 9,548 COST
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) 2010
Additional Data


Software ID: 10000128
Software Version: v2010.1.0
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Identifier Return Reference Explanation
PROGRAM SERVICE ACCOMPLISHMENTS - GENERAL INFORMATION FORM 990, PART III, LINE 4A (CONTINUED FROM FORM 990, PART III, LINE 4A) THE ORGANIZATION STRIVES TO ENSURE CONTINUED ACCESS TO SERVICES FOR ANYONE IN THE COMMUNITY. IN 2010, $2,300,000 OF FREE AND SUBSIDIZED CARE WAS PROVIDED THROUGH CHARITY CARE AND COMMUNITY-FUNDED, COMPLEMENTARY PROGRAMMING, WHICH INCLUDED MASSAGE, MUSIC SERVICES AND CULTURALLY SENSITIVE INITIATIVES. IN 2010, 25 HOSPICE PATIENTS RECEIVED MASSAGES TO RELIEVE SYMPTOMS AND PROVIDE THE COMFORT OF GENTLE HUMAN TOUCH. MUSIC-THANATOLOGISTS HELD 418 VIGILS TO BENEFIT A TOTAL OF 301 PATIENTS AND FAMILIES. MUSIC THERAPISTS PROVIDED 1,331 MUSIC THERAPY SESSIONS FOR 250 HOSPICE PATIENTS. ADDITIONALLY, THROUGH THE ORGANIZATION'S JEWISH CARE SERVICES PROGRAM, 546 PATIENTS RECEIVED HOSPICE CARE WITH AN EMPHASIS ON JEWISH CUSTOMS AND TRADITIONS. MIDWEST PALLIATIVE & HOSPICE CARECENTER, A COMMUNITY-BASED PROVIDER OF HOSPICE, PALLIATIVE CARE AND GRIEF SUPPORT SERVICES, IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. MIDWEST CARECENTER PROVIDES SERVICES TO ALL PATIENTS REGARDLESS OF RACE, COLOR, NATIONAL ANCESTRY, RELIGION, AGE, HANDICAPPING CONDITION, GENDER, SEXUAL ORIENTATION OR SOURCE OF PAYMENT. IN 2010, THE ORGANIZATION SERVED PATIENTS AND FAMILIES IN 150 COMMUNITIES IN COOK AND LAKE COUNTIES. MIDWEST CARECENTER OPERATES THE LARGEST NONPROFIT, NON-HOSPITAL-AFFILIATED HOSPICE IN THE CHICAGO AREA, AND IS RECOGNIZED AS A LEADER IN THE PROVISION OF HOSPICE CARE, PALLIATIVE MEDICINE, BEREAVEMENT SERVICES, AND EDUCATION IN END-OF-LIFE ISSUES AND PRACTICE BOTH LOCALLY AND NATIONALLY. IN RECOGNITION OF ITS LEADERSHIP ROLE, MIDWEST CARECENTER WAS AWARDED THE PRESTIGIOUS CIRCLE OF LIFE AWARD (2001) BY THE AMERICAN HOSPITAL ASSOCIATION FOR EXCELLENCE IN END-OF-LIFE CARE. MIDWEST CARECENTER OFFERS HOSPICE SERVICES FOR THE BENEFIT OF PATIENTS AND FAMILIES WHO ARE COPING WITH THE CHALLENGES OF A TERMINAL ILLNESS. THE ORGANIZATION'S GOALS ARE TO CARE FOR THE PATIENT AND FAMILY AS A WHOLE AND TO PROMOTE THE PATIENT'S DIGNITY AND QUALITY OF LIFE BY MANAGING SYMPTOMS, RELIEVING PAIN AND PROVIDING TOTAL PATIENT CARE. IN 2010, 1,942 PATIENTS RECEIVED HOSPICE CARE FROM MIDWEST CARECENTER PHYSICIANS, NURSES, SOCIAL WORKERS, CHAPLAINS AND