TY 2015 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)
(1) Graham Cook Board Chair	1.0 ................. 3.0	X	X
(2) Debra Milligan Chair-Elect	1.0 ................. 3.0	X	X
(3) John Pittman Board Secretary	1.0 ................. 3.0	X	X
(4) Jesse Wurth Board Treasurer	1.0 ................. 3.0	X	X
(5) Mark Beerman Director	1.0 ................. 2.0	X
(6) Chuck Cutler Director (term ended 9/2015)	1.0 ................. 2.0	X
(7) Nick Henderson Director	1.0 ................. 2.0	X
(8) Gary Hoff Director (term ended 9/2015)	1.0 ................. 2.0	X
(9) Connie Isaacson Director	1.0 ................. 2.0	X
(10) Ann Jeffries Director (term ended 9/2015)	1.0 ................. 2.0	X
(11) Kent Mauck Director	1.0 ................. 2.0	X
(12) Matthew Meyer Director (term ended 9/2015)	1.0 ................. 2.0	X
(13) John Paule Director (term ended 9/2015)	1.0 ................. 2.0	X
(14) Rebecca Purnell Director (term ended 9/2015)	1.0 ................. 2.0	X
(15) Judith Ralston-Hansen Director (term ended 9/2015)	1.0 ................. 2.0	X
(16) Sally Reavely Director	1.0 ................. 2.0	X
(17) Ryan Riley Director (term ended 9/2015)	1.0 ................. 2.0	X

- 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

2015

Open to Public
Inspection

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

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 (Form 990 or 990-EZ))

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 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. 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—2015. 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—2014. 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) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	1,099,225	1,120,124	1,267,765	1,365,758	1,143,027	5,995,899
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......	19,140,361	17,166,087	14,155,098	16,117,394	16,610,872	83,189,812
3	Gross receipts from activities that are not an unrelated trade or business under section 513...	359,255	216,560	342,149	370,371	397,299	1,685,634
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge..						0
6	Total. Add lines 1 through 5.	20,598,841	18,502,771	15,765,012	17,853,523	18,151,198	90,871,345
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...	0	0	0	0	0	0
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.	0	0	0	0	0	0
c	Add lines 7a and 7b..	0	0	0	0	0	0
8	Public support. (Subtract line 7c from line 6.)						90,871,345

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...	20,598,841	18,502,771	15,765,012	17,853,523	18,151,198	90,871,345
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	136,899	118,904	166,510	242,578	190,037	854,928
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	136,899	118,904	166,510	242,578	190,037	854,928
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.) ..	31,059	175,557	6,825	50,258	2,411	266,110
13	Total support. (Add lines 9, 10c, 11, and 12.)..	20,766,799	18,797,232	15,938,347	18,146,359	18,343,646	91,992,383

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 2015 (line 8, column (f) divided by line 13, column (f)) .........

98.78 %

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

98.84 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

0.93 %

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

0.85 %

19a

331/3% support tests—2015. 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—2014. 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) 2015

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 (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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 section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

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

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 9a) 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 9a) 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 section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b 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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) 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) 2015

Page 6

Part V

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

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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, Part III, Line 12 Other Income	DESCRIPTION - EDUCATION/INSTITUTE REVENUE, COLUMN A - 31009.0, COLUMN B - 4879.0, COLUMN C - 6825.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 42713.0; DESCRIPTION - MISCELLANEOUS REVENUE, COLUMN A - 50.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 4520.0, COLUMN E - 2411.0, COLUMN F - 6981.0; DESCRIPTION - VNS PURCHASED SERVICES, COLUMN A - 0.0, COLUMN B - 170678.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 170678.0; DESCRIPTION - GRANT/CONTRACT, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 45738.0, COLUMN E - 0.0, COLUMN F - 45738.0;

Return Reference

Explanation

Schedule A, Part III, Line 12 Other Income

DESCRIPTION - EDUCATION/INSTITUTE REVENUE, COLUMN A - 31009.0, COLUMN B - 4879.0, COLUMN C - 6825.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 42713.0; DESCRIPTION - MISCELLANEOUS REVENUE, COLUMN A - 50.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 4520.0, COLUMN E - 2411.0, COLUMN F - 6981.0; DESCRIPTION - VNS PURCHASED SERVICES, COLUMN A - 0.0, COLUMN B - 170678.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 170678.0; DESCRIPTION - GRANT/CONTRACT, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 45738.0, COLUMN E - 0.0, COLUMN F - 45738.0;

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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

2015

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

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 other 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Hospice of Central Iowa

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization Hospice of Central Iowa		Employer identification number 42-1093718

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization Hospice of Central Iowa			Employer identification number 42-1093718
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.) $ 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) (2015)

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

2015

Open to Public Inspection

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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 on 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 on 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) 2015

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	5,916,649	5,966,062	5,379,485	4,855,151	4,425,852
b	Contributions ...			0	0	441,614
c	Net investment earnings, gains, and losses	58,921	241,923	852,603	642,926	164,926
d	Grants or scholarships ...			0	0
e	Other expenditures for facilities and programs ...	303,813	291,336	266,026	118,592	177,241
f	Administrative expenses ....			0	0
g	End of year balance ......	5,671,757	5,916,649	5,966,062	5,379,485	4,855,151

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

Board designated or quasi-endowment SchDMd Bullet

92.44 %

Permanent endowment SchDMd Bullet

3.47 %

Temporarily restricted endowment SchDMd Bullet

4.09 %

The percentages on 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)

Yes

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

Yes

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' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	999,532		999,532
b	Buildings	9,391,726	3,651,416	5,740,310
c	Leasehold improvements	115,620	132,779	-17,159
d	Equipment ...	3,049,186	2,854,743	194,443
e	Other ...
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				6,917,126

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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
(1)Beneficial interest in net assets held by HCI Foundation	8,013,178	F
(2)INVESTMENT IN AFFILIATE	668,158	F
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	8,681,336

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Due to affiliates	1,953,843
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,953,843
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
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
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
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
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Schedule D, Part V, Line 4 Intended uses of endowment funds

HCI Foundation holds endowment funds for the benefit of the organization; these endowment funds consist of numerous gifts established to fund and support the organization's mission.

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

The Organization is exempt from income taxes on income from related activities under Section 501(c)(3) of the U.S. Internal Revenue Code and corresponding state tax law. Accordingly, no provision has been made for federal or state income taxes. U.S. GAAP requires that a tax position is recognized as a benefit only if it is "more likely than not" that the tax position would be sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized is the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the "more likely than not" test, no tax benefit is recorded. Due to its tax exempt status, the Organization is not subject to U.S. federal income tax or state income tax. The Organization's Form 990 has not been subject to examination by the Internal Revenue Service or the state of Iowa for the last three years. The Organization does not expect the total amount of unrecognized tax benefits to significantly change in the next 12 months. The Organization recognizes interest and/or penalties related to income tax matters in income tax expense. The Organization did not have any amounts accrued for interest and penalties at June 30, 2016 or 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
Hospice of Central Iowa

Employer identification number
42-1093718

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1) QUALITY OF LIFE GRANTS	716	0	21,769	COST	MISCELLANEOUS NON-CARE ITEMS
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.

HCI Care Services' (HCI) quality of life fund is maintained to provide services and/or items not covered under per diem reimbursement for hospice care to patients in need and to provide occasional small life amenities that enhance the patients' and families' quality of life. All HCI patients are eligible for quality of life fund benefits, and all attempts are made to utilize community resources prior to using the quality of life fund. Best efforts are used to ensure that assistance is provided for patients in need and without other means of assistance or access to other benefactors, and that use and circumstances for the funds is consistent. The amount of funds provided is determined by HCI Foundation board of trustees within the annual budget. Reports of fund expenditures are submitted to the board of trustees on the statement of revenue and expense. Any staff member may submit a written or verbal request for utilization of quality of life funds. Requests less than $100 are approved by the patient's team director. Requests more than $100 are approved by a member of the executive team, who also ensures that appropriate oversight and review are conducted.

Schedule I (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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" on 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

2015

Open to Public Inspection

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

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 on 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 on 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 on 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," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

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

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

For persons listed on 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 ............

Yes

Were any amounts reported on 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" on 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) 2015

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 on 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 on 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)
1Kelly Dennis Vice President & CFO	(i) (ii)	0 ------------- 150,901	0 ------------- 10,850	0 ------------- 0	0 ------------- 5,286	0 ------------- 8,993	0 ------------- 176,030	0 ------------- 0
2Norene Mostkoff President & CEO	(i) (ii)	0 ------------- 280,958	0 ------------- 41,962	0 ------------- 0	0 ------------- 10,224	0 ------------- 19,268	0 ------------- 352,412	0 ------------- 0
3Tray Wade Senior Vice President & COO	(i) (ii)	0 ------------- 145,437	0 ------------- 10,500	0 ------------- 1,200	0 ------------- 5,274	0 ------------- 8,659	0 ------------- 171,070	0 ------------- 0
4Thomas Mouser Chief Medical Officer	(i) (ii)	200,437 ------------- 0	15,000 ------------- 0	0 ------------- 0	7,009 ------------- 0	20,110 ------------- 0	242,556 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation

Compensation for the organization's top management official is established and paid by HCI VNS Care Services, a related tax-exempt organization. HCI VNS Care Services utilizes the following methods in determining the top management official's compensation: -Independent compensation consultant -Form 990 of other organizations -Compensation survey or study -Approval by the board or compensation committee

Schedule J, Part I, Line 7 Non-fixed payments

DISCRETIONARY BONUSES WERE PAID TO THE VICE PRESIDENT & CFO AND SENIOR VICE PRESIDENT & COO. THE OFFICERS' INCENTIVES ARE BASED ON STANDARDS AND GOALS SET FORTH BY, AND ARE APPROVED BY, THE CEO.

Schedule J (Form 990) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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

2015

Open to Public Inspection

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..	X		10,048	Other
5 Clothing and household goods .......	X		284,544	Other
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( SPECIALTY/MISC )	X	5,300	38,387	Other
26 Other ( MISCELLANEOUS )	X	1,657	8,190	Other
27 Other ( DECORATIONS & SUPPLIES )	X	11,200	56,130	Market value
28 Other ( )

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?

Yes

32a

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

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

32a

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) (2015)

Page 2

Part II

Supplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
Schedule M, Part I Explanations of reporting method for number of contributions	Books and publications: Number of items received Clothing and household goods: Number of items received Other: Number of items received Other: Number of items received Other: Number of items received

Schedule M (Form 990) (2015)

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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

2015

Open to Public
Inspection

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

Return Reference	Explanation
Form 990, Part III, Line 1 ORGANIZATION'S MISSION	FOUNDED IN 1978, HCI CARE SERVICES IS THE STATE'S OLDEST HOSPICE CARE PROVIDER. AN INDEPENDENT, NOT-FOR-PROFIT, COMMUNITY-BASED ORGANIZATION, THE ORGANIZATION'S MISSION IS: "PROMOTING DIGNITY, INDEPENDENCE AND QUALITY OF LIFE FOR ALL THROUGH EDUCATION, COMPASSIONATE AND EFFECTIVE COMMUNITY BASED CARE." THE ORGANIZATION IS ALSO GUIDED BY ITS VALUES: WE ACT WITH INTEGRITY AND RESPECT. WE SERVE WITH COMPASSION. WE LEAD THROUGH EXCELLENCE. WE UNITE THROUGH TEAMWORK.
Form 990, Part III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS	HCI CARE SERVICES OFFERS THE FOLLOWING SERVICES. HCI HOSPICE CARE SERVICES: - HCI HOSPICE CARE SERVICES IS A NON-PROFIT, COMMUNITY-BASED SERVICE SERVING 41 COUNTIES. - IN-HOME HOSPICE SERVICES, INCLUDING VISITS FROM NURSES, SOCIAL WORKERS, HOSPICE AIDES, SPIRITUAL CARE COUNSELORS, BEREAVEMENT COUNSELORS, VOLUNTEERS AND THERAPISTS. FOR THE FISCAL YEAR ENDING JUNE 30, 2016, HCI HOSPICE CARE SERVICES PROVIDED END OF LIFE CARE TO APPROXIMATELY 1,690 PATIENTS. - ACCESS TO CLINICIANS WHO HAVE RECEIVED SPECIALIZED TRAINING IN END-OF-LIFE CARE; MANY ARE CERTIFIED IN HOSPICE AND PALLIATIVE CARE. - TEAM PHYSICIANS AND NURSE PRACTITIONERS ON STAFF. - EXPERT PAIN AND SYMPTOM MANAGEMENT. - INTERDISCIPLINARY CARE TEAMS WHO PROVIDE PERSONALIZED, COORDINATED CARE. - DEDICATED HOSPICE ROOMS WITHIN HOSPITALS AND CARE FACILITIES IN OUR SERVICE AREA. - GRIEF SUPPORT GROUPS AND EDUCATIONAL RESOURCES. - ACCESS TO HIGHLY-SKILLED CLINICAL STAFF 24 HOURS A DAY, SEVEN DAYS A WEEK. - MEDICAL EQUIPMENT, SUPPLIES AND MEDICATIONS RELATED TO THE LIFE-LIMITING ILLNESS. - FOUR RESIDENTIAL HOSPICE CARE FACILITIES IN IOWA: KAVANAGH HOUSE ON 56TH STREET IN DES MOINES OFFERS 15 PRIVATE PATIENTS ROOMS, GREATER REGIONAL HOSPICE HOME IN CRESTON OFFERS SIX PRIVATE ROOMS, AND HOSPICE WITH HEART HOSPICE HOUSE IN GLENWOOD PROVIDES EIGHT PRIVATE ROOMS. - SPECIALIZED SERVICES FOR PATIENTS WHO ARE MILITARY VETERANS AND FOR PATIENTS WHO OWN PETS. -IN 2016 HCI CARE SERVICES RECEIVED A 2016 IOWA'S TOP WORKPLACES AWARD. THE AWARD WAS BASED SOLELY ON EMPLOYEE FEEDBACK THROUGH A SURVEY CONDUCTED BY AN INDEPENDENT THIRD PARTY. EXTRACARE SERVICES: - EXTRACARE SERVICES IS A NON-PROFIT, PRIVATE DUTY SERVICE WHICH SUPPORTS INDIVIDUALS' EFFORTS TO CONTINUE LIVING AT THEIR CURRENT PLACE OF RESIDENCE. IN THE FISCAL YEAR ENDING JUNE 30, 2016, EXTRACARE SERVICES PROVIDED OVER 16,786 HOURS OF CARE TO PATIENTS. - NURSES, HOME HEALTH AIDES AND TRAINED COMPANIONS OFFER EXPERTISE AND COMPANIONSHIP RANGING FROM ONE HOUR/DAY TO 24-HOUR ASSISTANCE. - EXAMPLES OF SERVICES INCLUDE SKILLED NURSING SERVICES, ASSISTANCE WITH BATHING, GROOMING, DRESSING, TOILETING, LAUNDRY, LIGHT HOUSEKEEPING, TRANSPORTATION AND CHRONIC DISEASE CASE MANAGEMENT. - EXTRACARE SERVICES IS A PRIVATE PAY SERVICE. CLIENTS PAY ONLY FOR THE SERVICES THEY SELECT. HCI GIVING TREE: - HCI GIVING TREE IS A NON-PROFIT THRIFT STORE WITH TWO LOCATIONS: 3330 100TH ST. IN URBANDALE, IOWA, AND 521 E. LOCUST ST., SUITE 102, DES MOINES. - THE STORE SELLS AND ACCEPTS DONATIONS OF GENTLY-USED FURNITURE, CLOTHING AND HOME FURNISHINGS. - ALL PROCEEDS FROM STORE SALES SUPPORT SERVICES PROVIDED TO PATIENTS OF HCI HOSPICE CARE SERVICES, ENSURING CARE IS AVAILABLE TO ALL WHO NEED HOSPICE CARE SERVICES - REGARDLESS OF THEIR ABILITY TO PAY. - WITH THE EXCEPTION OF TWO PAID STAFF, THE STORE IS OPERATED BY A DEDICATED CORPS OF UNPAID VOLUNTEERS. - HCI GIVING TREE VOLUNTEERS PROVIDED 7,748 HOURS OF SERVICE TO THE STORE - A VALUE OF $209,873. HCI CARE SERVICES ALSO OFFERS: - CAREGIVER TRAINING AND SUPPORT; - EDUCATIONAL CONFERENCES, SEMINARS AND RESOURCES; - FREE ADVANCE CARE PLANNING RESOURCES; AND GRIEF SUPPORT GROUPS, WHICH ARE FREE OF CHARGE AND ARE OPEN TO THE PUBLIC STRUCTURE: HCI CARE SERVICES IS COMMITTED TO THE COMMUNITIES IT SERVES AND TAKES ADVANTAGE OF EXPERT RESOURCES WITHIN THOSE COMMUNITIES FOR GUIDANCE, ADVOCACY AND ASSISTANCE. HCI CARE SERVICES EMPLOYEES ARE GUIDED BY A VOLUNTEER BOARD OF DIRECTORS. THE ORGANIZATION'S FUNDRAISING SUPPORT COMES FROM THE HCI FOUNDATION, WHICH RECEIVES OVERSIGHT FROM ITS VOLUNTEER BOARD OF TRUSTEES. IN RURAL IOWA, EACH HCI CARE SERVICES OFFICE SERVES A MULTI-COUNTY AREA AND IS GUIDED BY A VOLUNTEER ADVISORY BOARD. SOURCES OF FUNDING: HCI CARE SERVICES IS SUPPORTED PRIMARILY THROUGH THIRD PARTY REIMBURSEMENTS. FOR THE FISCAL YEAR ENDING JUNE 30, 2016, APPROXIMATELY 88 PERCENT OF THE ORGANIZATION'S NET PATIENT REVENUE WAS DERIVED FROM MEDICARE AND MEDICAID PROGRAMS. HOWEVER, HCI CARE SERVICES ALSO RECEIVES SIGNIFICANT SUPPORT FROM DONOR CONTRIBUTIONS, BEQUESTS, GRANTS AND FUNDRAISING ACTIVITIES CONDUCTED THROUGH THE HCI FOUNDATION. DONORS MAY DESIGNATE THEIR GIFTS TO SPECIFIC AREAS SERVED BY HCI CARE SERVICES, WHICH REFLECTS THE ORGANIZATION'S COMMITMENT TO COMMUNITY-BASED CARE. HCI CARE SERVICE'S ADVISORY BOARDS HELP DETERMINE HOW LOCALLY-DESIGNATED DONATIONS ARE SPENT - BENEFITING THE ORGANIZATION AND THE COMMUNITY BY FUNDING, FOR EXAMPLE, BOOK DONATIONS ON END-OF-LIFE CARE TO LOCAL LIBRARIES OR HELPING ESTABLISH HOSPICE ROOMS IN LOCAL HOSPITALS AND NURSING CARE FACILITIES. GRIEF SUPPORT SERVICES: THROUGHOUT ITS SERVICE AREA, HCI CARE SERVICES OFFERS BEREAVEMENT CARE FOR PATIENTS, THEIR FAMILIES AND THE COMMUNITY AT LARGE. GRIEF SUPPORT GROUPS ARE OFFERED IN THE COMMUNITIES WE SERVE AT NO COST TO PARTICIPANTS, AND ARE OPEN TO ALL WHO HAVE LOST A LOVED ONE - REGARDLESS OF WHETHER THEY HAVE BEEN SERVED BY HCI CARE SERVICES. GRIEF EDUCATION AND SPECIAL SUPPORT GROUPS ARE ALSO OFFERED TO YOUTHS AND TO NURSING CARE FACILITY STAFF. IN THE YEAR ENDING JUNE 30, 2016, BEREAVEMENT COUNSELORS HELD 153 BEREAVEMENT SUPPORT GROUPS AND MEMORIAL EVENTS, PROVIDED 1,170 HOURS OF BEREAVEMENT SERVICES TO SURVIVORS SERVED BY HCI CARE SERVICES, AND PROVIDED 291 HOURS OF BEREAVEMENT SERVICES TO NON-SERVED SURVIVORS.
Form 990, Part V, Line 1a FORM 1096 REPORTING - COMMON PAYMASTER	HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, AND HCI FOUNDATION; THEREFORE ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES.
Form 990, Part V, Line 2a FORM W-3 AND W-2 REPORTING - COMMON PAYMASTER	HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, HCI FOUNDATION AND AMANDA CARES; THEREFORE ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES. HCI CARE SERVICES HAS APPROXIMATELY 308 EMPLOYEES. HCI VNS CARE SERVICES, THE COMMON PAYING AGENT, REPORTED 565 EMPLOYEES ON FORM W-3 FOR 2015.
Form 990, Part VI, Line 15 COMPENSATION OF TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS/KEY EMPLOYEES	THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES ARE PAID BY HCI VNS CARE SERVICES (EIN: 45-5189289), A RELATED TAX-EXEMPT ORGANIZATION; THEREFORE LINES 15A AND 15B HAVE BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. BELOW IS THE PROCESS USED BY HCI VNS CARE SERVICES TO REVIEW AND APPROVE COMPENSATION FOR THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES. EVERY TWO YEARS, THE ORGANIZATION'S BOARD OF DIRECTORS ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO PERFORM A COMPENSATION SURVEY FOR THE ORGANIZATION'S OFFICERS. VERISIGHT COMPLETED THE ORGANIZATION'S COMPENSATION SURVEYS IN 2009, 2011, 2013 and 2015. THE FINDINGS OF THE SURVEYS ARE PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MEMBERS USE THE SURVEY TO REVIEW AND ESTABLISH THE AMOUNT OF COMPENSATION FOR THE PRESIDENT & CEO. THE REVIEW PROCESS IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MEETING MINUTES. THE PRESIDENT AND CEO USE THE SURVEY TO REVIEW AND ESTABLISH COMPENSATION FOR THE FOLLOWING OFFICERS AND KEY EMPLOYEES: VICE PRESIDENT & CFO, CHIEF OPERATING OFFICER, AND THE CHIEF MEDICAL DIRECTOR.
Form 990, Part VI, Line 1a Delegate broad authority to a committee	The Board of Directors may establish one or more committees of the Board, including an executive committee, and appoint members of the Board to serve on them. Each committee shall have the powers and duties delegated to it by the Board of Directors. Each committee shall have a separate charter established by the Board of Directors specifying the scope of the committee's authority. The current committees consist of an Executive, Governance, Finance, Audit, Quality and Compliance.
Form 990, Part VI, Line 6 Classes of members or stockholders	The organization's sole member is HCI VNS Care Services, an Iowa nonprofit corporation.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	All corporation directors are appointed by HCI VNS Care Services, the organization's sole member; any director of the organization may be removed either for or without cause by HCI VNS Care Services.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	None of the corporation's assets or any other rights thereto, whether real, personal or intangible, shall be sold, conveyed, assigned, transferred, mortgaged, encumbered, exchanged, alienated, or leased without the prior approval of HCI VNS Care Services, the Corporation's sole corporate member. The Corporation shall not be a party to any merger, acquisition, consolidation, joint venture, reorganization, restructuring or similar event, nor shall it become a member, partner, shareholder, trustee or other fiduciary of any other organization or entity, without the prior approval of HCI VNS Care Services, the Corporation's sole corporate member. No amendment, alteration or repeal of any of the provisions of the corporation's bylaws shall be adopted without the prior approval of HCI VNS Care Services, the Corporation's sole corporate member.
Form 990, Part VI, Line 11b Review of form 990 by governing body	The full Form 990 is provided to the organization's President and CEO, CFO, and Audit Committee for initial review. After all questions have been addressed and any changes have been made, the organization's tax advisors present a final draft of the full Form 990 to the full board of directors for final review and approval prior to submission to the IRS.
Form 990, Part VI, Line 12c Conflict of interest policy	All members of the board of directors are required to promptly report any ongoing or incidental material interests or affiliations which could result in a potential conflict of interest; members of the board of directors are also required to sign an annual conflict of interest declaration. The board of directors and officers also complete an annual automated conflict of interest questionnaire as part of the 990 completion process. The declarations and questionnaire responses are reviewed by the President and CEO and CFO to determine if any potential or actual conflicts of interest exist. Any board member determined to have a conflict of interest is required to abstain from any decision or voting process related to the conflicting issue.
Form 990, Part VI, Line 19 Required documents available to the public	The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request.
Form 990, Part VII, Section A, Line 1a Compensation Paid by Related Organization	The organization's officers are paid by HCI VNS Care Services, a related tax-exempt organization, for services provided to HCI Care Services, HCI Foundation, HCI VNS Care Services, and Visiting Nurse Services of Iowa. Per the Form 990 instructions, total compensation paid by HCI VNS Care Services is reported in its Form 990, Part VII, Section A, Line 1a, columns (D) and (F); additionally, total compensation paid by HCI VNS Care Services is also reported in each of the three related organizations' Forms 990, Part VII, Section A, Line 1a, columns (E) and (F) (as compensation paid by a related organization). The time each officer devotes to each respective organization is shown in Form 990, Part VII, Section A, Line 1a, column (B).
Form 990, Part VII, Section B, Line 1 INDEPENDENT CONTRACTORS	HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, AND HCI FOUNDATION; THEREFORE ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES. INDEPENDENT CONTRACTOR INFORMATION IS ENTERED IN PART VII, SECTION B, AT THE ORGANIZATIONAL LEVEL AS THE PAYMENTS RELATE TO EACH ENTITY'S BUSINESS.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	MISCELLANEOUS - Total Revenue: 2411, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 2411;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF HCI FOUNDATION - -310579; CHANGE IN INVESTMENT IN AFFILIATE - -119981;

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

- 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

2015

Open to Public Inspection

Name of the organization

Hospice of Central Iowa

Employer identification number

42-1093718

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) HOSPICE OF CENTRAL IOWA THRIFT STORE LLC DBA HCI GIVING TREE 3330 100TH STREET URBANDALE,IA503223854 27-3099690	RESALE OF DONATED MERCHANDISE TO THE PUBLIC	IA	397,299	30,400	HOSPICE OF CENTRAL IOWA
(2) HCI EXTRACARE LLC 2910 WESTOWN PARKWAY SUITE 200 WEST DES MOINES,IA50266 30-0661072	PRIVATE DUTY NURSING AND COMPANION SERVICES	IA	445,026	0	HOSPICE OF CENTRAL IOWA

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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
(1)HOSPICE OF CENTRAL IOWA FOUNDATION DBA HCI FOUNDATION 2910 WESTOWN PARKWAY SUITE 200 WEST DES MOINES,IA502661332 42-1239748	FUNDRAISING TO SUPPORT HOSPICE OF CENTRAL IOWA AND VISITING NURSE SERVICES OF IOWA	IA	501(c)(3	7	HCI VNS CARE SERVICES		No
(2)HCI VNS CARE SERVICES 2910 WESTOWN PARKWAY SUITE 200 WEST DES MOINES,IA50266 45-5189289	ADMINISTRATIVE AND MANAGEMENT SERVICES (MSO)	IA	501(c)(3	Type I	NA		No
(3)VISITING NURSE SERVICES OF IOWA 1111 9TH STREET SUITE 320 DES MOINES,IA50314 42-0680446	HEALTH AND HEALTH RELATED SERVICES	IA	501(c)(3	7	HCI VNS CARE SERVICES		No
(4)AMANDA CARES INC 1821 GRAND AVENUE WEST DES MOINES,IA50265 42-1166117	HEALING SERVICES	IA	501(c)(3	7	HCI VNS CARE SERVICES		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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) 2015

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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) 2015

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) 2015

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) 2015

Additional Data

Software ID:	15000238
Software Version:	2015v2.1

1	Briefly describe the organization’s mission or most significant activities: HCI Care Services' mission is "Promoting dignity, independence and quality of life through compassionate and effective community based care."
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	308
6	Total number of volunteers (estimate if necessary) .............	6	477
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,365,758	1,143,027
9	Program service revenue (Part VIII, line 2g) .........	16,117,394	16,610,872
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	584,488	525,895
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	110,233	-71,480
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	18,177,873	18,208,314
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	26,177	21,769
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	10,030,583	10,424,057
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 55,709
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	8,365,104	8,015,134
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	18,421,864	18,460,960
19	Revenue less expenses. Subtract line 18 from line 12.......	-243,991	-252,646
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	24,950,581	23,329,804
21	Total liabilities (Part X, line 26).............	3,764,388	3,257,630
22	Net assets or fund balances. Subtract line 21 from line 20.....	21,186,193	20,072,174

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 16,162,536 including grants of $ 21,769 ) (Revenue $ 16,610,872 )
	DONOR SUPPORT HELPS ENSURE ALL WHO NEED HCI CARE SERVICES' CARE RECEIVE IT. FROM JULY 1, 2015, THROUGH JUNE 30, 2016, QUALIFYING HCI CARE SERVICES PATIENTS IN NEED RECEIVED CHARITY CARE AT AN ESTIMATED COST OF APPROXIMATELY $295,514. HCI CARE SERVICES ALSO RECEIVES SIGNIFICANT IN-KIND DONATIONS OF TIME AND EFFORT THROUGH ITS VOLUNTEERS. IN THE YEAR ENDING JUNE 30, 2016, MORE THAN 477 VOLUNTEERS DONATED 17,426 VOLUNTEER HOURS, EQUAL TO $384,161 IN VALUE TO THE ORGANIZATION. (CONTINUED IN SCHEDULE O)

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses16,162,536

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Priscilla Ruhe Director	1.0 .......................2.0	X			0	0	0
(19) Katie Turner Director	1.0 .......................2.0	X			0	0	0
(20) Kim Willis Director (term ended 9/2015)	1.0 .......................2.0	X			0	0	0
(21) Brad Wycoff Director	1.0 .......................2.0	X			0	0	0
(22) Pat Barry Director	1.0 .......................2.0	X			0	0	0
(23) Kelly Dennis Vice President & CFO	5.0 .......................35.0		X		0	161,751	14,279
(24) Jim Knoepfler Vice President, Strategy & Business Development (term ended 6/2016)	5.0 .......................35.0		X		0	81,388	24,813
(25) Norene Mostkoff President & CEO	5.0 .......................35.0		X		0	322,920	29,492
(26) Tray Wade Senior Vice President & COO	5.0 .......................35.0		X		0	157,137	13,933
(27) Thomas Mouser Chief Medical Officer	40.0 .......................0			X	215,437	0	27,119

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	215,437	723,196	109,636

(A) Name and business address	(B) Description of services	(C) Compensation
HCI VNS CARE SERVICES 2910 WESTOWN PARKWAY SUITE 200 WEST DES MOINES,IA50266	ADMINISTRATIVE OVERHEAD SUPPORT	1,668,417
CONSOLIDATED MANAGEMENT 2670 106TH ST STE 140 WEST DES MOINES,IA50322	CONTRACTED FOOD SERVICE	150,920



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 2

1a	Federated campaigns..		1a	261,942
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	825,195
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	55,890

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		1,143,027

			Business Code
2a	Patient service revenue	621610	16,610,872	16,610,872
b
c
d
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			16,610,872

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			190,037			190,037
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,730,919
b	Less: cost or other basis and sales expenses		1,395,061
c	Gain or (loss)	0	335,858
d	Net gain or (loss).....			335,858			335,858
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
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		397,299
b	Less: cost of goods sold ..b		471,190
c	Net income or (loss) from sales of inventory..			-73,891			-73,891
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....			2,411	0	0	2,411
e	Total. Add lines 11a–11d ......			2,411
12	Total revenue. See Instructions......			18,208,314	16,610,872	0	454,415

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	21,769	21,769
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	242,556	242,556
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	8,351,957	8,018,908	333,049
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	197,082	198,131	-1,049
9	Other employee benefits .......	1,008,376	745,647	262,729
10	Payroll taxes ...........	624,086	548,672	75,414
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	11,740		11,740
c	Accounting ...........	31,943		31,943
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,719,248	404,660	1,314,588	0
12	Advertising and promotion ....	146,167	109,258	18,451	18,458
13	Office expenses .......	333,703	272,868	60,835
14	Information technology ......	75,511	74,023	1,488
15	Royalties ..
16	Occupancy ...........	426,936	362,670	64,266
17	Travel ............	601,312	596,385	4,927
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	5,286	5,286
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	511,543	465,883	45,660
23	Insurance ...
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	CONTRACTED FACILITY AND ROOM AND BOARD	1,952,720	1,952,720
b	Pharmacy and Direct Patient Supplies	1,032,522	1,032,522
c	Medical Equipment	492,522	492,522
d	Patient Care	430,660	430,510	150
e	All other expenses	243,321	187,546	18,524	37,251
25	Total functional expenses. Add lines 1 through 24e	18,460,960	16,162,536	2,242,715	55,709
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).

1	Cash–non-interest-bearing ........			2,325	1	2,475
2	Savings and temporary cash investments .........			115,859	2	22,203
3	Pledges and grants receivable, net ......			117,417	3	104,308
4	Accounts receivable, net .............			2,581,612	4	1,974,955
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........				8
9	Prepaid expenses and deferred charges ......			81,289	9	35,582
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	13,556,064
b	Less: accumulated depreciation	10b	6,638,938	7,350,459	10c	6,917,126
11	Investments—publicly traded securities .			5,411,496	11	5,435,717
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			9,111,896	13	8,681,336
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			178,228	15	156,102
16	Total assets. Add lines 1 through 15 (must equal line 34)...			24,950,581	16	23,329,804

17	Accounts payable and accrued expenses .....	1,376,623	17	1,303,787
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	0	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	2,387,765	25	1,953,843
26	Total liabilities. Add lines 17 through 25..	3,764,388	26	3,257,630

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	12,622,700	27	11,851,171
28	Temporarily restricted net assets ...........	8,553,935	28	8,211,445
29	Permanently restricted net assets	9,558	29	9,558
	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 ...........	21,186,193	33	20,072,174
34	Total liabilities and net assets/fund balances ........	24,950,581	34	23,329,804