Form990
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 private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 07-01-2013 , 2013, and ending 06-30-2014
BCheck if applicable:
CName of organization
HOSPICE OF CENTRAL IOWA
 
Doing Business As
HCI CARE SERVICES
 
Number and street (or P.O. box if mail is not delivered to street address)
2910 Westown Parkway
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
West Des Moines, IA502661332
D Employer identification number

42-1093718
E Telephone number

G Gross receipts $ 17,442,283
F Name and address of principal officer:
NORENE MOSTKOFF
2910 Westown Parkway
West Des Moines,IA502661332
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HCI-VNS.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
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: IA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: HCI CARE SERVICES' MISSION IS "PROMOTING DIGNITY, INDEPENDENCE AND QUALITY OF LIFE THROUGH COMPASSIONATE AND EFFECTIVE COMMUNITY BASED CARE."
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 206
6 Total number of volunteers (estimate if necessary) ............. 6 808
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) ......... 1,120,124 1,267,765
9 Program service revenue (Part VIII, line 2g) ......... 17,166,087 14,155,098
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 323,471 396,959
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 392,117 348,974
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 19,001,799 16,168,796
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 385,067 14,945
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) 11,642,532 9,000,518
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet53,581    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 8,010,715 7,456,595
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 20,038,314 16,472,058
19 Revenue less expenses. Subtract line 18 from line 12....... -1,036,515 -303,262
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 22,945,392 24,693,502
21 Total liabilities (Part X, line 26)............. 3,652,533 3,552,852
22 Net assets or fund balances. Subtract line 21 from line 20..... 19,292,859 21,140,650
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 Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: HCI CARE SERVICES PROVIDES END-OF-LIFE CARE FOR INDIVIDUALS AND FAMILIES LIVING WITH A SERIOUS ILLNESS. THESE SERVICES PROVIDE PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL CARE FOR PATIENTS WITH A LIMITED LIFE EXPECTANCY. (CONTINUED IN SCHEDULE O)
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 organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 13,196,090 including grants of $ 14,945 ) (Revenue $ 14,161,923 )
DONOR SUPPORT HELPS ENSURE ALL WHO NEED HCI CARE SERVICES' CARE RECEIVE IT. FROM JULY 1, 2013, THROUGH JUNE 30, 2014, QUALIFYING HCI CARE SERVICES PATIENTS IN NEED RECEIVED CHARITY CARE AT AN ESTIMATED COST OF APPROXIMATELY $197,000. HCI CARE SERVICES ALSO RECEIVES SIGNIFICANT IN-KIND DONATIONS OF TIME AND EFFORT THROUGH ITS VOLUNTEERS. IN THE YEAR ENDING JUNE 30, 2014, MORE THAN 800 VOLUNTEERS DONATED 17,241 VOLUNTEER HOURS, EQUAL TO $368,784 IN VALUE TO THE ORGANIZATION. (CONTINUED IN SCHEDULE O)
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet13,196,090
Form 990 (2013)
Form 990 (2013)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? 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 for which 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 for escrow or custodial account liability; 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 temporarily restricted endowments, permanent endowments, 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, line 10?
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 VIIClick to see attachment.......
11b
Yes
 
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 XClick 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 XClick 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 and XII Click to see attachment.................
12a
Yes
 
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 and XII 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, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 I (see instructions)....
17
 
No
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............
18
 
No
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
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government 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 or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II.................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? 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 direct or indirect 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 M..Click 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.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
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........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, 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...
35b
 
No
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
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
 
 
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
206
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” to line 3b, 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, securities account, or other financial 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 as charitable contributions?...
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
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
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 or note to any line 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
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
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
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete 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 this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, 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," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletKelly Dennis2910 Westown Parkway Suite 200West Des MoinesIA50266 (515) 274-3400
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) ANN JEFFRIES........................................................................
Board Treasurer
 1.00
.......................2.00 		X   X       0 0 0
(2) JOHN PITTMAN........................................................................
Board Secretary
 1.00
.......................2.00 		X   X       0 0 0
(3) KIM WILLIS........................................................................
Board Chair
 1.00
.......................2.00 		X   X       0 0 0
(4) BRAD WYCKOFF........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(5) CONNIE ISAACSON........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(6) DEBRA MILLIGAN........................................................................
Director
 1.00
.......................1.00 		X           0 0 0
(7) GARY HOFF........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(8) GEMECHISA MOSA........................................................................
Director (Term ended 9/2013)
 1.00
.......................1.00 		X           0 0 0
(9) JOHN PAULE........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(10) JUDITH RALSTON-HANSEN........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(11) KATIE TURNER........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(12) KENT MAUCK........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(13) MARK BEERMAN........................................................................
Director (Term ended 9/2013)
 1.00
.......................2.00 		X           0 0 0
(14) MATTHEW MEYER........................................................................
Director
 1.00
.......................1.00 		X           0 0 0
(15) NICK HENDERSON........................................................................
Director (Term Ended 9/2013)
 1.00
.......................2.00 		X           0 0 0
(16) PRISCILLA RUHE........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(17) REBECCA PURNELL........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
Form 990 (2013)
Form 990 (2013)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) RYAN RILEY........................................................................
Director
 1.00
.......................2.00 		X           0 0 0
(19) SALLY REAVELY........................................................................
Director (Term ended 9/2013)
 1.00
.......................2.00 		X           0 0 0
(20) KELLY DENNIS........................................................................
Vice President & CFO
 20.58
.......................19.42 		    X       0 144,079 16,322
(21) NORENE MOSTKOFF........................................................................
President & CEO
 20.58
.......................19.42 		    X       0 254,952 31,510
(22) TRAY WADE........................................................................
Senior Vice President & COO
 20.58
.......................19.42 		    X       0 130,001 17,242
(23) THOMAS MOUSER........................................................................
Chief Medical Officer
 40.00
.......................0 		      X     195,486 0 31,610














1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 195,486 529,032 96,684
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
HCI VNS CARE SERVICES2910 WESTOWN PARKWAY SUITE 200WEST DES MOINESIA50266 ADMINISTRATIVE OVERHEAD SUPPORT 1,398,730
CONSOLIDATED MANAGEMENT2670 106TH ST STE 140DES MOINESIA50322 CONTRACTED FOOD SERVICE 156,280
MAXIM HEALTHCARE SERVICES INC12558 COLLECTIONS CENTER DRIVECHICAGOIL60693 CONTRACTED RN AND AIDE SERVICES 104,706
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet3
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 298,260
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 521,942
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		447,563
g Noncash contributions included in lines
1a-1f:$ 		1,999
h Total. Add lines 1a-1f.......MediumBullet 1,267,765
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 621610 14,155,098 14,155,098    
b     0      
c     0      
d     0      
e     0      
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 14,155,098
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 166,510     166,510
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 1,503,936  
b Less: cost or other basis and sales expenses 1,273,487  
c Gain or (loss) 230,449 0
d Net gain or (loss)..........MediumBullet 230,449     230,449
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 339,418
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 339,418     339,418
Miscellaneous Revenue Business Code
11a EDUCATION/INSTITUTE REVENUE 611710 6,825 6,825    
b     0      
c     0      
d All other revenue .... 2,731 0 0 2,731
e Total. Add lines 11a–11d ...... MediumBullet 9,556
12 Total revenue. See Instructions......MediumBullet 16,168,796 14,161,923 0 739,108
Form 990 (2013)
Form 990 (2013)
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).Check if Schedule O contains a response or note to any line in this Part IX ...............
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 United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 14,945 14,945
3 Grants and other assistance to governments, organizations, and individuals outside the United States. 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 .... 227,096 227,096    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 7,173,997 6,397,889 776,108  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 178,634 169,482 9,152  
9 Other employee benefits ....... 825,496 549,481 276,015  
10 Payroll taxes ........... 595,295 482,818 112,477  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 27,192   27,192  
c Accounting ........... 5,440   5,440  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 920,666 798,108 122,558 0
12 Advertising and promotion .... 161,876 93,742 55,242 12,892
13 Office expenses ....... 244,431 199,545 44,886  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 488,460 431,013 57,447  
17 Travel ............ 392,454 375,912 16,542  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 21,153 20,295 858  
20 Interest ........... 46,627   46,627  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 681,584 439,140 242,444  
23 Insurance .............. 0      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a CONTRACTED FACILITY AND ROOM AND BOARD 1,539,210 1,539,210    
b BAD DEBT EXPENSE 43,300 43,300    
c MEMBERSHIP DUES 12,051 5,017 7,034  
d PHARMACY AND DIRECT PATIENT SUPPLIES 1,385,661 1,385,661    
e All other expenses 1,486,490 23,436 1,422,365 40,689
25 Total functional expenses. Add lines 1 through 24e 16,472,058 13,196,090 3,222,387 53,581
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 1,525 1 1,825
2 Savings and temporary cash investments ......... 200,187 2 326,625
3 Pledges and grants receivable, net ........... 127,795 3 131,034
4 Accounts receivable, net ............. 2,106,225 4 2,243,019
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
11,538 5 1,548
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges .......... 118,717 9 79,328
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 13,796,457
b Less: accumulated depreciation ..... 10b 6,036,701 8,356,858 10c 7,759,756
11 Investments—publicly traded securities .......... 4,479,248 11 5,017,568
12 Investments—other securities. See Part IV, line 11 ..... 5,870,661 12 8,102,026
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 1,672,638 15 1,030,773
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 22,945,392 16 24,693,502
Liabilities 17 Accounts payable and accrued expenses ......... 1,535,318 17 1,390,835
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 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 2,117,215 23 1,474,932
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 0 25 687,085
26 Total liabilities. Add lines 17 through 25......... 3,652,533 26 3,552,852
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 12,971,663 27 12,894,495
28 Temporarily restricted net assets ........... 6,321,196 28 8,246,155
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 19,292,859 33 21,140,650
34 Total liabilities and net assets/fund balances ........ 22,945,392 34 24,693,502
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
16,168,796
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
16,472,058
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-303,262
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
19,292,859
5
Net unrealized gains (losses) on investments ...............
5
291,447
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
1,859,606
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
21,140,650
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 13000248
Software Version: 2013v3.1
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.
right arrow 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 CENTRAL IOWA
 