VOLUNTEERS. THE ORGANIZATION FIRST EARNED ACCREDITATION FROM THE JOINT COMMISSION IN 1996, AND ITS HOSPICE SERVICES HAVE CONTINUOUSLY RECEIVED FULL ACCREDITATION IN SUBSEQUENT SURVEY VISITS, MOST RECENTLY IN JUNE 2011. IN ADDITION TO THE CORE HOSPICE SERVICES REQUIRED BY THE FEDERAL GOVERNMENT UNDER THE MEDICARE HOSPICE BENEFIT-NURSING, MEDICAL MANAGEMENT, SOCIAL WORK, SPIRITUAL CARE AND VOLUNTEER SERVICES-THE MIDWEST CARECENTER PATIENT BASE BENEFITED FROM ADDITIONAL COMPLEMENTARY THERAPIES, INCLUDING MASSAGE (25 IN 2010), MUSIC (1,331 SESSIONS IN 2010) AND MUSIC-THANATOLOGY (418 BEDSIDE VIGILS IN 2010). THESE SERVICES ARE PROVIDED AT NO ADDITIONAL COST TO THE PATIENT. THROUGH THE ORGANIZATION'S JEWISH CARE SERVICES PROGRAM, 546 PATIENTS RECEIVED HOSPICE CARE WITH AN EMPHASIS ON JEWISH CUSTOMS AND TRADITIONS. A PARTNERSHIP WITH THE JEWISH HEALING NETWORK OF CHICAGO HAS MADE IT POSSIBLE FOR MIDWEST CARECENTER TO OFFER MORE INFORMATION AND SUPPORT FOR THOSE WITH ADVANCED ILLNESS IN THE JEWISH COMMUNITY. ADDITIONALLY, TO IMPROVE ACCESS TO HOSPICE CARE AND PALLIATIVE MEDICINE FOR NON-ENGLISH-SPEAKING IMMIGRANT POPULATIONS, MIDWEST CARECENTER CONTINUED EFFORTS TO PROVIDE CULTURALLY-FOCUSED HOSPICE PROGRAMS DESIGNED TO SERVE SIGNIFICANT RUSSIAN- AND POLISH-SPEAKING POPULATIONS IN ITS SERVICE AREA. THROUGH ITS PALLIATIVE CARE SERVICES PROGRAM, MIDWEST CARECENTER SUPPORTS THE EFFECTIVE MEDICAL PRACTICE OF AREA PHYSICIANS BY PROVIDING CONSULTATIONS ON PAIN AND SYMPTOM MANAGEMENT FOR PATIENTS FACING SERIOUS, COMPLEX ILLNESS. IN 2010, 1,416 PATIENTS RECEIVED PALLIATIVE CARE CONSULTATIONS TO DEFINE, MANAGE AND COORDINATE HEALTHCARE GOALS AND PLANS. ON-SITE PALLIATIVE CARE CONSULTATIONS WERE PROVIDED TO PATIENTS WHO WERE HOSPITALIZED IN EIGHT AREA HOSPITALS. MIDWEST CARECENTER OFFERS COMMUNITY BEREAVEMENT SERVICES AT NO CHARGE TO THE PUBLIC. IN ADDITION TO INDIVIDUAL COUNSELING, GROUP SUPPORT, ARTISTIC AND EXPRESSIVE THERAPIES AND OTHER COUNSELOR-FACILITATED MODALITIES FOR FAMILY MEMBERS OF HOSPICE PATIENTS, THE ORGANIZATION OFFERS GRIEF SUPPORT SERVICES FREE TO ANY GRIEVING PERSON IN ITS SERVICE AREA. APPROXIMATELY 300 ADULTS AND 100 YOUTH RECEIVED BEREAVEMENT SERVICES IN 2010. MIDWEST CARECENTER ALSO CONTINUED ITS "NAVIGATING GRIEF" WORKSHOP IN 2010 TO HELP GRIEVING ADULTS FIND THEIR BEARINGS IMMEDIATELY AFTER A LOSS. THROUGH ITS FAMILIES WITH CHILDREN PROGRAM, MIDWEST CARECENTER COUNSELORS PROVIDED BEREAVEMENT COUNSELING TO MORE THAN 150 GRIEVING CHILDREN AND TEENS IN 2010. CAMPCARE, THE