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 OF SPOKANE
Employer identification number
91-0995069
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.") ....
873,837
796,506
779,220
699,301
1,229,063
4,377,927
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
873,837
796,506
779,220
699,301
1,229,063
4,377,927
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)..
49,941
6
Public support. Subtract line 5 from line 4.
4,327,986
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..
873,837
796,506
779,220
699,301
1,229,063
4,377,927
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
52,181
64,418
137,409
136,355
241,795
632,158
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.)..
24,590
39,090
-2,065
3,168
14,685
79,468
11
Total support (Add lines 7 through 10).
5,089,553
12
Gross receipts from related activities, etc. (see instructions)
..................
12
87,664,541
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
85.040 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
83.600 %
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 OF SPOKANE
Employer identification number
91-0995069
Return Reference
Explanation
FORM 990, PAGE 2, PART III, LINE 2
IN KEEPING WITH OUR MISSION, HOSPICE OF SPOKANE, DOING BUSINESS AS, SPOKANE PALLIATIVE CARE, CONTINUED THE PROVIDING PALLIATIVE CARE CONSULTATIONS TO 233 PATIENTS IN 2013. THE PROGRAM INTRODUCED IN 2012 EXPANDED COMMUNITY OFFERINGS PROVIDING NEEDED SERVICES TO INDIVIDUALS WITH LIFE-LIMITING DISEASES SUCH AS CANCER OR ADVANCED HEART, LUNG, HEPATIC, RENAL AND/OR NEUROLOGICAL CONDITIONS WHO ARE NOT HOSPICE-ELIGIBLE. A PALLIATIVE CARE- CERTIFIED INTERDISCIPLINARY TEAM CONSISTING OF MD, ARNP, RN, MSW, CHAPLAIN AND BEREAVEMENT COUNSELORS ARE AVAILABLE AT THE REFERRAL OF THE PATIENT'S PRIMARY CARE PROVIDER (PCP). THESE SERVICES ARE AVAILABLE MONDAY-FRIDAY 8A-5P (HOLIDAYS EXCLUDED) AND ARE OVERSEEN BY OUR MEDICAL DIRECTOR. SERVICES ARE DELIVERED IN THE SETTING THE CLIENT CALLS HOME (PRIVATE RESIDENCE, EXTENDED CARE FACILITY, ETC.) AND IN DEACONESS AND VALLEY HOSPITALS, ASSISTING THE PATIENT'S PCP WITH ACHIEVING IMPROVED ADHERENCE TO TREATMENT PLANS, ASSISTING IN OPTIMAL SYMPTOM CONTROL AND IMPROVING QUALITY OF LIFE. WE WORK CLOSELY WITH THE PALLIATIVE CARE TEAM AT SACRED HEART AND HOLY FAMILY HOSPITALS AS WELL. THE SERVICES ARE CONSULTATIVE UPON THE PCP'S ORDER FOR COLLABORATION, CO-MANAGEMENT OR INITIATION OF THERAPEUTIC INTERVENTIONS. SERVICES DO NOT INCLUDE CHRONIC DISEASE MANAGEMENT OR CHRONIC PAIN MANAGEMENT FOR PATIENTS WITHOUT LIFE-LIMITING ILLNESS.
FORM 990, PAGE 2, PART III, LINE 4A
HOSPICE OF SPOKANE SERVED 2,010 UNDUPLICATED CLIENTS IN 2013, PROVIDING 99,599 DAYS OF ROUTINE HOME CARE, 3,226 DAYS OF ACUTE INPATIENT CARE, 175 DAYS OF RESPITE CARE AND 2 DAYS OF CONTINUOUS CARE FOR THE YEAR ENDED DECEMBER 31, 2013. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 15,569 FOR CHARITY CARE, 289,027 FOR MEDICARE (INCLUDES SEQUESTRATION 2% PAYMENT REDUCTIONS), 62,413 FOR MEDICAID AND 118,027 FOR OTHER THIRD-PARTY PAYERS FOR THE YEAR ENDED DECEMBER 31, 2013. IN KEEPING WITH ITS MISSION, HOSPICE OF SPOKANE CONTINUED OFFERINGS EXPANDED TO THE COMMUNITY IN 2012 BY PROVIDING PALLIATIVE CARE CONSULTATION TO NON-HOSPICE INDIVIDUALS WITH LIFE-LIMITING DISEASES DOING BUSINESS AS SPOKANE PALLIATIVE CARE. 233 PATIENTS WERE SERVED BY THE PALLIATIVE CARE CERTIFIED INTERDISCIPLINARY TEAM, ACHIEVING IMPROVED ADHERENCE TO TREATMENT PLANS, ASSISTING IN OPTIMAL SYMPTOM CONTROL AND IMPROVING QUALITY OF LIFE DESPITE LIFE-LIMITING ILLNESS. IN JANUARY OF 2013, HOSPICE OF SPOKANE FURTHER EXPANDED OUR PALLIATIVE CARE SERVICES TO INCLUDE PRIMARY CARE FOR INDIVIDUALS WHO HAVE DIFFICULTY GETTING TO AND FROM A PRIMARY CARE PROVIDER. DOING BUSINESS AS MOBILE MEDICINE OF SPOKANE, THIS CARE IS PROVIDED BY TWO ARNPS WITH COLLABORATION AND GUIDANCE OF OUR MEDICAL DIRECTOR. IN 2013, 386 PATIENTS WERE SERVED THROUGH MOBILE MEDICINE OF SPOKANE. THERE CONTINUES TO BE MORE DEMAND THAN WE CURRENTLY HAVE CAPACITY FOR. THIS IS A MUCH-NEEDED PRIMARY PALLIATIVE CARE SERVICE, FOCUSED ON BRINGING PRIMARY CARE TO INDIVIDUALS IN ASSISTED LIVING AND ADULT FAMILY HOMES.
