Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
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. | ||||||
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. | ||||||
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.") . | 1,905,018 | 2,541,632 | 2,787,926 | 2,281,380 | 3,251,854 | 12,767,810 |
| 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...... | 20,637,001 | 19,670,337 | 20,024,584 | 20,343,706 | 18,423,933 | 99,099,561 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 22,542,019 | 22,211,969 | 22,812,510 | 22,625,086 | 21,675,787 | 111,867,371 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 111,867,371 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 22,542,019 | 22,211,969 | 22,812,510 | 22,625,086 | 21,675,787 | 111,867,371 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 445 | 423 | 284 | 2,946 | 5 | 4,103 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 445 | 423 | 284 | 2,946 | 5 | 4,103 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 74,530 | 65,577 | 74,400 | 9,738 | 31,348 | 255,593 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 22,616,994 | 22,277,969 | 22,887,194 | 22,637,770 | 21,707,140 | 112,127,067 |
| 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) | |||||
| 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 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 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) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | KANSAS CITY HOSPICE, INC IS A NONPROFIT ORGANIZATION OFFERING A RANGE OF SERVICES FOR PEOPLE OF ALL AGES AND AT ANY STAGE OF SERIOUS ILLNESS. WE'VE BEEN PROVIDING COMFORT AND CARE TO THE SERIOUSLY ILL AND THEIR FAMILIES IN THE GREATER KANSAS CITY AREA SINCE 1980. a) KANSAS CITY HOSPICE HOMECARE PROGRAM - KANSAS CITY HOSPICE PROVIDES IN HOME (WHETHER IT BE A HOME, LONG TERM CARE FACILITY, ASSISTED LIVING FACILITY OR OTHER TYPE OF HOME) CARE TO PATIENTS RESIDING IN 9 COUNTIES. IN THE KANSAS CITY METROPOLITAN AREA SPECIALLY TRAINED STAFF, OF MULTIPLE DISCIPLINES, HELPS PATIENTS AND THEIR LOVED ONES WITH THE CHALLENGES OF LIFE-THREATENING ILLNESSES. WE HAD 1,259 ADMISSIONS AND 68,337 TOTAL CARE DAYS IN THIS YEAR. b) INPATIENT FACILITY HOSPICE HOUSE - IN APRIL OF 2006, KANSAS CITY HOSPICE OPENED THE FIRST INPATIENT HOSPICE FACILITY IN THE KANSAS CITY METROPOLITAN AREA. THE KANSAS CITY HOSPICE HOUSE PROVIDES THE COMFORTS OF HOME COUPLED WITH THE ADDITION OF EXPERTS AT THE PATIENT'S SIDE. THE 32-BED FACILITY ADDRESSES NOT ONLY MEDICAL AND NURSING CARE FOR PATIENTS FACING ADVANCED ILLNESSES, BUT ALSO EMOTIONAL AND SPIRITUAL SUPPORT FOR PATIENTS AND THEIR FAMILIES. THIS PROGRAM IS A SUPPLEMENT TO OUR HOMECARE PROGRAM IN THAT IT IS USED WHEN MEDICAL PROBLEMS ARE TOO SERIOUS TO MANAGE IN THE HOME SETTING. WE HAD 894 ADMISSIONS AND 7,881 CARE DAYS IN THIS YEAR. c) KANSAS CITY HOSPICE PALLIATIVE HOME CARE PROGRAM - THE PALLIATIVE HOME CARE PROGRAM IS LIKE OUR HOSPICE PROGRAM. AN INTERDISCIPLINARY TEAM FOCUSES ON SPECIALIZED MANAGEMENT OF PAIN AND OTHER SYMPTOMS. THE TEAM ADDRESSES EMOTIONAL NEEDS OF THE PATIENT AND FAMILY. ITS GOAL IS TO MAKE THE MOST OF THE REMAINING LIFE OF THE PATIENT. THE PROGRAM SERVES PEOPLE WHO HAVE LIFE-THREATENING ILLNESSES, BUT WHO WANT TO CONTINUE SEEKING CURATIVE TREATMENT OR WHO DO NOT WISH TO ELECT HOSPICE CARE. KANSAS CITY HOSPICE ALSO HAS A PALLIATIVE MEDICINE PROGRAM WHICH IS A PHYSICIAN SERVICE FOCUSING ON IMPROVING THE QUALITY OF LIFE FOR PATIENTS FACING LIFE-LIMITING ILLNESSES. THE PROGRAM ALSO ASSISTS PATIENTS' FAMILIES. CARE IS CONCENTRATED ON PREVENTING AND RELIEVING SUFFERING THROUGH TREATING PAIN AND SYMPTOMS AS WELL AS BY PROVIDING EMOTIONAL AND SPIRITUAL SUPPORT. WE HAD 347 ADMISSIONS AND 21,180 CARE DAYS IN THIS YEAR. d) CAROUSEL PROGRAM - WE HAVE A PEDIATRIC PROGRAM. OUR TEAM OF PROFESSIONALS PROVIDES SUPPORT TO FAMILIES. WHEN HOME IS NOT THE IDEAL SETTING OUR HOSPICE HOUSE IS AVAILABLE. WE CARED FOR 34 FAMILIES IN 2014. ADDITIONAL SERVICES TO CHILDREN INCLUDES GRIEF SUPPORT GROUP AND INDIVIDUAL COUNSELING PROGRAMS CALLED SOLACE HOUSE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN WAS PREPARED BY AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT OF KANSAS CITY HOSPICE, INC. THE KANSAS CITY HOSPICE, INC BOARD MEMBERS ARE PROVIDED A COPY OF THE KANSAS CITY HOSPICE, INC'S FORM 990 FOR PERSONAL REVIEW PRIOR TO SUBMISSION WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND OFFICERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE KCH BOARD EXECUTIVE COMMITTEE REVIEWS ALL FORMS WITH CONFLICTS. BOARD MEMBERS WILL ABSTAIN FROM PARTICIPATION IN PERTINENT DISCUSSION IF APPLICABLE WHEN CONFLICT OF INTEREST SITUATIONS ARISE. THE CONFLICT OF INTEREST FORM IS COMPLETED ANNUALLY BY ALL ONGOING BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE CEO'S SALARY IS REVIEWED BY THE EXECUTIVE COMMITIEE OF THE BOARD OF DIRECTORS. AN OUTSIDE COMPENSATION CONSULTANT'S COMPENSATION REVIEW IS RETAINED APPROXIMATELY EVERY THREE YEARS. THE CEO AND DIRECTOR OF HUMAN RESOURCES DETERMINE THE COMPENSATION FOR OFFICERS AND KEY MANAGEMENT PERSONNEL (WITH THE EXCEPTION OF THE CEO POSITION ITSELF). THREE SOURCES OF MARKET DATA ARE USED WHICH SPECIALIZE IN THE HOSPICE AND HEALTHCARE INDUSTRY. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | REQUESTS FOR INFORMATION ON FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE EVALUATED ON A CASE BY CASE BASIS BY THE ORGANIZATION'S MANAGEMENT. |
| FORM 990, PART XI, LINE 9 | NET ASSETS TRANSFERRED TO FOUNDATION $(2,231,992) |
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