TY 2014 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) LORING FLINT MD........................................................................ BOARD MEMBER	1.00 .......................	X				0	0	0
(2) MALENE DAVIS........................................................................ PRESIDENT/CEO	40.00 .......................	X	X			541,044	0	49,485
(3) VERA DVORAK MD........................................................................ BOARD MEMBER	1.00 .......................	X				0	0	0
(4) LYNN MENTO........................................................................ VICE CHAIR	1.00 .......................	X				0	0	0
(5) DAN A D'AGOSTINO JR........................................................................ BOARD MEMBER	1.00 .......................	X				0	0	0
(6) MARK WEBER........................................................................ BOARD MEMBER/TREASURER	1.00 .......................	X				0	0	0
(7) TYRONE PITTS........................................................................ BOARD MEMBER	1.00 .......................	X				0	0	0
(8) LEN ADLER........................................................................ BOARD MEMBER	1.00 .......................	X				0	0	0
(9) TOM KOUTSOUMPAS........................................................................ CHAIR	2.00 .......................	X				0	0	0
(10) DAVID SCHWIND........................................................................ EXECUTIVE VP CFO	40.00 .......................		X			259,355	0	50,194
(11) JAMES CAMERON MUIR........................................................................ EVP QUALITY & ACCESS	40.00 .......................			X		322,712	0	51,467
(12) MICHAEL BYAS-SMITH........................................................................ MEDICAL DIRECTOR	40.00 .......................				X	281,350	0	26,567
(13) DIANE TRAFICANTE........................................................................ HPM PHYSICIAN	40.00 .......................				X	183,575	0	5,655
(14) MUHAMMAD M SIDDIQUI........................................................................ NBRHD LEAD PHYSICIAN	40.00 .......................				X	180,757	0	15,211
(15) DEBORAH CARL........................................................................ VP - HUMAN RESOURCES	40.00 .......................				X	176,573	0	25,179
(16) IMRAN SHARIFF........................................................................ HPM PHYSICIAN	40.00 .......................				X	173,355	0	5,581

(A) Name and business address	(B) Description of services	(C) Compensation
NMS HEALTHCARE OF HYATTSVILLE 4922 LASALLE ROAD HYATTSVILLE,MD20782	NURSING HOME SERVICE	5,416,245
WILBEA MEDICAL EQUIPMENT PO BOX 3449 HARKER HEIGHTS,TX76548	MEDICAL EQUIPMENT RENTAL	2,486,909
CARROLL MANOR NURSING HOME 1150 VARUM STREET NE WASHINGTON,DC20017	NURSING HOME SERVICE	829,113
FAIRFAX NURSING CENTER 10701 MAIN ST FAIRFAX,VA220306995	NURSING HOME SERVICE	670,558
LISNER LOUISE NURSING HOME 5425 WESTERN AVE NW WASHINGTON,DC20015	NURSING HOME SERVICE	592,258
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 55

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 domestic organizations and domestic governments. See Part IV, line 21 ....	6,050	6,050
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....	500	500
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	1,242,088	269,454	947,134	25,500
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	40,878,723	37,819,445	2,175,418	883,860
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	948,513	877,952	50,084	20,477
9	Other employee benefits .......	4,445,077	4,114,401	234,709	95,967
10	Payroll taxes ...........	3,123,190	2,890,852	164,910	67,428
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	124,527	2,165	122,345	17
c	Accounting ...........	99,156	23,183	75,949	24
d	Lobbying ...........	1,725			1,725
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	143,755		143,755
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	17,049,449	15,869,743	860,863	318,843
12	Advertising and promotion ....	173,819	108,212	45,356	20,251
13	Office expenses .......	1,824,119	855,944	752,916	215,259
14	Information technology ......	1,920,555	1,173,930	652,637	93,988
15	Royalties ..
16	Occupancy ...........	1,659,515	1,249,283	233,747	176,485
17	Travel ............	1,467,247	1,263,502	188,264	15,481
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	39,868	28,728	9,734	1,406
20	Interest ...........	464,122	1,847	399,197	63,078
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	1,309,930	1,216,891	70,720	22,319
23	Insurance ..............	329,046	309,405	12,886	6,755
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	MEDICAL SUPPLIES	7,816,062	7,815,175	858	29
b	BAD DEBT	3,528,683	3,528,683
c	OTHER	89,402	81,967	3,271	4,164
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	88,685,121	79,507,312	7,144,753	2,033,056
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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	15,822,548	2	11,915,167
3	Pledges and grants receivable, net ...........	71,732	3	3,457
4	Accounts receivable, net .............	8,987,345	4	10,083,549
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
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
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	18,714	8	15,650
9	Prepaid expenses and deferred charges ..........	480,054	9	405,817
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	42,347,558
b	Less: accumulated depreciation .....	10b	12,306,697	25,867,326	10c	30,040,861
11	Investments—publicly traded securities ..........	15,936,357	11	17,288,566
12	Investments—other securities. See Part IV, line 11 .....	4,414,127	12	7,563,664
13	Investments—program-related. See Part IV, line 11 .....	3,400,000	13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	487,658	15	3,020,925
16	Total assets. Add lines 1 through 15 (must equal line 34)......	75,485,861	16	80,337,656
	17	Accounts payable and accrued expenses .........	5,997,122	17	7,103,096
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	6,565,000	20	6,380,000
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..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
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....................	1,216,496	25	1,726,200
26	Total liabilities. Add lines 17 through 25.........	13,778,618	26	15,209,296
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	42,043,901	27	58,198,077
28	Temporarily restricted net assets ...........	15,157,963	28	2,185,158
29	Permanently restricted net assets ...........	4,505,379	29	4,745,125
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	61,707,243	33	65,128,360
34	Total liabilities and net assets/fund balances ........	75,485,861	34	80,337,656

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. 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 ....................... right arrow

33 1/3% support test—2013. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2014. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. 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 ....... right arrow

33 1/3% support tests—2013. 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 .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization CAPITAL HOSPICE

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization CAPITAL HOSPICE

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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
CAPITAL HOSPICE

Employer identification number

54-1920770

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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

(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

(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

(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

(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) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Yes

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

1,739

Total. Add lines 1c through 1i ...............................

1,739

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATIONS (NHPCO) DUES PERCENT FOR LOBBYING. NHPCO ARRANGED A DAY FOR VISITING CONGRESS IN WHICH OUR PRESIDENT PARTICIPATED TO MAKE THEM AWARE OF THE NEED TO RESCIND THE CUT IN MEDICARE HOSPICE PAYMENT.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

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 value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

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:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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 ....	32,544,708	29,332,201	24,892,384	22,037,437	18,711,870
b	Contributions ........	355,135	1,195,004	3,293,566	2,989,222	1,940,464
c	Net investment earnings, gains, and losses	1,321,461	2,314,142	1,513,143	174,302	1,649,411
d	Grants or scholarships .....				203,368	166,791
e	Other expenditures for facilities and programs ........	13,327,940	168,058	247,019
f	Administrative expenses ....	143,755	128,581	119,873	105,209	97,517
g	End of year balance ......	20,749,609	32,544,708	29,332,201	24,892,384	22,037,437

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

67.000 %

Permanent endowment SchDMd Bullet

23.000 %

Temporarily restricted endowment SchDMd Bullet

10.000 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	3,412,712		3,412,712
b	Buildings ................	27,513,014	4,376,132	23,136,882
c	Leasehold improvements ............	499,083	499,083	0
d	Equipment ................	10,211,041	7,411,023	2,800,018
e	Other .................	711,708	20,459	691,249
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				30,040,861

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther 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
(2)Closely-held equity interests
(3)Other (A) US GOVERNMENT SECURITIES	759,046	F
(B) CD'S AND MONEY MARKET FUNDS	6,352,457	F
(C) CORPORATE DEBT SECURITIES	358,847	F
(D) CASH AND CASH EQUIVALENTS	93,314	F





Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	7,563,664

Part VIII

InvestmentsProgram 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.)

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.)...........

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
CHARITABLE GIFT ANNUITIES		79,121
CAPITAL LEASE OBLIGATION		158,917
INTEREST RATE SWAP		1,488,162






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		1,726,200
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) 2014

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	92,950,665
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	474,464
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	474,464
3	Subtract line 2e from line 1.....................			3	92,476,201
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	143,755
b	Other (Describe in Part XIII.) ...........	4b	437,320
c	Add lines 4a and 4b.......................			4c	581,075
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	93,057,276

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	89,023,538
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	482,172
e	Add lines 2a through 2d......................			2e	482,172
3	Subtract line 2e from line 1.....................			3	88,541,366
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	143,755
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................			4c	143,755
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	88,685,121

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
PART V, LINE 4:	CAPITAL HOSPICE INTENDS TO INVEST ITS PERMANENTLY RESTRICTED ENDOWMENT FUNDS UNTIL THEY REACH FIVE MILLION DOLLARS AT WHICH TIME, WITH THE BOARD OF TRUSTEES APPROVAL, EIGHTY PERCENT OF ANY EARNINGS WOULD BE USED TO SUPPORT ONGOING OPERATIONS AND TWENTY PERCENT WOULD BE ADDED TO THE FUND. TEMPORARILY RESTRICTED FUNDS ARE USED AS INTENDED. THE LARGEST TEMPORARILY RESTRICTED FUND AT THE BEGINNING OF THE YEAR WAS USED DURING THE YEAR TO PAY FOR THE CONSTRUCTION OF A HOSPICE INPATIENT UNIT IN ADLER, VIRGINIA.THE BOARD DESIGNATED RESTRICTED FUNDS ARE TO BE USED FOR ANY EMERGENCY OR NEW SERVICE THAT THE BOARD APPROVES.
PART X, LINE 2:	THE HOSPICE WAS RECOGNIZED AS A PUBLIC CHARITY GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE PURSUANT TO A DETERMINATION LETTER ISSUED BY THE IRS IN APRIL 1998. THE HOSPICE IS ENTITLED TO RELY ON THIS DETERMINATION AS LONG AS THERE ARE NO SUBSTANTIAL CHANGES IN ITS CHARACTER, PURPOSES, OR OPERATIONS. MANAGEMENT HAS CONCLUDED THAT THERE HAVE BEEN NO SUCH CHANGES AND THEREFORE THE HOSPICE'S STATUS AS A PUBLIC CHARITY EXEMPT FROM FEDERAL INCOME TAXATION REMAINS IN EFFECT. THE STATES IN WHICH THE HOSPICE OPERATES ALSO PROVIDE GENERAL EXEMPTION FROM STATE INCOME TAXATION FOR ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAXATION. HOWEVER, THE HOSPICE IS SUBJECT TO BOTH FEDERAL AND STATE INCOME TAXATION AT CORPORATE TAX RATES ON ITS UNRELATED BUSINESS INCOME. EXEMPTION FROM OTHER STATE TAXES, SUCH AS REAL AND PERSONAL PROPERTY TAXES, IS SEPARATELY DETERMINED. THE OPERATIONS OF CPCC IS INCLUDED IN THE HOSPICE'S FILING. THE HOSPICE DID NOT HAVE MATERIAL UNRECOGNIZED TAX BENEFITS DURING THE PERIODS PRESENTED. FOR TAX PERIODS WITH RESPECT TO WHICH THE HOSPICE DID NOT RECOGNIZE ANY UNRELATED BUSINESS INCOME, THE HOSPICE WAS NOT REQUIRED TO FILE ANY INCOME TAX RETURNS. INFORMATION RETURNS (FORM 990) AND TAX RETURNS (FORM 990-T) FOR THE YEAR ENDED DECEMBER 31, 2013 BECOME DUE ON MAY 15, 2014 AND MAY BE EXTENDED TO NOVEMBER 15, 2014. THE HOSPICE HAS FILED INFORMATION RETURNS FOR 2012 AND PRIOR PERIODS AND TAX RETURNS FOR TAX YEAR 2012. THE 2012 TAX YEAR REMAINS OPEN FOR EXAMINATION UNTIL 2016. FOR ANY TAX PERIODS PRIOR TO THE 2012 TAX YEAR FOR WHICH A TAX RETURN (FORM 990-T) WAS NOT FILED FOR THE HOSPICE, SUCH TAX PERIOD WILL REMAIN OPEN FOR EXAMINATION. THE STATUTE OF LIMITATIONS DOES NOT BEGIN TO RUN FOR A PARTICULAR TAX PERIOD UNTIL A TAX RETURN FOR SUCH PERIOD HAS BEEN FILED. CURRENT ACCOUNTING STANDARDS DEFINE THE THRESHOLD FOR RECOGNIZING UNCERTAIN INCOME TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS AS "MORE LIKELY THAN NOT" THAT THE POSITION IS SUSTAINABLE, BASED ON ITS TECHNICAL MERITS, AND ALSO PROVIDE GUIDANCE ON THE MEASUREMENT, CLASSIFICATION AND DISCLOSURE OF TAX RETURN POSITIONS IN THE FINANCIAL STATEMENTS. MANAGEMENT BELIEVES THERE IS NO IMPACT ON THE HOSPICE'S ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS RELATED TO UNCERTAIN INCOME TAX POSITIONS.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	SPECIAL EVENTS EXPENSE -482,172. RESTRICTED CONTRIBUTION 919,216. TAX INCOME 276.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	SPECIAL EVENTS EXPENSE 482,172.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization
CAPITAL HOSPICE

Employer identification number

54-1920770

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ

filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total .................

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2014

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 DAFFODIL BALL (event type)	(b) Event #2 GALA DINNER (event type)	(c) Other events 1 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	173,600	389,042	43,840	606,482
2	Less: Contributions . .	141,100	314,042	23,440	478,582
3	Gross income (line 1 minus line 2) . . .	32,500	75,000	20,400	127,900
4	Cash prizes . . .
5	Noncash prizes . .
6	Rent/facility costs . .		17,000	2,000	19,000
7	Food and beverages .	28,690	71,199	17,739	117,628
8	Entertainment . . .	3,250	2,750	2,500	8,500
9	Other direct expenses .	20,198	299,175	17,671	337,044
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				482,172
11	Net income summary. Subtract line 10 from line 3, column (d)...........				-354,272

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2014

Page 3

Does the organization conduct gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activities conducted in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

If "Yes," did the organization make it available to the public? ..............

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	2,524,609		2,524,609	2.850 %
b	Medicaid (from Worksheet 3, column a) ....	15,294,854	16,606,373	-1,311,519	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	17,819,463	16,606,373	1,213,090	2.850 %
Other Benefits		13,994		13,994	0.020 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	13,994		13,994	0.020 %
f	Health professions education (from Worksheet 5) ..	344,751	3,640	341,111	0.380 %
g	Subsidized health services (from Worksheet 6) ..	11,401,149	6,846,566	4,554,583	5.140 %
h	Research (from Worksheet 7)	374,842	35,985	338,857	0.380 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	6,050		6,050	0.010 %
j	Total. Other Benefits ..	12,140,786	6,886,191	5,254,595	5.930 %
k	Total. Add lines 7d and 7j .	29,960,249	23,492,564	6,467,685	8.780 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,322,475

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

54,881,842

Enter Medicare allowable costs of care relating to payments on line 5.....

44,199,436

Subtract line 6 from line 5. This is the surplus (or shortfall)........

10,682,406

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)			Other (describe)
1	CAPITAL HOSPICE HALQUIST MEMORIAL CENTER 4715 N 15TH STREET ARLINGTON,VA222052640	X	HOSPICE IMPATIENT CENTER

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CAPITAL HOSPICE HALQUIST MEMORIAL CENTER
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Yes

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.CAPITALCARING.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): WWW.CAPITALCARING.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	CAPITAL HOSPICE HALQUIST MEMORIAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	CAPITAL HOSPICE HALQUIST MEMORIAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER	PART V, SECTION B, LINE 5: THE HOSPITAL FACILITY RECEIVED INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, AS WELL AS LEADERS AND REPRESENTATIVES OF MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASE NEEDS. IN PARTICULAR, A SURVEY WAS DEVELOPED BY THE ORGANIZATION, WHICH WAS ADMINISTERED TO LEADERS AND REPRESENTATIVES FROM ORGANIZATIONS ACROSS THE COMMUNITY, INCLUDING: UNIVERSITY OF MARYLAND PREVENTION RESEARCH CENTER, GEORGE WASHINGTON UNIVERSITY HOSPITAL, PROVIDENCE HOSPITAL, DIMENSIONS HEALTHCARE SYSTEM, LIVINRITE HOME HEALTH, AARP DEPARTMENT OF AGING, THE DC OFFICE ON AGING, HEAVEN SENT LLC, MORNINGSIDE HOUSE OF LAUREL, N STREET VILLAGE, SEABURY RESOURCES FOR AGING, AND THE RESIDENCES AT THOMAS CIRCLE.
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER	PART V, SECTION B, LINE 11: CAPITAL CARING COMPLETED ITS FIRST COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AT THE END OF 2013. IN THAT CHNA, SURVEY RESPONDENTS INDICATED THAT THE MOST PRESSING AREAS OF CONCERN WERE IN THE AREAS OF ALZHEIMERS DISEASE, GENERAL AGING, AND MENTAL ILLNESS. CAPITAL CARING TOOK STEPS DURING 2014 TO ATTEMPT TO ADDRESS THESE NEEDS THAT WERE IDENTIFIED IN THE CHNA. IN PARTICULAR, CAPITAL CARING UNDERTOOK THE FOLLOWING ACTIVITIES DURING 2014: - SIGNIFICANT COMMUNITY OUTREACH AND EDUCATION EFFORTS WERE UNDERTAKEN WITH RESPECT TO THE NEEDS OF THE ELDERLY, INCLUDING MENTAL HEALTH, INCLUDING CLASSES WERE HELD AT THE LOCAL ARLINGTON ACUTE CARE HOSPITAL ON DEMENTIA AND DELIRIUM IN THE ELDERLY;- A SIMILAR DEMENTIA AND DELIRIUM CLASS WAS PUT ON BY CAPITAL CARING AT A LOCAL SCHOOL OF NURSING;- IN ADDITION, CLASSES WERE HELD AT LOCAL NURSING HOME AND ASSISTED LIVING FACILITIES;- WORKSHOPS WERE HELD FOR LOCAL CLERGY AND FAITH COMMUNITY LEADERS AS THESE INDIVIDUALS OFTEN SERVE AS THE PRIMARY SOURCE OF HEALTH INFORMATION AND ADVICE FOR MANY INDIVIDUALS.AS THE RATE OF ALZHEIMER'S DISEASE AND DEMENTIA CONTINUE TO GROW WITHIN OUR COMMUNITIES, WE WILL CONTINUE TO EXPAND OUR OFFERINGS TO THE COMMUNITY ON THESE ISSUES. THE ORGANIZATION WILL NOT ATTEMPT TO ADDRESS ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED IN THE CHNA. IN PARTICULAR, THE ORGANIZATION WILL NOT ATTEMPT TO ADDRESS THE TREATMENT OF ALZHEIMER'S DISEASE AND MENTAL ILLNESS. THE REASON THE ORGANIZATION WILL NOT ATTEMPT TO ADDRESS THESE NEEDS IS THAT CAPITAL CARING IS A HOSPICE ORGANIZATION THAT OPERATES TO PROVIDE PALLIATIVE AND SUPPORT CARE FOR THOSE FACING LIFE-LIMITING ADVANCED ILLNESSES. OTHER ORGANIZATIONS, SUCH AS ACUTE CARE HOSPITALS AND PSYCHIATRIC HOSPITALS, HAVE GREATER EXPERIENCE AND ARE IN A BETTER POSITION TO ADDRESS THE ONSET AND TREATMENT OF THESE ILLNESSES.AS DESCRIBED IN GREATER DETAIL IN THE CHNA, CAPITAL CARING'S COMMUNITY IS DEFINED AS THOSE INDIVIDUALS WHO HAVE OR WILL HAVE A LIFE-LIMITING ADVANCED ILLNESS AND LIVE IN THE CAPITAL CARING SERVICE AREA. IT IS THEORGANIZATION'S INTENTION TO ATTEMPT TO ADDRESS THE SHORTAGES/GAPS IDENTIFIED IN THE CHNA RELATED TO THE QUANTITY, QUALITY, OR ACCESS TO HOSPICE AND PALLIATIVE CARE SERVICES AVAILABLE TO ITS COMMUNITY.
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER	PART V, SECTION B, LINE 13H: THE HOSPITAL FACILITY DETERMINES THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUALS (THAT DO NOT QUALIFY FOR FREE CARE) FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THROUGH THE USE OF A SLIDING FEE SCHEDULE FOR FINANCIAL ASSISTANCE PATIENTS. THE SLIDING SCALE BEGINS AT A LEVEL BELOW THE RATES BILLED TO MEDICARE OR ANY COMMERCIAL INSURERS FOR SUCH CARE FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 300% OF THE FEDERAL POVERTY GUIDELINES AND GOES DOWN TO 25% OF FULL CHARGES (APPROXIMATELY 35-40% OF MEDICARE RATES) FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 225% OF THE FEDERAL POVERTY GUIDELINES. IN ADDITION, THE HOSPITAL FACILITY PROVIDES A 20% DISCOUNT TO ALL UNINSURED PATIENTS THAT HAVE FAMILY ANNUAL INCOME UP TO 400% OF THE FEDERAL POVERTY GUIDELINES AND DO NOT QUALIFY UNDER THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY. IF THE UNINSURED PATIENT IS DEEMED TO BE MEDICALLY INDIGENT, THEN THE HOSPITAL FACILITY WILL PROVIDE A GREATER DISCOUNT.
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER	PART V, SECTION B, LINE 18D: THE HOSPITAL FACILITY MAKES REASONABLE EFFORTS TO DETERMINE A PATIENT'S ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY BEFORE TURNING OVER THE UNPAID ACCOUNT TO A COLLECTION AGENCY FOR ATTEMPTED RECOVERY (NO OTHER 3RD PARTY COLLECTION ACTIVITY OR EXTRAORDINARY COLLECTION ACTIONS ARE UNDERTAKEN BY THE ORGANIZATION). THE HOSPITAL FACILITY VISITS EACH PATIENT BEFORE THE PATIENT IS ADMITTED TO THE FACILITY. AS PART OF THAT VISIT ANY INSURANCE COVERAGE OR ELIGIBILITY FOR MEDICAID IS DISCUSSED. IF IT IS APPARENT THAT INSURANCE COVERAGE OR MEDICAID COVERAGE IS NOT AVAILABLE, OR IS LIMITED, THEN THE FACILITY ENCOURAGES THE PATIENT TO APPLY FOR ITS FINANCIAL ASSISTANCE POLICY. IF THE PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE AT THAT TIME, THE FACILITY CONTINUES TO NOTIFY THE PATIENT OF THE EXISTENCE OF ITS FINANCIAL ASSISTANCE POLICY UPON ADMISSION TO THE FACILITY AND WITH EACH BILL THAT IS SENT TO THE PATIENT. ADDITIONALLY, THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED ON THE HOSPITAL FACILITY'S WEBSITE AND IS MADE AVAILABLE UPON REQUEST.
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER	PART V, SECTION B, LINE 21C: THE HOSPITAL FACILITY SOLELY PROVIDES HOSPICE AND PALLIATIVE CARE. AS A RESULT, THE HOSPITAL FACILITY DOES NOT PROVIDE ANY EMERGENCY CARE SERVICES.
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER	PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY DETERMINES THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE ELIGIBLE INDIVIDUALS (THAT DO NOT QUALIFY FOR FREE CARE) FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THROUGH THE USE OF A SLIDING FEE SCHEDULE FOR FINANCIAL ASSISTANCE PATIENTS. THE SLIDING SCALE BEGINS AT A LEVEL BELOW THE RATES BILLED TO MEDICARE OR ANY COMMERCIAL INSURERS FOR SUCH CARE FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 300% OF THE FEDERAL POVERTY GUIDELINES AND GOES DOWN TO 25% OF FULL CHARGES (APPROXIMATELY 35-40% OF MEDICARE RATES) FOR PATIENTS THAT HAVE FAMILY ANNUAL INCOME OF 225% OF THE FEDERAL POVERTY GUIDELINES.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER PART V, SECTION B, LINE 16A WEBSITE:	WWW.CAPITALCARING.ORG
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER PART V, SECTION B, LINE 16B WEBSITE:	WWW.CAPITALCARING.ORG
CAPITAL HOSPICE HALQUIST MEMORIAL CENTER PART V, SECTION B, LINE 16C WEBSITE:	WWW.CAPITALCARING.ORG