FORM 990, PAGE 2, PART III, LINE 4B
AND THEIR FAMILIES.
FORM 990, PAGE 6, PART VI, LINE 11B
A COPY OF THE 990 IS PROVIDED TO THE CEO AND THE DIRECTOR OF FINANCE, WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS, ALONG WITH THE HOSPICE OF SPOKANE BOARD FINANCE COMMITTEE. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL APPROVAL IS GIVEN TO THE PREPARER BEFORE FINALIZING THE RETURN. THE CEO SIGNS OFF ON THE FORM 8879-EO BEFORE THE RETURN IS E-FILED BY THE PREPARER.
FORM 990, PAGE 6, PART VI, LINE 12C
NEW EMPLOYEES, VOLUNTEERS, AND TRUSTEES RECEIVE, REVIEW, AND SIGN THE CONFLICT OF INTEREST POLICY DURING ORIENTATION. THE POLICY IS INCLUDED IN THE EMPLOYEE HANDBOOK RECEIVED BY ALL STAFF. ONGOING ENFORCEMENT OCCURS VIA ROUTINE EDUCATION AND DISCUSSION AT VARIOUS TEAM MEETINGS AND AT ALL STAFF MEETINGS. CHART AUDITS, QUALITY ASSURANCE PERFORMANCE IMPROVEMENT QUARTERLY REVIEWS, SUPERVISORY VISITS, CARE CONFERENCES, AND SELF REPORTING ALLOW FOR CONTINUED MONITORING. IF AN ISSUE ARISES, THE SITUATION IS INVESTIGATED AND DISCIPLINARY PROCESSES ARE IMPLEMENTED ACCORDING TO THE POLICY, IF NECESSARY.
FORM 990, PAGE 6, PART VI, LINE 15A
COMPETITIVE WAGE INFORMATION IS OBTAINED THROUGH A CONSULTANT, ONLINE DATA, THROUGH PARTICIPATION IN AN INDUSTRY SURVEY, AND OTHER SIMILAR ORGANIZATIONS' IRS FORM 990. THE EXECUTIVE COMMITTEE (MADE UP OF THE OFFICERS OF THE BOARD OF TRUSTEES) REVIEWS THE COMPENSATION DATA AND MAKES A RECOMMENDATION TO THE BOARD OF TRUSTEES FOR THE CEO COMPENSATION. THE BOARD OF TRUSTEES MUST THEN APPROVE AND DOCUMENT THE COMPENSATION AND NOTIFY HUMAN RESOURCES.
FORM 990, PAGE 6, PART VI, LINE 15B
COMPETITIVE WAGE INFORMATION IS OBTAINED THROUGH A CONSULTANT, ONLINE DATA, THROUGH PARTICIPATION IN AN INDUSTRY SURVEY, AND OTHER SIMILAR ORGANIZATIONS' IRS FORM 990. THE CEO USES THE COMPENSATION DATA OBTAINED TO MAKE COMPENSATION DECISIONS FOR OTHER OFFICERS AND EMPLOYEES.
FORM 990, PAGE 6, PART VI, LINE 19
HOSPICE OF SPOKANE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G
CONTRACT SERVICES & PRO FEES 1,784,566 68,460 6,757
FORM 990, PART XI, LINE 9
CHANGE IN BENEFICIAL INTEREST IN TRUSTS 39,237
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.