ORGANIZATION'S GRIEF SUPPORT SUMMER PROGRAM FOR YOUTH, OFFERED A TWO-DAY FAMILY GRIEF CAMP, AN OVERNIGHT CAMP, AND AN ADVENTURE CANOE TRIP, SERVING A TOTAL OF 52 CHILDREN AND TEENS (PRESCHOOL THROUGH HIGH SCHOOL) WHO WERE IMPACTED BY LOSS. AS PART OF THE ORGANIZATION'S EDUCATIONAL OUTREACH PROGRAMS IN 2010, BEREAVEMENT STAFF CONDUCTED TRAINING SESSIONS ABOUT CHILDREN'S GRIEF ISSUES FOR ALL SOCIAL WORK AND COUNSELING STAFF OF THE CHICAGO PUBLIC SCHOOL SYSTEM AT NO COST TO THE SCHOOLS. VOLUNTEERS ARE AN INTEGRAL FORCE IN ADVANCING THE MISSION OF THE ORGANIZATION THROUGH DIRECT CARE OR ADMINISTRATIVE SUPPORT. IN 2010, OVER 300 VOLUNTEERS PROVIDED 17,400 HOURS OF SERVICE THROUGH MIDWEST CARECENTER PATIENT CARE, OFFICE SUPPORT, FUNDRAISING, GOVERNANCE AND YOUTH OUTREACH SERVICES. DIRECT PATIENT CARE WAS PROVIDED TO 325 PATIENTS BY 134 VOLUNTEERS. IN ADDITION, 79 YOUNG VOLUNTEERS PARTICIPATED IN CARING KIDS IN ACTION, WHICH GIVES AREA YOUTH THE OPPORTUNITY TO SERVE ELDERLY INDIVIDUALS AND HOSPICE PATIENTS. THROUGH MIDWEST CARECENTER CHARITY CARE AND SUBSIDIZED PROGRAMS, SERVICES ARE PROVIDED TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. BECAUSE MIDWEST CARECENTER SERVES AN OLDER PATIENT BASE AS AN END-OF-LIFE PROVIDER, MOST OF ITS PATIENT SERVICES ARE PAID FOR BY MEDICARE. NONETHELESS, WHILE 93% OF PATIENTS WHO SOUGHT SERVICES FROM MIDWEST CARECENTER IN 2010 WERE COVERED BY GOVERNMENTAL PLANS OR BY PRIVATE INSURANCE, PATIENTS RECEIVED $2,300,000 OF FREE CARE OR SUBSIDIZED CARE UNDER THE PROGRAM. PATIENTS SEEKING HOSPICE AND PALLIATIVE CARE SERVICES WITHOUT GOVERNMENTAL OR PRIVATE INSURANCE QUALIFY FOR CHARITY CARE AND RECEIVE SERVICES FREE OF CHARGE. PATIENTS WITH INADEQUATE INSURANCE OR WITH OTHER FINANCIAL NEED RECEIVE CARE AT REDUCED RATES, BASED ON A SLIDING SCALE. DETERMINATION OF NEED IS BASED ON INDIVIDUALIZED ASSESSMENT OF ASSETS AND TOTAL COSTS FOR CARE; PRIMARY RESIDENCES ARE EXCLUDED FROM ASSETS.
PROGRAM SERVICE ACCOMPLISHMENTS - GENERAL INFORMATION FORM 990, PART III, LINE 4A PATIENTS ARE INFORMED OF THE AVAILABILITY OF FREE AND SUBSIDIZED CARE AT THEIR INITIAL REFERRAL FOR SERVICES; APPLICATION FORMS ARE INCLUDED WITH ADMISSIONS FORMS; AND ADMISSIONS STAFF ARE AVAILABLE TO ASSIST PATIENTS OR FAMILIES WITH COMPLETING THE APPLICATIONS. MIDWEST CARECENTER PROMOTES ITS CHARITY CARE AND SUBSIDIZED CARE PROGRAMS AGGRESSIVELY THROUGH ADVERTISING AND PROMOTIONAL MATERIALS. MIDWEST CARECENTER BUILDS RELATIONSHIPS WITH OTHER PROVIDERS TO ENHANCE HEALTHCARE SERVICES FOR PATIENTS AND FAMILIES IN ITS SERVICE AREA. THE ORGANIZATION CONTRACTED WITH EIGHT AREA HOSPITALS TO DELIVER HOSPICE CARE IN THE HOSPITAL SETTING AND PROVIDED CARE TO RESIDENTS OF MORE THAN 100 SENIOR CARE FACILITIES IN ITS SERVICE AREA. IN ADDITION, OUTREACH ACTIVITIES INCLUDED COLLABORATIONS WITH HOWARD BROWN HEALTH CENTER, CJE SENIORLIFE, HEARTLAND ALLIANCE AND RUSH UNIVERSITY MEDICAL CENTER TO PROVIDE HEALTHCARE AND RESOURCES FOR LESBIAN, GAY, BISEXUAL AND TRANSGENDERED OLDER ADULTS IN CHICAGO THROUGH "AGING AS WE ARE." CENTRAL TO THE MIDWEST CARECENTER MISSION ARE EDUCATION, TRAINING AND RESEARCH. THE ORGANIZATION SPONSORS AND CONDUCTS SEMINARS AND TRAINING SESSIONS, FREE OF CHARGE, ON A VARIETY OF TOPICS RELATED TO END-OF-LIFE CARE FOR MEDICAL PROFESSIONALS AND FOR MEMBERS OF THE GENERAL PUBLIC. OVER 3,000 HEALTHCARE PROFESSIONALS, STUDENTS AND COMMUNITY MEMBERS LEARNED ABOUT HOSPICE, ADVANCE DIRECTIVES, HOW TO HELP GRIEVING CHILDREN AND ADULTS, AND OTHER RELATED HEALTHCARE TOPICS IN 2010. EDUCATION AND RESEARCH IS LARGELY SUPPORTED THROUGH PATIENT REVENUES, WITH SOME GRANT SUPPORT. MIDWEST CARECENTER ALSO PARTICIPATES IN AN INTEGRATED FELLOWSHIP PROGRAM WITH RUSH UNIVERSITY MEDICAL CENTER AND JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY TO TRAIN PHYSICIANS TO DEMONSTRATE COMPETENCE IN SPECIALIST-LEVEL EXPERTISE IN PALLIATIVE CARE. IN 2009, THE PROGRAM WAS ACCREDITED BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION. MIDWEST CARECENTER ASSUMED THE FULL COST OF PLANNING AND ADMINISTRATIVE COSTS FOR TWO FELLOWS AND CONTRIBUTED HALF OF SALARY AND BENEFITS FOR EACH. FINALLY, TO ENSURE THAT ALL PATIENTS HAVE ACCESS TO AN EXCEPTIONAL LEVEL OF CARE NOW AND IN THE YEARS AHEAD, MIDWEST CARECENTER LAUNCHED THE KEEPING OUR PROMISE CAMPAIGN IN 2009. THE $18-MILLION CAPITAL AND ENDOWMENT CAMPAIGN INCLUDES PLANS TO BUILD AN INPATIENT HOSPICE PAVILION AND CREATE A HEALING GARDEN ON ITS GLENVIEW CAMPUS AS WELL AS SECURE AN ENDOWMENT TO ENSURE QUALITY END-OF-LIFE CARE FOR FUTURE GENERATIONS. LEAD NAMING GIFTS WERE SECURED: THE MARSHAK FAMILY INPATIENT PAVILION AND THE WAUD FAMILY HEALING GARDEN.
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b PRIOR TO FILING THE RETURN WITH THE IRS, A DRAFT OF THE COMPLETED FORM 990 IS REVIEWED BY THE ORGANIZATION'S FINANCE COMMITTEE. AFTER REVIEW, COPIES OF THE FINAL FORM 990 ARE DISTRIBUTED TO THE FULL BOARD FOR REVIEW AND APPROVAL. SUBSEQUENT TO THE BOARD'S APPROVAL THE RETURN IS FILED WITH THE IRS.
Conflict of interest policy Form 990, Part VI, Section B, Line 12c ANNUALLY, THE ORGANIZATION REQUIRES ALL INTERESTED PERSONS TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST. THE CHIEF FINANCIAL OFFICER THEN REVIEWS THE POTENTIAL OR ACTUAL CONFLICTS TO DETERMINE IF AN ACTUAL CONFLICT OF INTEREST EXISTS. ADDITIONALLY, ANY POSSIBLE CONFLICT OF INTEREST OF ANY DIRECTOR (OR MEMBER OF THE DIRECTOR'S IMMEDIATE FAMILY) SHALL BE FULLY DISCLOSED TO THE OTHER DIRECTORS AND MADE A MATTER OF RECORD. WHEN ANY POSSIBLE CONFLICT OF INTEREST BECOMES RELEVANT TO ANY MATTER REQUIRING BOARD OF DIRECTORS OR COMMITTEE ACTION, THE DIRECTOR SHALL NOT VOTE ON THE MATTER, SHALL NOT USE PERSONAL INFLUENCE IN CONNECTION WITH THE MATTER, AND SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. HOWEVER, THE DIRECTOR MAY BRIEFLY STATE THE DIRECTOR'S POSITION IN THE MATTER AND ANSWER PERTINENT QUESTIONS WHEN THE DIRECTOR'S KNOWLEDGE OF THE MATTER WILL ASSIST THE BOARD OR COMMITTEE. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, AND THAT THE INTERESTED DIRECTOR ABSTAINED FROM VOTING AND WAS NOT COUNTED IN DETERMINING THE QUORUM FOR THE MEETING. THIS POLICY SHALL ALSO APPLY TO ANY PERSON, OTHER THAN A DIRECTOR, WHO IS SERVING AS A MEMBER OF A BOARD COMMITTEE. A CONFLICT OF INTEREST ARISES WHEN A DIRECTOR, OFFICER, OR MANAGEMENT EMPLOYEE HOLDS A DIRECT OR INDIRECT FINANCIAL INTEREST IN OR WILL RECEIVE A BENEFIT FROM A BUSINESS FURNISHING GOODS OR SERVICES TO CARECENTER. A DIRECT FINANCIAL INTEREST IS THE RECEIPT OF REMUNERATION OF ANY SORT. AN INDIRECT FINANCIAL INTEREST EXISTS IF A DIRECTOR, OFFICER, OR MANAGEMENT EMPLOYEE, OR A MEMBER OF HIS/HER IMMEDIATE FAMILY, HAS A MATERIAL FINANCIAL INTEREST IN, OR A SUBSTANTIAL BUSINESS RELATIONSHIP WITH, OR IS AN OFFICER, DIRECTOR, OR GENERAL PARTNER OF A PERSON OR ENTITY TRANSACTING BUSINESS WITH CARECENTER. IT IS PERMISSIBLE FOR A DIRECTOR, OFFICER, OR STAFF TO BE A DIRECT OR INDIRECT PARTY TO A TRANSACTION WHICH MIGHT CREATE THE APPEARANCE OF A CONFLICT OF INTEREST IF THE ABOVE DISCLOSURE AND OTHER REQUIREMENTS ARE MET AND IF THE TRANSACTION IS FAIR AS DETERMINED BY THE BOARD.
Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE EXECUTIVE COMMITTEE (AN INDEPENDENT GROUP OF BOARD MEMBERS) REVIEWS AND APPROVES THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL AT LEAST ANNUALLY. THE LAST REVIEW WAS COMPLETED SEPTEMBER 2010 AND THE PRIOR REVIEW WAS COMPLETED JANUARY 2010. THE REVIEW BY THE EXECUTIVE COMMITTEE INCLUDES INFORMATION PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS AND SURVEYS AND IS DOCUMENTED ON A TIMELY BASIS. THE COMPENSATION ARRANGEMENT FOR THE TOP MANAGEMENT OFFICIAL IS DOCUMENTED IN A WRITTEN EMPLOYMENT CONTRACT.
Public Disclosure Form 990, Part VI, Section C, Line 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. THE ORGANIZATION INCLUDES ITS ANNUAL REPORT ON ITS WEBSITE THAT IS AVAILABLE TO THE PUBLIC.
COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES FORM 990, PART VI, LINE 15B USING THE DATA PROVIDED BY A COMPENSATION CONSULTANT AND INPUT FROM THE ORGANIZATION'S VICE PRESIDENT OF HUMAN RESOURCES, THE CEO CONDUCTED ANNUAL PERFORMANCE REVIEWS OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES. THE RESULTS OF THE PERFORMANCE REVIEWS ARE THE BASIS FOR THE DETERMINATION OF THE OTHER OFFICERS AND KEY EMPLOYEES' COMPENSATION PACKAGES AND ANY ADJUSTMENTS TO ESTABLISHED AMOUNTS. IN 2010 A SUBCOMMITTEE OF THE ORGANIZATION'S BOARD REVIEWED AND APPROVED THE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES.
Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 288213;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID: 10000128
Software Version: v2010.1.0
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
MIDWEST PALLIATIVE & HOSPICE CARECENTER
 
Employer identification number

36-2996608
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) PCCNS PRIVATE CARE INC
2050 CLAIRE COURT
GLENVIEW,IL60025
36-4218039 		PRIVATE CARE SERVICES IL NA
  		C CORPORATION 206 15,847 100 %












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID: 10000128
Software Version: v2010.1.0