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?16
Name and address		Type of Facility (describe)
1	CAPITAL HOSPICE 2900 TELESTAR COURT FALLS CHURCH,VA220421206	HOSPICE OFFICE
2	CAPITAL HOSPICE 209 GIBSON STREET LEESBURG,VA201762122	HOSPICE OFFICE
3	CAPITAL HOSPICE 10530 LINDEN LAKE PLAZA SUITE 200 MANASSAS,VA201096434	HOSPICE OFFICE
4	CAPITAL HOSPICE 5845 RICHMOND HIGHWAY SUITE 150 ALEXANDRIA,VA223031868	HOSPICE OFFICE
5	CAPITAL HOSPICE 950 NORTH GLEBE ROAD SUITE 500 ARLINGTON,VA222034183	HOSPICE OFFICE
6	CAPITAL HOSPICE 50 F STREET NW SUITE 3300 WASHINGTON,DC200011565	HOSPICE OFFICE
7	CAPITAL HOSPICE 1801 MCCORMICK DRIVE SUITE 180 LARGO,MD207745345	HOSPICE OFFICE
8	CAPITAL HOSPICE 4501 EMPIRE COURT FREDERICKSBURG,VA224081949	HOSPICE OFFICE
9	CAPITAL HOSPICE ADLER CENTER FOR CARING 24419 MILLSTREAM DRIVE ALDIE,VA201055837	HOSPICE OFFICE
10	CPCC ALEXANDRIA CLINIC 4660 KENMORE AVENUE SUITE 1018 ALEXANDRIA,VA223041306	PALLIATIVE CARE CLINIC
11	HALQUIST MEMORIAL INPATIENT CENTER 4715 NORTH 15TH STREET ARLINGTON,VA222052640	PALLIATIVE CARE CLINIC
12	CPCC PROSPERITY CLINIC 8503 ARLINGTON BLVD SUITE 400 FAIRFAX,VA22031	PALLIATIVE CARE CLINIC
13	CPCC LEESBURG CLINIC 44035 RIVERSIDE PARKWAY SUITE 300 LEESBURG,VA20176	PALLIATIVE CARE CLINIC
14	CPCC DC CLINIC 110 IRVING STREET NW WASHINGTON,DC20010	PALLIATIVE CARE CLINIC
15	CPCC FREDERICKSBURG CLINIC 4501 EMPIRE COURT FREDERICKSBURG,VA224081949	PALLIATIVE CARE CLINIC
16	CAPITAL HOSPICE CTR FOR PAIN & PALLIATIV 24419 MILLSTREAM DRIVE ALDIE,VA201055837	PALLIATIVE CARE CLINIC

