Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 705,383 | 700,287 | 427,542 | 509,776 | 431,402 | 2,774,390 |
| 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 | 705,383 | 700,287 | 427,542 | 509,776 | 431,402 | 2,774,390 |
| 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).. | 9,480 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 2,764,910 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 705,383 | 700,287 | 427,542 | 509,776 | 431,402 | 2,774,390 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 5,323 | 1,625 | 6,018 | 7,274 | 6,443 | 26,683 |
| 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.).. | 160,949 | 147,383 | 111,801 | 109,008 | 182,775 | 711,916 |
| 11 | Total support Add lines 7 through 10. | 3,512,989 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part II, Line 10 Other Income | DESCRIPTION - GROSS INCOME FROM FUNDRAISING EVENTS, COLUMN A - 82310.0, COLUMN B - 89086.0, COLUMN C - 68715.0, COLUMN D - 59138.0, COLUMN E - 91539.0, COLUMN F - 390788.0; DESCRIPTION - OTHER INCOME, COLUMN A - 78639.0, COLUMN B - 58297.0, COLUMN C - 43086.0, COLUMN D - 49870.0, COLUMN E - 91236.0, COLUMN F - 321128.0; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4c PROGRAM DESCRIPTION | (CONTINUED FROM PART III) July 8, 2014 The TALK: The Greatest Gift you can Give to Those You Love, for residents and guests of Providence Point. 72 attendees. A presentation and discussion of the importance of talking with your loved ones about your end-of-life wishes. July 31, 2014 The TALK: The Greatest Gift you can Give to Those You Love, at Orbis Cafe. 23 attendees. A presentation and discussion of the importance of talking with your loved ones about your end-of-life wishes. September 7, 2014. Hospice Myths and Facts at Bower Hill Community Church Adult Education class. 20 attendees. A presentation and discussion of what hospice is, when it is needed, how it is accessed, and how it is paid for. September 15, 2014 Hospice Myths and Facts before the members of the Dormont/Castle Shannon Rotary. 27 attendees. A presentation and discussion of what hospice is, when it is needed, how it is accessed, and how it is paid for. October 26, 2014 Hospice Myths and Facts before 40 attendees, Folkstone Drive neighborhood dinner. A presentation and discussion of what hospice is, when it is needed, how it is accessed, and how it is paid for. October 29, 2014 The TALK: The Greatest Gift you can Give to Those You Love, at Upper Saint Clair Senior Citizens Center, 35 people. A presentation and discussion of the importance of talking with your loved ones about your end-of-life wishes. |
| Form 990, Part VI, Line 15b COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES | THE PRESIDENT/CEO EVALUATES ANNUAL COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES USING THE SAME PROCESS, BASED ON ANNUAL PERFORMANCE GOALS AND OBJECTIVES, THE KEY EMPLOYEE'S SCOPE OF RESPONSIBILITIES AND MANAGEMENT COMPENSATION PAID BY OTHER COMPARABLE ORGANIZATIONS. THE PROCESS IS DOCUMENTED IN EACH EMPLOYEE'S FILE. THE PROCESS WAS LAST UNDERTAKEN IN 2015. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | The Executive Committee, to the extent provided in the resolution of the Board of Directors, shall have and may exercise all of the powers and authority of the Board of Directors in the management of the Hospice in the intervals between meetings of the Board. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | Directors of the Board shall be elected at regularly scheduled meetings of the Board. The slate of potential Directors shall be prepared by the Governance Committee in accordance with applicable provisions of the Bylaws. The Board shall elect and maintain a Board that reflects diverse skills, influences and demographics and meets the following composition: - One (1) Corporate Affiliate Board Designee per Corporate Affiliate; - The President of the Hospice, who shall serve as an ex-officio member with vote; and - The remainder of the Board shall be comprised of community members at large. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | The corporate members have the contractual right to appoint members to the organization's board of directors, which must be approved by the organization's entire board of directors. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The Finance Committee will review the final Form 990 and recommend approval to the board of directors. The Board of Directors will approve the final version prior to filing with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Family Hospice and Palliative Care requires its interested persons (which includes its Board of Directors, Board of Officers, Board-Delegated Committee Members, President, Chief Executive Officer, Vice Presidents, Directors, or any other individual who may either influence or has the authority to enter into agreements on behalf of Family Hospice and Palliative Care), to disclose any financial interest to the board of directors whenever such financial interest arises. Also, such interested persons must, on an annual basis, acknowledge receipt of a copy of Family Hospice and Palliative Care's conflict of interest policy and confirm the existence and nature of any financial interests. After disclosure of a financial interest, the Board of Directors shall determine whether Family Hospice and Palliative Care can obtain with reasonable efforts a more advantageous transaction or arrangement from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably possible under circumstances not producing a conflict of interest, the Board of Directors shall determine by a majority vote of its disinterested directors whether the transaction or arrangement is in Family Hospice and Palliative Care's best interest, for its own benefit, and whether it is fair and reasonable. In conformity with the above determination the Board of Directors shall make its decision as to whether to enter into the transaction or arrangement. If the Board of Directors has reasonable cause to believe that a person has violated its conflict of interest policy by failing to disclose an actual or possible conflict of interest, the Board of Directors shall inform the person of the basis for such belief and afford such person an opportunity to explain the alleged failure to disclose. If after hearing the person's response and after making such further investigation as warranted by the circumstances, the Board of Directors determines that the person has failed to disclose an actual or possible conflict of interest, the Board of Directors shall take appropriate disciplinary and corrective action. |
| Form 990, Part VI, Line 19 Required documents available to the public | Governing documents, conflict of interest policy and financial statements are not made available to the public. |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |