Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Reverence Home Health & Hospice
Employer identification number
38-3408684
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
100,816
166,531
164,898
98,235
530,931
1,061,411
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
100,816
166,531
164,898
98,235
530,931
1,061,411
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.
1,061,411
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
100,816
166,531
164,898
98,235
530,931
1,061,411
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
141,014
761,254
520,383
276,966
1,699,617
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).
2,761,028
12
Gross receipts from related activities, etc. (see instructions)
..................
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.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
38.440 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
34.440 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Reverence Home Health & Hospice
Employer identification number
38-3408684
Return Reference
Explanation
Form 990, Part III, line 3
Effective June 30, 2014, Genesys Home Health & Hospice ("GHHH") merged into Reverence Home Health & Hospice ("RHHH"). GHHH transferred its home health operations and assets to RHHH.
Form 990, Part III:
Reverence Home Health and Hospice COMMUNITY BENEFIT REPORT For the Year Ended June 30, 2014 This report illustrates the significant degree to which Reverence Home Health and Hospice contributes to the positive health status of the communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, Reverence Home Health and Hospice continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of Reverence Home Health and Hospice is to perpetuate the healing mission of the church. Reverence Home Health and Hospice furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. In order to portray the full breadth of our contribution, our community benefit information is described below: ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT Reverence Home Health and Hospice provides a substantial portion of its services to the elderly and poor. Reverence Home Health and Hospice seeks to improve the physical, mental, social and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, Reverence Home Health and Hospice has developed the following programs to help achieve its mission: EXPANDING AWARENESS, EDUCATION, AND HEALTH PROMOTION Reverence Home Health and Hospice believes that it is essential to educate people regarding the types of behavior that improve their chances of living a healthy life. Reverence Home Health and Hospice has invested significantly in unique, top quality health education and materials to accomplish its goals. - 18th Annual Senior Expo - Breast Cancer Walk - Annual WWM Event - Caring Coalition Conference with The Jewish Hospice & Chaplaincy Network - Hearst of Love Event - Arts Beats & Eats MEDICAL EDUCATION Reverence Home Health and Hospice believes that, in order to provide the best health care to the community, the clinical associates need to receive ongoing education. Some examples of the education for July 2013 through June 2014 include: - Bereavement Program newsletter, support groups, education, counseling - Bereavement ROPE program - Adult Palliative Care Phone Support - New Mt Zion Missionary Baptist health professionals lecture - Providence Pain Clinic nurses presentation - Wound Vac class by KCI - WWM Pregnant Mother Support - Fingerstick class to all field nurses - ALS Association Michigan Chapter Support Group - IRB Hart Medical In-service X2 equipment use - Pain In-service partner with Greenfield Rehab - Annual Competencies 10 sessions - HHA Competencies - Quarterly - OASIS-C training for all 2014 for all staff - Palliative Care/Hospice In-services for Certified HC Teams - Hospice End of Life In-service for staff at our partner hospitals - Advance Care Planning Committee - Pediatric Team Outreach at Beaumont Royal Oak - Pediatric Team Partnership with Peds Palliative Care at SJHMC - Hospice Monthly Internal Med Resident Rotations In the spirit of principles adopted by Ascension Health, Reverence Home Health and Hospice has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 2014, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $894,801. Reverence Home Health and Hospice provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 2014, approximately 68% of the value of services rendered were to elderly patients under the Medicare program, and approximately 12% of the services were provided to patients who were deemed indigent under state, county, or Medical Center Guidelines. Reverence Home Health and Hospice offers a financial assistance program that responds to the needs of the elderly, poor persons with disabilities, the chronically mentally ill, or those who find it hard to meet basic needs due to on-going poverty. The care of the poor program is communicated to the public through case managers stationed at hospitals throughout St John Health System and through Reverence Home Health and Hospice liaisons located in various patient care facilities in the area. The patient accounting department also assists patients in filling out required paperwork and submitting appropriate documentation. OPERATIONS AND GOVERNANCE