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	IN ADDITION TO USING THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY, THE ORGANIZATION WILL, ON A CASE BY CASE DETERMINATION, ASSESS A PATIENT'S LIQUID ASSETS. THE PATIENT'S LIQUID ASSETS WILL BE ASSESSED IF THE PATIENT HAS HIGH MEDICAL DEBT OUTSTANDING.
PART I, LINE 7:	THE COSTING METHODOLOGY USED TO CALCULATE AMOUNTS REPORTED IN LINE 7 WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.
PART I, LINE 7G:	CAPITAL HOSPICE UNDERTAKES SEVERAL PROGRAMS AT A SIGNIFICANT LOSS IN ORDER TO MEET IDENTIFIED NEEDS IN THE COMMUNITY. FIRST, CAPITAL HOSPICE OPERATES A 15 BED INPATIENT UNIT FOR TREATMENT OF HOSPICE PATIENTS THAT NEED CONSTANT MONITORING BUT WHOSE PAIN AND SYMPTOMS CANNOT BE ADEQUATELY TREATED AT HOME. THE REIMBURSEMENT FOR THIS PROGRAM, PRIMARILY FROM MEDICAID AND MEDICARE, IS SIGNIFICANTLY LESS THAN THE COST TO OPERATE. IN ADDITION, CAPITAL HOSPICE PROVIDES CONTINUOUS CARE SERVICES FOR HOSPICE PATIENTS THAT NEED MONITORING, BUT WHO CAN REMAIN AT HOME. THE ORGANIZATION PROVIDES SUCH CONTINUOUS HOME CARE SERVICES PRIMARILY TO MEDICARE PATIENTS ANND IS REIMBURSED SIGNIFICANTLY LESS THAN COST.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE REPORTED IN THE ORGANIZATIONS AUDITED FINANCIAL STATEMENT IS $3,528,684, WHICH WAS REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGES OF TOTAL EXPENSES.
PART I, LINE 5	IT IS THE ORGANIZATION'S POLICY TO PROVIDE FINANCIAL ASSISTANCE TO ANY INDIVIDUAL THAT QUALIFIES UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, REGARDLESS OF THE AMOUNT OF CHARITY CARE PROVIDED BY THEORGANIZATION DURING THE YEAR.
PART III, LINE 4:	WE DO NOT HAVE A BAD DEBT FOOTNOTE IN OUR FINANCIAL STATEMENTS. THE FOOTNOTE TITLED "PATIENT ACCOUNTS RECEIVABLE" STATES, "PATIENT ACCOUNTS RECEIVABLE INCLUDE BILLINGS TO MEDICARE, MEDICAID (COMMONWEALTH OF VIRGINIA, DISTRICT OF COLUMBIA AND MARYLAND MEDICAL ASSISTANCE), BLUE CROSS (BLUE CROSS AND BLUE SHIELD OF THE NATIONAL CAPITAL AREA, CAREFIRST AND ANTHEM), TRICARE, COMMERCIAL INSURERS, AND SELF PAYING PATIENTS. PATIENT ACCOUNTS RECEIVABLE ARE SHOWN NET OF ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS, WHICH IS ESTIMATED BY MANAGEMENT BASED ON HISTORICAL COLLECTION ACTIVITIES. WE DO NOT INCLUDE ANY OF THE BAD DEBT AS A COMMUNITY BENEFIT. THE ORGANIZATION DOES NOT BELIEVE THAT ANY OF THE BAD DEBT IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANZATIONS FINANCIAL ASSISTANCE POLICY.
PART III, LINE 8:	THE COSTING SOURCE IS THE MEDICARE COST REPORT AND THE METHODOLOGY IS MEDICARE ALLOCABLE COSTS TO MEDICARE REVENUE RECEIVED.
PART III, LINE 9B:	THE ORGANIZATION PROVIDES FINANCIAL ASSISTANCE TO ALL PATIENTS THAT QUALIFY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE ORGANIZATION DOES NOT MAKE ANY ATTEMPT TO COLLECT FROM SUCH PATIENTS, IF WE BECOME AWARE THAT A PATIENT THAT WAS NOT INITIALLY IDENTIFIED AS QUALIFYING FOR FINANCIAL ASSISTANCE DOES IN FACT QUALIFY FOR FINANCIAL ASSISTANCE, THEN THE PATIENT RECEIVES FINANCIAL ASSISTANCE AND ALL COLLECTION EFFORTS (IF COMMENCED) ARE STOPPED IMMEDIATELY. PATIENTS DETERMINED TO BE FULLY ELIGIBLE FOR FINANCIAL ASSISTANCE SUBSEQUENT TO THE DATE OF SERVICE MAY BE ELIGIBLE FOR A REFUND OF PAYMENTS MADE IF IT IS DETERMINED THAT THE PATIENT WAS ELIGIBLE FOR FINANCIAL ASSISTANCE AT THE TIME OF SERVICE.
PART VI, LINE 2:	ANALYSIS RELATED TO THE NEEDS OF THE COMMUNITY IS AN INTERGRAL PART OF CAPITAL HOSPICE'S STRATEGIC PLANNING PROCESS. EMPIRICAL DATA IS COLLECTED BY: REFERRAL CENTER STAFF (WHICH FACILITATES ADMISSION INTO OUR PROGRAM); ACCESS STAFF, WHO INTERACT DIRECTLY WITH THE HOSPITALS, CLINICS, NURSING HOMES, ASSISTED LIVING FACILITIES AND PHYSICIAN PRACTICES THAT SERVE AS THE MAIN SOURCE OF REFERRALS INTO OUR CARE; UTREACH STAFF, WHO INTERACT DIRECTLY WITH MUNICIPAL AGENCIES, FAITH COMMUNITIES AND COMMUNITY ORGANZIATIONS; EDUCATION STAFF, WHO INTERACT WITH LOCAL UNIVERSITIES, AND PUBLIC RELATIONS STAFF ARE PRESENT AT COMMUNITY HEALTH FAIRS AND OTHER PUBLIC EVENTS. *ADDITIONALLY, CAPITAL HOSPICE MONITORS AND ANALYZES GOVERNMENT-PROVIDED STATISTICS TO COMPARE THE NUMBER OF DEATHS SERVED BY HOSPICE TO THE TOTAL NUMBER OF DEATHS IN OUR SERVICE AREA TO REVEAL WHERE SERVICES ARE UNDER-UTILIZED.
PART VI, LINE 3:	ALL PATIENTS RECEIVE AN ADMISSION VISIT BEFORE BEING ADMITTED INTO OUR HOSPICE CARE. AS PART OF THAT VISIT ANY INSURANCE COVERAGE IS VERIFIED. IF THE PATIENT HAS NO, OR LIMITED INSURANCE COVERAGE, THEN WE INQUIRE AS TO THE PATIENT'S ABILITY TO BE COVERED BY MEDICAID. IF IT IS APPARENT THAT NO MEDICAID COVERAGE IS AVAILABLE THEN THE PATIENT IS ENCOURAGED TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION FORM. BASED ON THE INFORMATION OBTAINED FROM THE FINANCIAL ASSISTANCE FORM THEN FINANCIAL ASSISTANCE IS GRANTED. IF THE PATIENT DOES NOT APPLY FOR FINANCIAL ASSISTANCE AT THE TIME OF THE ADMISSION VISIT, THE FACILITY CONTINUES TO NOTIFY THE PATIENT OF THE EXISTENCE OF ITS FINANCIAL ASSISTANCE POLICY UPON ADMISSION TO THE FACILITY AND WITH THE BILL THAT IS SENT TO THE PATIENT. ADDITIONALLY, THE EXISTENCE OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE AND IS MADE AVAILABLE UPON REQUEST.
PART VI, LINE 4:	CAPITAL HOSPICE SERVES AN ETHNIC, RACIAL, RELIGIOUS AND CULTURALLY DIVERSE REGION THAT ENCOMPASSES MUCH OF TWO STATES (VIRGINIA AND MARYLAND) AND THE DISTRICT OF COLUMBIA. COMMUNITIES SPAN THE SPECTRUM FROM URBAN/INNER CITY (DC) TO SUBURBAN (PRINCE GEORGE'S COUNTY, MD., FAIRFAX COUNTY, VA) TO RURAL (FAUQUIER COUNTY AND PARTS OF LOUDOUN COUNTY, VA). THE SOCIO-ECONOMIC COMPOSITION OF THE COMMUNITIES WE SERVE IS EQUALLY DIVERSE, RANGING FROM THE INDIGENT HOMELESS TO THE LOW-MODERATE INCOME TO ONE OF THE MOST AFFLUENT COUNTIES IN THE UNITED STATES. OUR SERVICE AREA ALSO IS HOME TO A VERY LARGE INTERNATIONAL COMMUNITY WITH A MULTITUDE OF LANGUAGES, TRADITIONS AND VALUES.
PART VI, LINE 5:	REGARDLESS OF THE VENUE OR CIRCUMSTANCE, CAPITAL HOSPICE STAFF AND VOLUNTEERS MAKE CLEAR THAT LACK OF INSURANCE OR RESOURCES TO PAY FOR OUR SERVICES IS NOT A BARRIER TO RECEIVING CARE. THAT ALSO IS CLEARLY STATED IN OUR LITERATURE AND OUR WEBSITE. ADDITIONALLY, CAPITAL HOSPICE PROVIDES GRIEF AND LOSS SERVICES (SEMINARS, WORKSHOPS, SUPPORT GROUPS) THROUGHOUT OUR SERVICE AREA, OFFERED AT NO CHARGE; THIS INCLUDES AN ANNUAL SUMMER WEEKEND CAMP FOR GRIEVING CHILDREN, TEENS AND ADULTS. ATTENDING/REFERRING PHYSICIANS FROM THE COMMUNITY ARE ENCOURAGED TO PARTICIPATE IN OR FOLLOW THEIR PATIENTS' CARE. PHYSICIANS SEEKING BOARD CERTIFICATION IN THE MEDICAL SUB-SPECIALTY OF PALLIATIVE MEDICINE CAN APPLY FOR THE PHYSICIAN FELLOWSHIP PROGRAM CAPITAL HOSPICE OFFERS JOINTLY WITH THE NATIONAL INSTITUTES OF HEALTH CLINICAL CENTER. HOSPICE PARTNERS WITH AREA HOSPITALS, NURSING HOMES AND PHYSICIAN PRACTICES TO PROVIDE FACILITY CLINICS FOR PALLIATIVE CARE CONSULTATIONS REQUESTED BY COMMUNITY PHYSICIANS. COMMUNITY ADVISORY BOARDS ARE UTILIZED TO DEVELOP STRATEGIES TO INCREASE AWARENESS OF CAPITAL HOSPICE SERVICES WITHIN THEIR RESPECTIVE COMMUNITIES. CAMINANDO JUNTOS IS AN OUTREACH PROGRAM DEDICATED TO RAISING AWARENESS OF THE AVAILABILITY OF CAPITAL HOSPICE SERVICES WITHIN THE LATINO COMMUNITY. CAPITAL HOSPICE STAFF REGULARLY CONDUCT TEACHING/TRAINING SESSIONS TO IMPROVE CARE PROVIDED JOINTLY WITH NURSING HOMES, HOSPITALS AND ASSISTED LIVING FACILITIES. THESE ARE OFFERED AT OUR PARTNERS' FACILITIES FOR NO CHARGE. CAPITAL HOSPICE REGULARLY OFFERS PALLIATIVE CARE GRAND ROUNDS AND JOSEFINO MAGNO PALLIATIVE CARE CONFERENCE SERIES AS INSTRUCTIONAL SESSIONS FOR COMMUNITY PHYSICIANS AND OTHER PROFESSIONAL HEALTH CARE PROVIDERS; PARTICIPATES IN AND OFFERS "VIEWING SITES" TO THE COMMUNITY FOR THE ANNUAL HOSPICE FOUNDATION OF AMERICA EDUCATIONAL TELECONFERENCE. MORE THAN A MAJORITY OF CAPITAL HOSPICE'S GOVERNING BODY IS COMPRISED OF INDEPENDENT PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. CAPITAL HOSPICE HAS AN OPEN MEDICAL STAFF POLICY, PURSUANT TO WHICH ALL QUALIFIED PHYSICIANS MAY BECOME MEMBERS OF THE MEDICAL STAFF. ANY SURPLUS FUNDS EARNED BY CAPITAL HOSPICE ARE USED TO IMPROVE PATIENT CARE AND PROVIDE FURTHER COMMUNITY BENEFIT.
PART VI, LINE 6:	CAPITAL HOSPICE IS NOT PART OF AN AFFILIATED GROUP.