Employer identification number

42-1093718
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 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) right arrow (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 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
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.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
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) right arrow (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.") . 963,858 996,722 1,099,225 1,120,124 1,267,765 5,447,694
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...... 19,633,210 20,396,394 19,140,361 17,166,087 14,155,098 90,491,150
3 Gross receipts from activities that are not an unrelated trade or business under section 513.. 900 224,169 359,255 216,560 342,149 1,143,033
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. 20,597,968 21,617,285 20,598,841 18,502,771 15,765,012 97,081,877
7a Amounts included on lines 1, 2, and 3 received from disqualified persons... 0 0 0 0 0 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 0 0 0 0 0
c Add lines 7a and 7b.. 0 0 0 0 0 0
8 Public support (Subtract line 7c from line 6.) 97,081,877
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6... 20,597,968 21,617,285 20,598,841 18,502,771 15,765,012 97,081,877
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 152,787 145,103 136,899 118,904 166,510 720,203
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 152,787 145,103 136,899 118,904 166,510 720,203
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.) .. 26,986 33,737 31,059 175,557 6,825 274,164
13 Total support. (Add lines 9, 10c, 11, and 12.).. 20,777,741 21,796,125 20,766,799 18,797,232 15,938,347 98,076,244
14
Section C. Computation of Public Support Percentage
15
15
98.980 %
16
16
99.020 %
Section D. Computation of Investment Income Percentage
17
17
0.730 %
18
18
0.720 %
19a
b
20
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: 13000248
Software Version: 2013v3.1
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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
HOSPICE OF CENTRAL IOWA
 
Employer identification number

42-1093718
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 on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
HOSPICE OF CENTRAL IOWA
  		Employer identification number

42-1093718
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
HOSPICE OF CENTRAL IOWA
  		Employer identification number

42-1093718
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
HOSPICE OF CENTRAL IOWA
  		Employer identification number

42-1093718
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(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) (2013)

Additional Data


Software ID: 13000248
Software Version: 2013v3.1
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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HOSPICE OF CENTRAL IOWA
 
Employer identification number

42-1093718
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 (ASC 958) 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 5,379,485 4,855,151 4,425,852 3,067,985 2,425,658
b Contributions ........     441,614 944,366 369,223
c Net investment earnings, gains, and losses 852,603 642,926 164,926 720,857 296,439
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		266,026 118,592 177,241 307,356 23,335
f Administrative expenses ....          
g End of year balance ...... 5,966,062 5,379,485 4,855,151 4,425,852 3,067,985
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet93.000 %
b
Permanent endowment SchDMd Bullet3.100 %
c
Temporarily restricted endowment SchDMd Bullet3.900 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
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)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   999,532 999,532
b Buildings ................   9,324,246 3,320,186 6,004,060
c Leasehold improvements ............   136,585 120,734 15,851
d Equipment ................   3,336,094 2,595,781 740,313
e Other .................       0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 7,759,756
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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 0  
(2)Closely-held equity interests 0  
(3)Other
(A) BENEFICIAL INTEREST IN NET ASSETS HELD BY HCI FOUNDATION 		8,102,026 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 8,102,026
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DUE TO AFFILIATES 687,085








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 687,085
2. Liability for uncertain tax positions In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 18,364,204
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 291,447
b Donated services and use of facilities ......... 2b 44,355
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 2,231,365
e Add lines 2a through 2d ..................... 2e 2,567,167
3 Subtract line 2e from line 1..................... 3 15,797,037
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  
b Other (Describe in Part XIII.) ........... 4b 371,759
c Add lines 4a and 4b....................... 4c 371,759
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 16,168,796
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 16,516,413
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a 44,355
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 0
e Add lines 2a through 2d...................... 2e 44,355
3 Subtract line 2e from line 1..................... 3 16,472,058
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  
b Other (Describe in Part XIII.) ............ 4b 0
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 16,472,058
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part V, Line 4, Intended uses of endowment funds HCI FOUNDATION HOLDS ENDOWMENT FUNDS FOR THE BENEFIT OF THE ORGANIZATION; THESE ENDOWMENT FUNDS CONSIST OF NUMEROUS GIFTS ESTABLISHED TO FUND AND SUPPORT THE ORGANIZATION'S MISSION.
Schedule D, Part X, Line 2, FIN 48 (ASC 740) footnote THE ORGANIZATION IS EXEMPT FROM INCOME TAXES ON INCOME FROM RELATED ACTIVITIES UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX LAW. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. U.S. GAAP REQUIRES THAT 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. 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 IOWA 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 JUNE 30, 2014 OR 2013.
Schedule D, Part XI, Line 2d, Other revenues in audited financial statements not in form 990 CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF HCI FOUNDATION - 2231365;
Schedule D, Part XI, Line 4b, Other revenues in form 990 not in audited financial statements ALLOWANCE FOR UNCOLLECTIBLE CONTRIBUTIONS - 371759;
Schedule D (Form 990) 2013

Additional Data


Software ID: 13000248
Software Version: 2013v3.1




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
HOSPICE OF CENTRAL IOWA
 
Employer identification number
42-1093718
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) QUALITY OF LIFE GRANTS 439 0 14,945 COST MISCELLANEOUS NON-CARE ITEMS