Reverence Home Health and Hospice has a continuum governing body in which independent persons representative of the community comprise a majority; Reverence Home Health and Hospice engages in the training and education of health care professionals; and participates in Medicaid, Medicare, CHAMPUS, Tricare, and/or other government-sponsored health care programs. PATIENT SERVICES Reverence Home Health and Hospice provides the following outpatient medical services to the community: Certified Nursing care, Hospice and Infusion care. During the fiscal year ending June 2014, Reverence Home Health and Hospice provided 222,159 certified visits; 101,837 Hospice days and 63,586 Infusion days to our patients. FINANCIAL INFORMATION The financial information presented below was prepared in accordance with the Catholic Health Association's (CHA) community benefit reporting guidelines. These guidelines recommend the following: Report care of the poor at cost, not charges. Do not include bad debt, contractual allowances, and quick pay discounts as part of care of the poor expense. Do not count Medicare shortfall as a community benefit. Report the net expense for community benefit services, i.e., the total community benefit expense minus any associated revenue from patients, payers, and other external sources. The CHA reporting guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the reporting guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health. For fiscal year ended June 2014: - Care of the poor - at cost = $267,212 - Government sponsored health care - net expense = $646,122 Unpaid cost of public indigent care programs (includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) Total quantifiable community benefit as determined in accordance with CHA reporting guidelines = $913,334 SUPPLEMENTAL INFORMATION - Bad debt = $2,694,632 Total quantifiable community benefit, including bad debt = $3,607,966
Form 990, Part VI, Section A, line 2
Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related entity boards.
Form 990, Part VI, Section A, line 4
Effective June 30, 2014, Genesys Home Health & Hospice ("GHHH") merged into Reverence Home Health & Hospice ("RHHH"). GHHH transferred its home health operations and assets to RHHH, and became member of RHHH, but GHHH retained its hospice assets and operations. Upon such merger, the separate existence of GHHH ceased and its assets and operations were vested in RHHH, and immediately prior to the merger, GHHH's membership interest in RHHH was transferred to Genesys Ambulatory Health Services.
Form 990, Part VI, Section A, line 6
Reverence Home Health & Hospice has four corporate members, St. John Health, Borgess Health Alliance, Inc., St. Mary's of Michigan Medical Center, Inc. and Genesys Ambulatory Health Services.
Form 990, Part VI, Section A, line 7a
Reverence Home Health & Hospice has four corporate members, St. John Health, Borgess Health Alliance, Inc., St. Mary's of Michigan Medical Center, Inc. and Genesys Home Health & Hospice, who have the ability to elect a member to the governing body of Reverence Home Health & Hospice. Ascension Health, a related organization of Reverence Home Health & Hospice, has the ability to elect members of the governing body of Reverence Home Health & Hospice.
Form 990, Part VI, Section A, line 7b
All decisions that have a material impact to Reverence Home Health & Hospice's financial information or corporation as a whole are subject to approval by its four corporate members, St. John Health, Borgess Health Alliance, Inc., St. Mary's of Michigan Medical Center, Inc. and Genesys Home Health & Hospice.
Form 990, Part VI, Section B, line 11
Management works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return all board members are provided the Form 990 and management team members are available to answer any board members' questions.
Form 990, Part VI, Section B, line 12c
The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, key employee, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer, and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Section B, line 15
In determining the compensation of the organization's President, the process, performed by St. John Health, a related organization of Reverence Home Health & Hospice, included a review and approval by independent persons, comparability data and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the President was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Individual was not present when his compensation was decided. In determining compensation of other officers of the organization, the process, performed by the various corporate members of Reverence Home Health & Hospice who compensate the individual, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the other officers of the organization were compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes.
Form 990, Part VI, Section C, line 19
The organization will provide any documents open to public inspection upon request.
Form 990, Part VII, Section A:
Where noted with a "(Sch O)" reference, the compensation listed is for services provided to this organization or a related organization in an employee capacity and not for participation in this organization's board.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.