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Yes

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

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 in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1MALENE DAVISPRESIDENT/CEO	(i) (ii)	421,885 ............................... 0	100,817 ............................... 0	18,342 ............................... 0	22,500 ............................... 0	26,985 ............................... 0	590,529 ............................... 0	0 ............................... 0
2DAVID SCHWINDEXECUTIVE VP CFO	(i) (ii)	216,569 ............................... 0	41,957 ............................... 0	829 ............................... 0	18,654 ............................... 0	31,540 ............................... 0	309,549 ............................... 0	0 ............................... 0
3JAMES CAMERON MUIREVP QUALITY & ACCESS	(i) (ii)	268,680 ............................... 0	53,638 ............................... 0	394 ............................... 0	17,500 ............................... 0	33,967 ............................... 0	374,179 ............................... 0	0 ............................... 0
4MICHAEL BYAS-SMITHMEDICAL DIRECTOR	(i) (ii)	281,249 ............................... 0	0 ............................... 0	101 ............................... 0	16,415 ............................... 0	10,152 ............................... 0	307,917 ............................... 0	0 ............................... 0
5DIANE TRAFICANTEHPM PHYSICIAN	(i) (ii)	183,194 ............................... 0	0 ............................... 0	381 ............................... 0	0 ............................... 0	5,655 ............................... 0	189,230 ............................... 0	0 ............................... 0
6MUHAMMAD M SIDDIQUINBRHD LEAD PHYSICIAN	(i) (ii)	180,709 ............................... 0	0 ............................... 0	48 ............................... 0	0 ............................... 0	15,211 ............................... 0	195,968 ............................... 0	0 ............................... 0
7DEBORAH CARLVP - HUMAN RESOURCES	(i) (ii)	156,637 ............................... 0	19,371 ............................... 0	565 ............................... 0	6,345 ............................... 0	18,834 ............................... 0	201,752 ............................... 0	0 ............................... 0
8IMRAN SHARIFFHPM PHYSICIAN	(i) (ii)	173,307 ............................... 0	0 ............................... 0	48 ............................... 0	0 ............................... 0	5,581 ............................... 0	178,936 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

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
PART I, LINE 6	IF THE ORGANIZATION REACHES ITS BUDGETED AMOUNT OF NET INCOME FROM OPERATIONS FOR THE YEAR THEN ALL EMPLOYEES ARE ELIGIBLE FOR A BONUS, WHICH IS BASED UPON CERTAIN KEY METRICS THAT ARE UNRELATED TO NET INCOME.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
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Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
CAPITAL HOSPICE

Employer identification number
54-1920770

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	FAIRFAX COUNTY ECONOMIC DEVELOPMENT AUTHORITY	91-1910090	30382YAA8	01-29-2009	7,200,000	PURCHASE AND RENOVATION OF A FACILITY		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	820,000
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	7,200,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	225,106
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	6,794,894
11 Other spent proceeds . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2014

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .
6 Total of lines 4 and 5 . . . . . . . . . . . . .
7 Does the bond issue meet the private security or payment test? . . . . .		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X
b Exception to rebate? . . . . . . . .		X
c No rebate due? . . . . . . . .	X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .	X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X
b Name of provider . . . . . . . . .	BB&T
c Term of hedge . . . . . . . . . .	10.000000000000
d Was the hedge superintegrated? . . . .		X
e Was the hedge terminated? . . . . . .		X

Schedule K (Form 990) 2014

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

PART IV, LINE 2C

ALL OF THE PROCEEDS OF THE TAX-EXEMPT BOND ISSUANCE WERE SPENT IMMEDIATELY UPON RECEIPT: $225,106 FOR ISSUANCE COSTS AND $6,974,894 TO PURCHASE THE ORGANIZATION'S PRIMARY FACILITY (THE TAX EXEMPT BOND ISSUE'S GOVERNMENTAL PURPOSE). AS A RESULT, NONE OF THE SALE PROCEEDS OF THE TAX-EXEMPT BOND ISSUANCE WERE USED TO MAKE HIGHER YIELDING INVESTMENTS FOR NONPURPOSE INVESTMENTS. IN ADDITION, THERE ARE NOT REPLACEMENT PROCEEDS WITH RESPECT TO THIS TAX-EXEMPT BOND ISSUANCE, AS THERE IS NOT A DIRECT NEXUS BETWEEN ANY OF THE ORGANIZATION'S FUNDS AND THE BOND ISSUE OR THE GOVERNMENTAL PURPOSE OF THE ISSUE. BASED UPON THE FOREGOING, THE ORGANIZATION WAS ABLE TO DETERMINE THAT THERE WAS NO REBATABLE ARBITRAGE WITH RESPECT TO THE TAX-EXEMPT BOND ISSUANCE AS OF JUNE 30, 2015.

PART IV, LINE 7

THE ORGANIZATION HAS ONLY UNDERTAKEN ONE TAX-EXEMPT BOND ISSUANCE, WHICH IS THE $7,200,000 VARIABLE INTEREST FAIRFAX COUNTY ECONOMIC DEVELOPMENT AUTHORITY BONDS ISSUED ON JANUARY 29, 2009 THAT IS REPORTED IN PART I. ALL OF THE PROCEEDS OF THIS TAX-EXEMPT BOND ISSUANCE WERE SPENT IMMEDIATELY UPON RECEIPT: $225,106 FOR ISSUANCE COSTS AND $6,974,894 TO PURCHASE THE ORGANIZATION'S PRIMARY FACILITY (THE TAX EXEMPT BOND ISSUE'S GOVERNMENTAL PURPOSE). AS A RESULT, NONE OF THE PROCEEDS OF THE TAX-EXEMPT BOND ISSUANCE WERE USED TO MAKE HIGHER YIELDING INVESTMENTS FOR NONPURPOSE INVESTMENTS, WHICH ARE REGULATED UNDER SECTION 148 OF THE INTERNAL REVENUE CODE. SINCE THE ORGANIZATION HAS NOT USED THE PROCEEDS FROM ANY TAX-EXEMPT BOND ISSUANCE TO MAKE HIGHER YIELDING INVESTMENTS OF NONPURPOSE INVESTMENTS, THE ORGANIZATION HAS NOT YET ESTABLISHED WRITTEN PROCEDURES TO MONITOR THE REQUIREMENTS OF SECTION 148.