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2, Procedures for monitoring use of grant funds HCI CARE SERVICES' (HCI) QUALITY OF LIFE FUND IS MAINTAINED TO PROVIDE SERVICES AND/OR ITEMS NOT COVERED UNDER PER DIEM REIMBURSEMENT FOR HOSPICE CARE TO PATIENTS IN NEED AND TO PROVIDE OCCASIONAL SMALL LIFE AMENITIES THAT ENHANCE THE PATIENTS' AND FAMILIES' QUALITY OF LIFE. ALL HCI PATIENTS ARE ELIGIBLE FOR QUALITY OF LIFE FUND BENEFITS, AND ALL ATTEMPTS ARE MADE TO UTILIZE COMMUNITY RESOURCES PRIOR TO USING THE QUALITY OF LIFE FUND. BEST EFFORTS ARE USED TO ENSURE THAT ASSISTANCE IS PROVIDED FOR PATIENTS IN NEED AND WITHOUT OTHER MEANS OF ASSISTANCE OR ACCESS TO OTHER BENEFACTORS, AND THAT USE AND CIRCUMSTANCES FOR THE FUNDS IS CONSISTENT. THE AMOUNT OF FUNDS PROVIDED IS DETERMINED BY HCI FOUNDATION BOARD OF TRUSTEES WITHIN THE ANNUAL BUDGET. REPORTS OF FUND EXPENDITURES ARE SUBMITTED TO THE BOARD OF TRUSTEES ON THE STATEMENT OF REVENUE AND EXPENSE. ANY STAFF MEMBER MAY SUBMIT A WRITTEN OR VERBAL REQUEST FOR UTILIZATION OF QUALITY OF LIFE FUNDS. REQUESTS LESS THAN $100 ARE APPROVED BY THE PATIENT'S TEAM DIRECTOR. REQUESTS MORE THAN $100 ARE APPROVED BY A MEMBER OF THE EXECUTIVE TEAM, WHO ALSO ENSURES THAT APPROPRIATE OVERSIGHT AND REVIEW ARE CONDUCTED.
Schedule I (Form 990) 2013


Additional Data


Software ID: 13000248
Software Version: 2013v3.1


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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HOSPICE OF CENTRAL IOWA
 
Employer identification number

42-1093718
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 or provision of all of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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 Regulations 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)NORENE MOSTKOFFPRESIDENT & CEO (i)
(ii)		 0
237,452 		0
0 		0
17,500 		0
8,860 		0
22,650 		0
286,462 		0
0
(2)KELLY DENNISVICE PRESIDENT & CFO (i)
(ii)		 0
137,579 		0
6,500 		0
0 		0
4,957 		0
11,365 		0
160,401 		0
0
(3)THOMAS MOUSERCHIEF MEDICAL OFFICER (i)
(ii)		 178,748
0 		3,500
0 		13,238
0 		6,499
0 		25,111
0 		227,096
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 3, Arrangement used to establish the top management official's compensation COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS ESTABLISHED AND PAID BY HCI VNS CARE SERVICES, A RELATED TAX-EXEMPT ORGANIZATION. HCI VNS CARE SERVICES UTILIZES THE FOLLOWING METHODS IN DETERMINING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J, Part I, Line 7, Non-fixed payments A DISCRETIONARY BONUS WAS PAID TO THE CHIEF MEDICAL OFFICER. THE INCENTIVE WAS BASED ON STANDARDS AND GOALS SET FORTH BY, AND WAS APPROVED BY, THE CEO.
Schedule J (Form 990) 2013

Additional Data


Software ID: 13000248
Software Version: 2013v3.1
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (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 CENTRAL IOWA
 
Employer identification number

42-1093718
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) THOMAS MOUSER
  		CMO SIGNING BONUS   X 30,000 1,548   No Yes   Yes  
Total ......Small Bullet $ 1,548
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2013

Additional Data


Software ID: 13000248
Software Version: 2013v3.1




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageInformation about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HOSPICE OF CENTRAL IOWA
 
Employer identification number

42-1093718
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications .. X 5,609 RESALE VALUE
5 Clothing and household
goods ....... 		X 294,718 RESALE VALUE
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
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 ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( SPECIALTY / MISC. ) X 5,417 37,058 RESALE VALUE
26 Other Right pointing arrow large image ( MISCELLANEOUS ) X 152 2,033 RESALE VALUE
27 Other Right pointing arrow large image ( DECORATIONS AND SUPPLIES ) X 7 1,999 MARKET VALUE
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 through 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 noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2013)
Schedule M (Form 990) (2013)
Page 2
Part II
Supplemental Information. Provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
Schedule M, Part I, Explanations of reporting method for number of contributions BOOKS AND PUBLICATIONS: N/A CLOTHING AND HOUSEHOLD GOODS: N/A OTHER: NUMBER OF ITEMS RECEIVED AND THEN RESOLD IN THE THRIFT STORE OTHER: NUMBER OF ITEMS RECEIVED AND THEN RESOLD IN THE THRIFT STORE OTHER: NUMBER OF DONATIONS
Schedule M, part I, column (b), Line 4, Number of contributions or items contributed. N/A
Schedule M, part I, column (b), Line 5, Number of contributions or items contributed. N/A
Schedule M, part I, column (b), Line other, Number of contributions or items contributed. OTHER=SPECIALTY / MISC. : NUMBER OF ITEMS RECEIVED AND THEN RESOLD IN THE THRIFT STORE
Schedule M, part I, column (b), Line other, Number of contributions or items contributed. OTHER=MISCELLANEOUS : NUMBER OF ITEMS RECEIVED AND THEN RESOLD IN THE THRIFT STORE
Schedule M (Form 990) (2013)
Additional Data


