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.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HOSPICE & COMMUNITY CARE
Employer identification number
23-2122735
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
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(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 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
Provide the following information about the supported organization(s).
(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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2,270,458
2,129,567
2,215,435
2,258,121
2,291,727
11,165,308
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
2,270,458
2,129,567
2,215,435
2,258,121
2,291,727
11,165,308
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)..
25,129
6
Public support. Subtract line 5 from line 4.
11,140,179
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
2,270,458
2,129,567
2,215,435
2,258,121
2,291,727
11,165,308
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
537,388
459,656
693,652
443,310
347,156
2,481,162
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
62,660
43,904
41,083
19,255
46,138
213,040
11
Total support (Add lines 7 through 10).
13,859,510
12
Gross receipts from related activities, etc. (see instructions)
..................
12
137,502,797
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
80.380 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
77.920 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
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.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HOSPICE & COMMUNITY CARE
Employer identification number
23-2122735
Return Reference
Explanation
990 PART I LINE 6
HOSPICE & COMMUNITY CARE HAD AN AGGREGATE OF 936 VOLUNTEERS DURING 2013. THESE VOLUNTEERS SERVED IN MANY DIFFERENT ROLES INCLUDING: PATIENT/FAMILY VOLUNTEERS IN HOME HOSPICE, OUR INPATIENT UNITS AND NURSING HOMES; PET THERAPY; MUSIC SUPPORT; BEREAVEMENT SUPPORT; OFFICE SUPPORT; GREETING AND WELCOMING VISITORS; DEVELOPMENT AND FUNDRAISING; COMMUNITY RELATIONS AND EDUCATION; AND GROUNDS MAINTENANCE. THE ORGANIZATION ALSO HAD VOLUNTEER OPPORTUNITIES FOR TEENS TO PROVIDE COMPANIONSHIP TO PATIENTS IN BOTH OUR INPATIENT UNITS AND IN NURSING HOMES.
990 PART V LINES 7A &7B
DONOR WAS NOTIFIED THROUGH ACKNOWLEDGEMENT OF GIFT AND/OR TICKET OF THE TAX DEDUCTIBLE PORTION.
FORM 990, PART VI, SECTION A, LINE 2
DIRECTORS NEVIN COOLEY AND ROGER MOYER HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 7A
EPHRATA COMMUNITY HOSPITAL AND WELLSPAN HEALTH SHALL EACH BE PERMITTED TO APPOINT TWO PERSONS OF THEIR CHOOSING TO THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11
THE AUDIT COMMITTEE OF THE BOARD, ACTING ON BEHALF OF THE BOARD, DID A DETAILED REVIEW OF THE FORM 990 WITH MANAGEMENT. A COPY WAS DISTRIBUTED ELECTRONICALLY TO THE FULL BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
BOARD MEMBERS AND OFFICERS ARE REQUIRED TO COMPLETE A NEW CONFLICT OF INTEREST STATEMENT ON A YEARLY BASIS. THE POLICY IS REVIEWED ANNUALLY AT A BOARD MEETING. THE AUDIT COMMITTEE IS RESPONSIBLE FOR MONITORING AND ENFORCING COMPLIANCE WITH THE POLICY.
FORM 990, PART VI, SECTION B, LINE 15
A COMPENSATION COMMITTEE MADE UP OF BOARD MEMBERS MEETS AT LEAST ANNUALLY TO REVIEW AND APPROVE THE SALARIES FOR THE PRESIDENT/CEO AND ALL VICE PRESIDENTS. INDUSTRY BENCHMARKS ARE USED FOR COMPARISON PURPOSES.
FORM 990, PART VI, SECTION C, LINE 18
990 AVAILABLE UPON REQUEST TO THE ORGANIZATION'S FISCAL OFFICE.
FORM 990, PART VI, SECTION C, LINE 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED IN THE FISCAL OFFICE OF THE ORGANIZATION. COPIES OF SUCH DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G
NURSING: PROGRAM SERVICE EXPENSES 920. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 920. PHARMACY: PROGRAM SERVICE EXPENSES 1,965,104. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,965,104. EQUIPMENT: PROGRAM SERVICE EXPENSES 1,073,137. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,073,137. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 720,423. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 720,423. RETIREMENT PLAN FEES: PROGRAM SERVICE EXPENSES 34,161. MANAGEMENT AND GENERAL EXPENSES 5,008. FUNDRAISING EXPENSES 754. TOTAL EXPENSES 39,923. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 116,703. MANAGEMENT AND GENERAL EXPENSES 6,660. FUNDRAISING EXPENSES 612. TOTAL EXPENSES 123,975.
FORM 990, PART XI, LINE 9:
CHANGE IN VALUE OF GIFT ANNUITIES -7,813. CHANGE IN VALUE OF PERPETUAL TRUSTS 45,269. DISTRIBUTIONS FROM PERPETUAL TRUSTS 30,690.
SCHEDULE G PART III LINE 11
THE ORGANIZATION OPERATES A RAFFLE AVAILABLE TO THE GENERAL PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.