Schedule K (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
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Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefiting 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) 2014

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) SUSAN MUIR	WIFE OF KEY EMPLOYEE CAMERON MUIR	2,020	ADLER CENTER ART PROJECT		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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete 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 image

Information about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

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 ....	X	7	25,252	FMV
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..	X		25	FMV
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	1	561	FMV
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 .....	X	2	160	FMV
19 Food inventory ...	X	6	2,480	FMV
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( VARIOUS HOUSEHOLD ITEMS )	X	34	42,530	FMV
26 Other ( VARIOUS TRAVEL, MEAL & ENTERTAINMENT TICKETS )	X	21	39,046	FMV
27 Other ( GIFT CERTIFICATES )	X	15	3,390	FMV
28 Other ( JEWELRY )	X	2	446	FMV

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 ...

Yes

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

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

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) (2014)

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
PART I, LINE 32B:	THE FIRM ROBINSON & LUKENS WAS USED TO SELL ANY STOCK GIFTS.

Schedule M (Form 990) (2014)

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 990-EZ 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

2014

Open to Public
Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11	THE 990 FOR CAPITAL HOSPICE IS REVIEWED BY THE CONTROLLER AND THE EXECUTIVE VICE PRESIDENT/CHIEF FINANCIAL OFFICER, WHO WILL SIGN THE RETURN WHEN IT IS FINALIZED. NEXT THE 990 IS SENT TO ALL THE MEMBERS OF THE BOARD OF TRUSTEES INCLUDING THE PRESIDENT OF CAPITAL HOSPICE FOR THEIR REVIEW AND TO SOLICIT ANY COMMENTS OR QUESTIONS. THE AUDIT COMMITTEE OF THE BOARD MEETS TO REVIEW AND DISCUSS THE FORM 990 IN DETAIL. THIS MEETING IS OPEN TO ALL BOARD MEMBERS INCLUDING THE COMPENSATION AND OTHER COMMITTEE CHAIRS. AFTER THE FORM 990 HAS BEEN REVIEWED BY THE BOARD AND ANY COMMENTS OR QUESTIONS FROM BOARD MEMBERS HAVE BEEN RESPONDED TO, THE FORM 990 WILL BE FINALIZED, SIGNED AND FILED.
FORM 990, PART VI, SECTION B, LINE 12C	ALL BOARD MEMBERS, OFFICERS AND KEY MANAGERS ARE REQUIRED TO REPORT ANY REAL OR POTENTIAL OR PERCEIVED CONFLICT OF INTEREST INVOLVING THEM OR ANOTHER PERSON BY PROMPTLY FILING A WRITTEN DISCLOSURE STATEMENT WITH THE PRESIDENT OR CHAIR OF THE BOARD OF TRUSTEES. THE PRESIDENT WILL REVIEW ALL SUCH STATEMENTS AND THE ANNUAL DISCLOSURE STATEMENTS AND DISCUSS WITH THE CHAIR OF THE BOARD ANY POTENTIAL CONFLICTS OF INTEREST. IF THE PRESIDENT AND THE CHAIR OF THE BOARD DETERMINE THAT A POTENTIAL CONFLICT EXISTS, THEN THE BOARD SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND ALLOW THE PERSON TO EXPLAIN AND DISCLOSE. FOR ANY TRANSACTION/ARRANGEMENT DISCUSSED DURING A BOARD MEETING FOR WHICH A CONFLICT OF INTEREST IS DEEMED TO EXIST, THE AFFECTED BOARD MEMBER SHALL NOT BE COUNTED IN DETERMINING THE QUOROM FOR THE MEETING BUT SHALL BE PERMITTED TO BRIEFLY STATE HIS POSITION ON THE MATTER AND ANSWER PERTINENT QUESTIONS OF OTHER BOARD MEMBERS BEFORE VACATING THE GOVERNING BOARD. THE BOARD MEMBER SHALL LEAVE THE GOVERNING BOARD AND A MAJORITY OF THE REMAINING BOARD MEMBERS SHALL DETERMINE WHETHER TO UNDERTAKE SUCH TRANSACTION/ARRANGEMENT. IF THE BOARD DECIDES THAT A PERSON HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE BOARD SHALL TAKE CORRECTIVE ACTION.
FORM 990, PART VI, SECTION B, LINE 15	THE INDEPENDENT COMPENSATION COMMITTEE OF CAPITAL HOSPICE HAS ENGAGED TOWERS WATSON, AN INDEPENDENT CONSULTING GROUP, EXPERIENCED IN THIS WORK, TO CONDUCT A SURVEY TO GATHER COMPARABLE, VALID MARKET DATA OF EXECUTIVE COMPENSATION FROM BOTH TAX-EXEMPT AND FOR-PROFIT EMPLOYERS, OF SIMILAR SIZE AND COMPARABLE SCOPE FOR THE CEO AND OTHER KEY PERSONNEL. THE REPORT WAS REVIEWED AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE AFTER THOROUGH DISCUSSION OF THE DATA, IT SOURCES AND THE FINDINGS. CAPITAL HOSPICE, AS SUBJECT TO INTERMEDIATE SANCTIONS UNDER INTERNAL REVENUE CODE (IRC) SECTION 4958, CONSIDERS THAT THE INTERMEDIATE SANCTIONS MARKET BENCHMARKING METHODOLOGY FOR DISQUALIFIED INDIVIDUALS, CONDUCTED BY TOWERS WATSON, HAS PROVIDED A VALID AND ROBUST MEANS OF DETERMINING MARKET BASED COMPENSATION COMPETITIVENESS. CAPITAL HOSPICE HAS APPOINTED AN INDEPENDENT COMPENSATION COMMITTEE TO REVIEW AND APPROVE (WITH CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION) THE COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES OF CAPITAL HOSPICE. THE REVIEW IS DONE IN CONJUNCTION WITH INDEPENDENT MARKET REVIEW AND FINDINGS PRESENTED FROM TOWERS WATSON.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	PHYSICIAN SERVICE: PROGRAM SERVICE EXPENSES 298,538. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 298,538. CONTRACT SERVICES NURSING HOME : PROGRAM SERVICE EXPENSES 13,978,151. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,978,151. CONTRACT SERVICES LABOR : PROGRAM SERVICE EXPENSES 99,934. MANAGEMENT AND GENERAL EXPENSES 42,101. FUNDRAISING EXPENSES 65,134. TOTAL EXPENSES 207,169. CONSULTANTS: PROGRAM SERVICE EXPENSES 153,738. MANAGEMENT AND GENERAL EXPENSES 574,806. FUNDRAISING EXPENSES 253,284. TOTAL EXPENSES 981,828. CONTRACT SERVICES INPATIENT : PROGRAM SERVICE EXPENSES 602,628. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 602,628. CONTRACT SERVICES OTHER PATIENT RELATED : PROGRAM SERVICE EXPENSES 505,934. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 505,934. CONTRACT SERVICES OTHER : PROGRAM SERVICE EXPENSES 230,820. MANAGEMENT AND GENERAL EXPENSES 243,956. FUNDRAISING EXPENSES 425. TOTAL EXPENSES 475,201.
FORM 990, PART XI, LINE 9:	UNREALIZED LOSS ON INTEREST RATE SWAP -506,286. NET ASSETS RELEASED FROM RESTRICTION -919,216.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