Software ID: 13000248
Software Version: 2013v3.1
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.
MediumBullet 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 CENTRAL IOWA
 
Employer identification number

42-1093718
Return Reference Explanation
FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION FOUNDED IN 1978, HCI CARE SERVICES IS THE STATE'S OLDEST HOSPICE CARE PROVIDER. AN INDEPENDENT, NOT-FOR-PROFIT, COMMUNITY-BASED ORGANIZATION, THE ORGANIZATION'S MISSION IS: "PROMOTING DIGNITY, INDEPENDENCE AND QUALITY OF LIFE FOR ALL THROUGH EDUCATION, COMPASSIONATE AND EFFECTIVE COMMUNITY BASED CARE." THE ORGANIZATION IS ALSO GUIDED BY ITS VALUES: WE ACT WITH INTEGRITY AND RESPECT. WE SERVE WITH COMPASSION. WE LEAD THROUGH EXCELLENCE. WE UNITE THROUGH TEAMWORK.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS HCI CARE SERVICES OFFERS THE FOLLOWING SERVICES. HCI HOSPICE CARE SERVICES: - HCI HOSPICE CARE SERVICES IS A NON-PROFIT, COMMUNITY-BASED SERVICE SERVING 35 COUNTIES. - IN-HOME HOSPICE SERVICES, INCLUDING VISITS FROM NURSES, SOCIAL WORKERS, HOSPICE AIDES, SPIRITUAL CARE COUNSELORS, BEREAVEMENT COUNSELORS, VOLUNTEERS AND THERAPISTS. FOR THE FISCAL YEAR ENDING JUNE 30, 2014, HCI HOSPICE CARE SERVICES PROVIDED END OF LIFE CARE TO APPROXIMATELY 1,354 PATIENTS. - ACCESS TO CLINICIANS WHO HAVE RECEIVED SPECIALIZED TRAINING IN END-OF-LIFE CARE; MANY ARE CERTIFIED IN HOSPICE AND PALLIATIVE CARE. - TEAM PHYSICIANS AND NURSE PRACTITIONERS ON STAFF. - EXPERT PAIN AND SYMPTOM MANAGEMENT. - INTERDISCIPLINARY CARE TEAMS WHO PROVIDE PERSONALIZED, COORDINATED CARE. - DEDICATED HOSPICE ROOMS WITHIN HOSPITALS AND CARE FACILITIES IN OUR SERVICE AREA. - GRIEF SUPPORT GROUPS AND EDUCATIONAL RESOURCES. - ACCESS TO HIGHLY-SKILLED CLINICAL STAFF 24 HOURS A DAY, SEVEN DAYS A WEEK. - MEDICAL EQUIPMENT, SUPPLIES AND MEDICATIONS RELATED TO THE LIFE-LIMITING ILLNESS. - TWO RESIDENTIAL HOSPICE CARE FACILITIES IN DES MOINES, IOWA -- KAVANAGH HOUSE ON 56TH STREET OFFERS 15 PRIVATE PATIENTS ROOMS, AND BRIGHT KAVANAGH HOUSE HAS 24 PRIVATE ROOMS. - SPECIALIZED SERVICES FOR PATIENTS WHO ARE MILITARY VETERANS AND FOR PATIENTS WHO OWN PETS. -IN 2012 HCI CARE SERVICES RECEIVED A 2012 IOWA'S TOP WORKPLACES AWARD. THE AWARD WAS BASED SOLELY ON EMPLOYEE FEEDBACK THROUGH A SURVEY CONDUCTED BY AN INDEPENDENT THIRD PARTY. EXTRACARE SERVICES: - EXTRACARE SERVICES IS A NON-PROFIT, PRIVATE DUTY SERVICE WHICH SUPPORTS INDIVIDUALS' EFFORTS TO CONTINUE LIVING AT THEIR CURRENT PLACE OF RESIDENCE. IN THE FISCAL YEAR ENDING JUNE 30, 2014, HCI EXTRA CARE PROVIDED OVER 11,715 HOURS OF CARE TO PATIENTS. - NURSES, HOME HEALTH AIDES AND TRAINED COMPANIONS OFFER EXPERTISE AND COMPANIONSHIP RANGING FROM ONE HOUR/DAY TO 24-HOUR ASSISTANCE. - EXAMPLES OF SERVICES INCLUDE SKILLED NURSING SERVICES, ASSISTANCE WITH BATHING, GROOMING, DRESSING, TOILETING, LAUNDRY, LIGHT HOUSEKEEPING AND CHRONIC DISEASE CASE MANAGEMENT. - EXTRACARE SERVICES IS A PRIVATE PAY SERVICE. CLIENTS PAY ONLY FOR THE SERVICES THEY SELECT. HCI GIVING TREE: - HCI GIVING TREE IS A NON-PROFIT THRIFT STORE, LOCATED AT 3330 100TH ST. IN URBANDALE, IOWA. - THE STORE SELLS AND ACCEPTS DONATIONS OF GENTLY-USED FURNITURE, CLOTHING AND HOME FURNISHINGS. - ALL PROCEEDS FROM STORE SALES SUPPORT SERVICES PROVIDED TO PATIENTS OF HCI HOSPICE CARE SERVICES, ENSURING CARE IS AVAILABLE TO ALL WHO NEED HOSPICE CARE SERVICES - REGARDLESS OF THEIR ABILITY TO PAY. - WITH THE EXCEPTION OF TWO PAID STAFF, THE STORE IS OPERATED BY A DEDICATED CORE OF UNPAID VOLUNTEERS. - HCI GIVING TREE VOLUNTEERS PROVIDED 9,534 HOURS OF SERVICE TO THE STORE - A VALUE OF $214,992. HCI CARE SERVICES ALSO OFFERS: - CAREGIVER TRAINING AND SUPPORT; - EDUCATIONAL CONFERENCES, SEMINARS AND RESOURCES; - FREE ADVANCE CARE PLANNING RESOURCES; AND - GRIEF SUPPORT GROUPS, WHICH ARE FREE OF CHARGE AND ARE OPEN TO THE PUBLIC STRUCTURE: HCI CARE SERVICES IS COMMITTED TO THE COMMUNITIES IT SERVES AND TAKES ADVANTAGE OF EXPERT RESOURCES WITHIN THOSE COMMUNITIES FOR GUIDANCE, ADVOCACY AND ASSISTANCE. HCI CARE SERVICES EMPLOYEES ARE GUIDED BY A VOLUNTEER BOARD OF DIRECTORS. THE ORGANIZATION'S FUNDRAISING SUPPORT COMES FROM THE HCI FOUNDATION, WHICH RECEIVES OVERSIGHT FROM ITS VOLUNTEER BOARD OF TRUSTEES. IN RURAL IOWA, EACH HCI CARE SERVICES OFFICE SERVES A MULTI-COUNTY AREA AND IS GUIDED BY A VOLUNTEER ADVISORY BOARD. SOURCES OF FUNDING: HCI CARE SERVICES IS SUPPORTED PRIMARILY THROUGH THIRD PARTY REIMBURSEMENTS. FOR THE FISCAL YEAR ENDING JUNE 30, 2014, APPROXIMATELY 88 PERCENT OF THE ORGANIZATION'S NET PATIENT REVENUE WAS DERIVED FROM MEDICARE AND MEDICAID PROGRAMS. HOWEVER, HCI CARE SERVICES ALSO RECEIVES SIGNIFICANT SUPPORT FROM DONOR CONTRIBUTIONS, BEQUESTS, GRANTS AND FUNDRAISING ACTIVITIES CONDUCTED THROUGH THE HCI FOUNDATION. DONORS MAY DESIGNATE THEIR GIFTS TO SPECIFIC AREAS SERVED BY HCI CARE SERVICES, WHICH REFLECTS THE ORGANIZATION'S COMMITMENT TO COMMUNITY-BASED CARE. HCI CARE SERVICE'S ADVISORY BOARDS HELP DETERMINE HOW LOCALLY-DESIGNATED DONATIONS ARE SPENT - BENEFITING THE ORGANIZATION AND THE COMMUNITY BY FUNDING, FOR EXAMPLE, BOOK DONATIONS ON END-OF-LIFE CARE TO LOCAL LIBRARIES OR HELPING ESTABLISH HOSPICE ROOMS IN LOCAL HOSPITALS AND NURSING CARE FACILITIES. GRIEF SUPPORT SERVICES: THROUGHOUT ITS SERVICE AREA, HCI CARE SERVICES OFFERS BEREAVEMENT CARE FOR PATIENTS, THEIR FAMILIES AND THE COMMUNITY AT LARGE. GRIEF SUPPORT GROUPS ARE OFFERED IN THE COMMUNITIES WE SERVE AT NO COST TO PARTICIPANTS, AND ARE OPEN TO ALL WHO HAVE LOST A LOVED ONE - REGARDLESS OF WHETHER THEY HAVE BEEN SERVED BY HCI CARE SERVICES. GRIEF EDUCATION AND SPECIAL SUPPORT GROUPS ARE ALSO OFFERED TO YOUTHS AND TO NURSING CARE FACILITY STAFF. IN THE YEAR ENDING JUNE 30, 2014, BEREAVEMENT COUNSELORS HELD 217 SUPPORT GROUP MEETINGS, PROVIDED 1,998 HOURS OF BEREAVEMENT SERVICES TO SURVIVORS SERVED BY HCI CARE SERVICES, AND PROVIDED 503 HOURS OF BEREAVEMENT SERVICES TO NON-SERVED SURVIVORS.
FORM 990, PART V, LINE 1A, FORM 1096 REPORTING - COMMON PAYMASTER HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, AND HCI FOUNDATION; THEREFORE ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES.
FORM 990, PART V, LINE 2A, FORM W-3 AND W-2 REPORTING - COMMON PAYMASTER HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, AND HCI FOUNDATION; THEREFORE ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES. HCI CARE SERVICES HAS APPROXIMATELY 206 EMPLOYEES. HCI VNS CARE SERVICES, THE COMMON PAYING AGENT, REPORTED 515 EMPLOYEES ON FORM W-3 FOR 2013.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee THE BOARD OF DIRECTORS MAY ESTABLISH ONE OR MORE COMMITTEES OF THE BOARD, INCLUDING AN EXECUTIVE COMMITTEE, AND APPOINT MEMBERS OF THE BOARD TO SERVE ON THEM. EACH COMMITTEE SHALL HAVE THE POWERS AND DUTIES DELEGATED TO IT BY THE BOARD OF DIRECTORS. EACH COMMITTEE SHALL HAVE A SEPARATE CHARTER ESTABLISHED BY THE BOARD OF DIRECTORS SPECIFYING THE SCOPE OF THE COMMITTEE'S AUTHORITY. THE CURRENT COMMITTEES CONSIST OF AN EXECUTIVE, GOVERNANCE, FINANCE, AUDIT, QUALITY AND COMPLIANCE.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders THE ORGANIZATION'S SOLE MEMBER IS HCI VNS CARE SERVICES, AN IOWA NONPROFIT CORPORATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body ALL CORPORATION DIRECTORS ARE APPOINTED BY HCI VNS CARE SERVICES, THE ORGANIZATION'S SOLE MEMBER; ANY DIRECTOR OF THE ORGANIZATION MAY BE REMOVED EITHER FOR OR WITHOUT CAUSE BY HCI VNS CARE SERVICES.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders NONE OF THE CORPORATION'S ASSETS OR ANY OTHER RIGHTS THERETO, WHETHER REAL, PERSONAL OR INTANGIBLE, SHALL BE SOLD, CONVEYED, ASSIGNED, TRANSFERRED, MORTGAGED, ENCUMBERED, EXCHANGED, ALIENATED, OR LEASED WITHOUT THE PRIOR APPROVAL OF HCI VNS CARE SERVICES, THE CORPORATION'S SOLE CORPORATE MEMBER. THE CORPORATION SHALL NOT BE A PARTY TO ANY MERGER, ACQUISITION, CONSOLIDATION, JOINT VENTURE, REORGANIZATION, RESTRUCTURING OR SIMILAR EVENT, NOR SHALL IT BECOME A MEMBER, PARTNER, SHAREHOLDER, TRUSTEE OR OTHER FIDUCIARY OF ANY OTHER ORGANIZATION OR ENTITY, WITHOUT THE PRIOR APPROVAL OF HCI VNS CARE SERVICES, THE CORPORATION'S SOLE CORPORATE MEMBER. NO AMENDMENT, ALTERATION OR REPEAL OF ANY OF THE PROVISIONS OF THE CORPORATION'S BYLAWS SHALL BE ADOPTED WITHOUT THE PRIOR APPROVAL OF HCI VNS CARE SERVICES, THE CORPORATION'S SOLE CORPORATE MEMBER.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body THE FULL FORM 990 IS PROVIDED TO THE ORGANIZATION'S PRESIDENT AND CEO, CFO, AND AUDIT COMMITTEE FOR INITIAL REVIEW. AFTER ALL QUESTIONS HAVE BEEN ADDRESSED AND ANY CHANGES HAVE BEEN MADE, THE ORGANIZATION'S TAX ADVISORS PRESENT A FINAL DRAFT OF THE FULL FORM 990 TO THE FULL BOARD OF DIRECTORS FOR FINAL REVIEW AND APPROVAL PRIOR TO SUBMISSION TO THE IRS.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO PROMPTLY REPORT ANY ONGOING OR INCIDENTAL MATERIAL INTERESTS OR AFFILIATIONS WHICH COULD RESULT IN A POTENTIAL CONFLICT OF INTEREST; MEMBERS OF THE BOARD OF DIRECTORS ARE ALSO REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST DECLARATION. THE BOARD OF DIRECTORS AND OFFICERS ALSO COMPLETE AN ANNUAL AUTOMATED CONFLICT OF INTEREST QUESTIONNAIRE AS PART OF THE 990 COMPLETION PROCESS. THE DECLARATIONS AND QUESTIONNAIRE RESPONSES ARE REVIEWED BY THE PRESIDENT AND CEO AND CFO TO DETERMINE IF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST EXIST. ANY BOARD MEMBER DETERMINED TO HAVE A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM ANY DECISION OR VOTING PROCESS RELATED TO THE CONFLICTING ISSUE.
FORM 990, PART VI, LINE 15, COMPENSATION OF TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS/KEY EMPLOYEES THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES ARE PAID BY HCI VNS CARE SERVICES (EIN: 45-5189289), A RELATED TAX-EXEMPT ORGANIZATION; THEREFORE LINES 15A AND 15B HAVE BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. BELOW IS THE PROCESS USED BY HCI VNS CARE SERVICES TO REVIEW AND APPROVE COMPENSATION FOR THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES. EVERY TWO YEARS, THE ORGANIZATION'S BOARD OF DIRECTORS ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO PERFORM A COMPENSATION SURVEY FOR THE ORGANIZATION'S OFFICERS. VERISIGHT COMPLETED THE ORGANIZATION'S COMPENSATION SURVEYS IN 2009, 2011 AND 2013. THE FINDINGS OF THE SURVEYS ARE PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MEMBERS USE THE SURVEY TO REVIEW AND ESTABLISH THE AMOUNT OF COMPENSATION FOR THE PRESIDENT & CEO. THE REVIEW PROCESS IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MEETING MINUTES AND WAS COMPLETED IN OCTOBER 2013. THE PRESIDENT AND CEO USES THE SURVEY TO REVIEW AND ESTABLISH COMPENSATION FOR THE FOLLOWING OFFICERS AND KEY EMPLOYEES, VICE PRESIDENT & CFO, SENIOR VICE PRESIDENT & COO, AND THE CHIEF MEDICAL DIRECTOR.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, SECTION A, LINE 1A, COMPENSATION PAID BY RELATED ORGANIZATION THE ORGANIZATION'S OFFICERS ARE PAID BY HCI VNS CARE SERVICES, A RELATED TAX-EXEMPT ORGANIZATION, FOR SERVICES PROVIDED TO HCI CARE SERVICES, HCI FOUNDATION, HCI VNS CARE SERVICES, AND VISITING NURSE SERVICES OF IOWA. PER THE FORM 990 INSTRUCTIONS, TOTAL COMPENSATION PAID BY HCI VNS CARE SERVICES IS REPORTED IN ITS FORM 990, PART VII, SECTION A, LINE 1A, COLUMNS (D) AND (F); ADDITIONALLY, TOTAL COMPENSATION PAID BY HCI VNS CARE SERVICES IS ALSO REPORTED IN EACH OF THE THREE RELATED ORGANIZATIONS' FORMS 990, PART VII, SECTION A, LINE 1A, COLUMNS (E) AND (F) (AS COMPENSATION PAID BY A RELATED ORGANIZATION). THE TIME EACH OFFICER DEVOTES TO EACH RESPECTIVE ORGANIZATION IS SHOWN IN FORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B).
FORM 990, PART VII, SECTION B, LINE 1, INDEPENDENT CONTRACTORS HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, AND HCI FOUNDATION; THEREFORE ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES. INDEPENDENT CONTRACTOR INFORMATION IS ENTERED IN PART VII, SECTION B, AT THE ORGANIZATIONAL LEVEL AS THE PAYMENTS RELATE TO EACH ENTITY'S BUSINESS.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF HCI FOUNDATION - 2231365; ALLOWANCE FOR UNCOLLECTIBLE CONTRIBUTIONS - -371759;
Schedule M, part I, column (b), Line other, Number of contributions or items contributed. OTHER=DECORATIONS AND SUPPLIES : NUMBER OF DONATIONS
Schedule M, part I, column (b), Line 4, Number of contributions or items contributed. N/A
Schedule M, part I, column (b), Line 5, Number of contributions or items contributed. N/A
Schedule M, part I, column (b), Line other, Number of contributions or items contributed. OTHER=SPECIALTY / MISC. : NUMBER OF ITEMS RECEIVED AND THEN RESOLD IN THE THRIFT STORE
Schedule M, part I, column (b), Line other, Number of contributions or items contributed. OTHER=MISCELLANEOUS : NUMBER OF ITEMS RECEIVED AND THEN RESOLD IN THE THRIFT STORE
Schedule M, part I, column (b), Line other, Number of contributions or items contributed. OTHER=DECORATIONS AND SUPPLIES : NUMBER OF DONATIONS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID: 13000248
Software Version: 2013v3.1
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HOSPICE OF CENTRAL IOWA
 