CAPITAL HOSPICE

Employer identification number

54-1920770

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) CAPITAL PALLIATIVE CARE CONSULTANTS 2900 TELESTAR CT FALLS CHURCH,VA22042 52-2361003	PALLIATIVE	MD	1,321,348	5,948,033	CAPITAL HOSPICE

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?
(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	Yes	No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No

Schedule R (Form 990) 2014

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) 2014

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

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) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE MISSION OF CAPITAL HOSPICE IS TO IMPROVE CARE FOR THOSE FACING LIFE-LIMITING ILLNESSES THROUGH DIRECT SUPPORT OF PATIENTS AND THEIR FAMILIES, PUBLIC EDUCATION AND ADVOCACY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	835
6	Total number of volunteers (estimate if necessary) .............	6	713
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	4,500
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-2,220

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,306,384	5,781,461
9	Program service revenue (Part VIII, line 2g) .........	80,099,628	86,435,085
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	768,472	986,216
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-291,347	-145,486
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	85,883,137	93,057,276
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	16,000	6,550
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)	48,928,962	50,637,591
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 2,033,056
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	32,542,970	38,040,980
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	81,487,932	88,685,121
19	Revenue less expenses. Subtract line 18 from line 12.......	4,395,205	4,372,155
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	75,485,861	80,337,656
21	Total liabilities (Part X, line 26).............	13,778,618	15,209,296
22	Net assets or fund balances. Subtract line 21 from line 20.....	61,707,243	65,128,360

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 68,659,210 including grants of $ 6,550 ) (Revenue $ 80,544,525 )
	CAPITAL HOSPICE PROVIDES EXPERT MEDICAL, EMOTIONAL, SPIRITUAL AND PRACTICAL CARE AND SUPPORT TO PATIENTS WITH SERIOUS, PROGRESSIVE ILLNESS AND THEIR FAMILIES 24 HOURS A DAY, SEVEN DAYS A WEEK TO PATIENTS WHEREVER THEY LIVE BY QUALIFIED PHYSICIANS, NURSES, NURSES' AIDES, SOCIAL WORKERS, NON-DENOMINATIONAL CHAPLAINS AND OTHER PROFESSIONALS. IT IS THE OBJECTIVE OF CAPITAL HOSPICE TO PROVIDE CARE TO ANYONE MEDICALLY ELIGIBLE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. CAPITAL HOSPICE PROVIDED SERVICES TO 5,815 PATIENTS DURING 2014 AND HAD 420,531 PATIENT DAYS OF CARE. CAPITAL HOSPICE HAD COSTS RELATED TO SERVICES AND SUPPLIES UNDER ITS CHARITY CARE POLICY OF APPROXIMATELY $2,623,000 IN 2014. IN ADDITION, CAPITAL HOSPICE PROVIDED UNCOMPENSATED CARE, WHERE REIMBURSEMENT FOR SERVICES IS LESS THAN THE ACTUAL COST OF CARE PROVIDED, OF APPROXIMATELY $3,095,000.

4b	(Code: ) (Expenses $ 4,661,153 including grants of $ ) (Revenue $ 3,725,418 )
	HALQUIST MEMORIAL INPATIENT CENTER AND THE ADLER CENTER FOR CARING PROVIDES CARE FOR OUR HOSPICE PATIENTS THAT NEED CONSTANT MONITORING AND WHOSE PAIN AND SYMPTOMS CAN'T BE ADEQUATELY MANAGED AT HOME. IT IS THE OBJECTIVE OF THE HALQUIST MEMORIAL INPATIENT CENTER AND THE ADLER CENTER FOR CARING TO MAKE OUR PATIENTS AS SYMPTOM FREE AND AS COMFORTABLE AS POSSIBLE. THE HALQUIST MEMORIAL INPATIENT CENTER PROVIDED CARE TO 652 PATIENTS AND HAD 4,877 PATIENT DAYS OF CARE IN 2014. THE ADLER CENTER FOR CARING PROVIDED CARE TO 112 PATIENTS AND HAD 697 PATIENT DAYS OF CARE IN 2014.

4c	(Code: ) (Expenses $ 6,186,949 including grants of $ ) (Revenue $ 2,165,142 )
	CAPITAL PALLIATIVE CARE CONSULTANTS PROVIDES PHYSICIAN SERVICES TO OUR HOSPICE PATIENTS, AND TO NON-HOSPICE ELIGIBLE PATIENTS WHO ARE IN NEED OF SYMPTOM MANAGEMENT. IT IS THE OBJECTIVE OF CAPITAL PALLIATIVE CARE CONSULTANTS TO PROVIDE PHYSICIAN SERVICES TO ALL PATIENTS IN NEED OF SYMPTOM MANAGEMENT, REGARDLESS OF THE PATIENT'S ABILITY TO PAY. CAPITAL PALLIATIVE CARE CONSULTANTS PROVIDED 19,162 PATIENT VISITS DURING 2014.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses79,507,312

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,118,721	0	229,339

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c		478,582
d	Related organizations...1d
e	Government grants (contributions)1e		79,110

f	All other contributions, gifts, grants, and similar amounts not included above1f		5,223,769

g	Noncash contributions included in lines 1a-1f:$		113,890
h	Total. Add lines 1a-1f.......			5,781,461
			Business Code
2a	PATIENT SERVICES			86,435,085	86,435,085
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			86,435,085
3	Investment income (including dividends, interest, and other similar amounts).......			713,052			713,052
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	273,367
b	Less: cost or other basis and sales expenses	0	203
c	Gain or (loss)	273,367	-203
d	Net gain or (loss)..........			273,164			273,164
8a	Gross income from fundraising events (not including $ 478,582 of contributions reported on line 1c). See Part IV, line 18 ..
	a		127,900
b	Less: direct expenses ...b		482,172
c	Net income or (loss) from fundraising events..			-354,272			-354,272
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...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	MISCELLANEOUS		541700	184,677	180,177	4,500
b	CLINICAL TRIAL			20,945	20,945
c	FOOD SERVICE REVENUE			3,164	3,164
d	All other revenue ....
e	Total. Add lines 11a–11d ......			208,786
12	Total revenue. See Instructions......			93,057,276	86,639,371	4,500	631,944


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............				1
2	Savings and temporary cash investments .........			15,822,548	2	11,915,167
3	Pledges and grants receivable, net ...........			71,732	3	3,457
4	Accounts receivable, net .............			8,987,345	4	10,083,549
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
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
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			18,714	8	15,650
9	Prepaid expenses and deferred charges ..........			480,054	9	405,817
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	42,347,558
b	Less: accumulated depreciation .....	10b	12,306,697	25,867,326	10c	30,040,861
11	Investments—publicly traded securities ..........			15,936,357	11	17,288,566
12	Investments—other securities. See Part IV, line 11 .....			4,414,127	12	7,563,664
13	Investments—program-related. See Part IV, line 11 .....			3,400,000	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			487,658	15	3,020,925
16	Total assets. Add lines 1 through 15 (must equal line 34)......			75,485,861	16	80,337,656
17	Accounts payable and accrued expenses .........			5,997,122	17	7,103,096
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			6,565,000	20	6,380,000
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..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
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....................			1,216,496	25	1,726,200
26	Total liabilities. Add lines 17 through 25.........			13,778,618	26	15,209,296
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			42,043,901	27	58,198,077
28	Temporarily restricted net assets ...........			15,157,963	28	2,185,158
29	Permanently restricted net assets ...........			4,505,379	29	4,745,125
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			61,707,243	33	65,128,360
34	Total liabilities and net assets/fund balances ........			75,485,861	34	80,337,656