Employer identification number

42-1093718
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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
(1) HOSPICE OF CENTRAL IOWA THRIFT STORE LLC DBA HCI GIVING TREE
3330 100TH STREET
URBANDALE,IA503223854
27-3099690 		RESALE OF DONATED MERCHANDISE TO THE PUBLIC IA 339,418 17,700 HOSPICE OF CENTRAL IOWA
 
(2) HCI EXTRACARE LLC
2910 WESTOWN PARKWAY SUITE 200
WEST DES MOINES,IA50266
30-0661072 		PRIVATE DUTY NURSING AND COMPANION SERVICES IA 301,535 0 HOSPICE OF CENTRAL IOWA
 








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 entity?
Yes No
(1) HOSPICE OF CENTRAL IOWA FOUNDATION DBA HCI FOUNDATION

2910 WESTOWN PARKWAY SUITE 200

WEST DES MOINES,IA502661332
42-1239748 		FUNDRAISING TO SUPPORT HOSPICE OF CENTRAL IOWA AND VISITING NURSE SERVICES OF IOWA IA 501(C)(3) 7 HCI VNS CARE SERVICES
 
 
No
(2) HCI VNS CARE SERVICES

2910 WESTOWN PARKWAY SUITE 200

WEST DES MOINES,IA50266
45-5189289 		ADMINISTRATIVE AND MANAGEMENT SERVICES (MSO) IA 501(C)(3) 11 - Type II NA
 
 
No
(3) VISITING NURSE SERVICES OF IOWA

1111 9TH STREET SUITE 320

DES MOINES,IA50314
42-0680446 		HEALTH AND HEALTH RELATED SERVICES IA 501(C)(3) 7 HCI VNS CARE SERVICES
 
 
No








For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


Software ID: 13000248
Software Version: 2013v3.1