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 (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) 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.) .... | 779,220 | 699,301 | 1,229,063 | 1,138,315 | 660,977 | 4,506,876 |
| 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 | 779,220 | 699,301 | 1,229,063 | 1,138,315 | 660,977 | 4,506,876 |
| 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).. | 70,351 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 4,436,525 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 779,220 | 699,301 | 1,229,063 | 1,138,315 | 660,977 | 4,506,876 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 137,409 | 136,355 | 241,795 | 144,781 | 225,570 | 885,910 |
| 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.).. | -2,065 | 3,168 | 14,685 | 25,696 | 7,569 | 49,053 |
| 11 | Total support. Add lines 7 through 10. | 5,441,839 | |||||
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 | 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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 | ||||
| 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 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 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) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART II, LINE 10 | FUNDRAISING & OTHER INCOME 49,053 |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 2 | IN KEEPING WITH OUR MISSION, HOSPICE OF SPOKANE, DOING BUSINESS AS, SPOKANE PALLIATIVE CARE, CONTINUED THE PROVIDING PALLIATIVE CARE CONSULTATIONS TO 278 PATIENTS IN 2015. THE PROGRAM INTRODUCED IN 2012 EXPANDED COMMUNITY OFFERINGS PROVIDING NEEDED SERVICES TO INDIVIDUALS WITH LIFE-LIMITING DISEASES SUCH AS CANCER OR ADVANCED HEART, LUNG, HEPATIC, RENAL AND/OR NEUROLOGICAL CONDITIONS WHO ARE NOT HOSPICE-ELIGIBLE. A PALLIATIVE CARE- CERTIFIED INTERDISCIPLINARY TEAM CONSISTING OF MD, ARNP, RN, MSW, CHAPLAIN AND BEREAVEMENT COUNSELORS ARE AVAILABLE AT THE REFERRAL OF THE PATIENT'S PRIMARY CARE PROVIDER (PCP). THESE SERVICES ARE AVAILABLE MONDAY-FRIDAY 8A-5P (HOLIDAYS EXCLUDED) AND ARE OVERSEEN BY OUR MEDICAL DIRECTOR. SERVICES ARE DELIVERED IN THE SETTING THE CLIENT CALLS HOME (PRIVATE RESIDENCE, EXTENDED CARE FACILITY, ETC.) AND THROUGH A CONTRACT WITH DEACONESS AND VALLEY HOSPITALS FOR ON-SITE CONSULTATION, ASSISTING THE PATIENT'S PCP WITH ACHIEVING IMPROVED ADHERENCE TO TREATMENT PLANS, ASSISTING IN OPTIMAL SYMPTOM CONTROL AND IMPROVING QUALITY OF LIFE. WE WORK CLOSELY WITH THE PALLIATIVE CARE TEAM AT SACRED HEART AND HOLY FAMILY HOSPITALS AS WELL. THE SERVICES ARE CONSULTATIVE UPON THE PCP'S ORDER FOR COLLABORATION, CO-MANAGEMENT OR INITIATION OF THERAPEUTIC INTERVENTIONS. SERVICES DO NOT INCLUDE CHRONIC DISEASE MANAGEMENT OR CHRONIC PAIN MANAGEMENT FOR PATIENTS WITHOUT LIFE-LIMITING ILLNESS. |
| FORM 990, PAGE 2, PART III, LINE 4A | HOSPICE OF SPOKANE SERVED 2,198 UNDUPLICATED CLIENTS IN 2015, PROVIDING 99,456 DAYS OF ROUTINE HOME CARE, 4,608 DAYS OF ACUTE INPATIENT CARE, 176 DAYS OF RESPITE CARE AND 1 DAY OF CONTINUOUS CARE FOR THE YEAR ENDED DECEMBER 31, 2015. THE UNREIMBURSED VALUE OF PROVIDING CARE TO ALL PATIENTS WAS 59,962 FOR CHARITY CARE, 524,593 FOR MEDICARE (INCLUDES SEQUESTRATION 2% PAYMENT REDUCTIONS), 73,325 FOR MEDICAID AND 30,611 FOR OTHER THIRD-PARTY PAYERS FOR THE YEAR ENDED DECEMBER 31, 2015. IN KEEPING WITH ITS MISSION, HOSPICE OF SPOKANE (DBA SPOKANE PALLIATIVE CARE) CONTINUES OFFERING PALLIATIVE CARE CONSULTATION TO NON-HOSPICE INDIVIDUALS WITH LIFE-LIMITING DISEASES. 278 PATIENTS WERE SERVED BY THE PALLIATIVE CARE CERTIFIED INTERDISCIPLINARY TEAM, ACHIEVING IMPROVED ADHERENCE TO TREATMENT PLANS, ASSISTING IN OPTIMAL SYMPTOM CONTROL AND IMPROVING QUALITY OF LIFE DESPITE LIFE-LIMITING ILLNESS. IN JANUARY OF 2013, HOSPICE OF SPOKANE FURTHER EXPANDED OUR PALLIATIVE CARE SERVICES TO INCLUDE PRIMARY CARE FOR INDIVIDUALS WHO HAVE DIFFICULTY GETTING TO AND FROM A PRIMARY CARE PROVIDER. DOING BUSINESS AS MOBILE MEDICINE OF SPOKANE, THIS CARE IS PROVIDED BY ARNPS WITH COLLABORATION AND GUIDANCE OF OUR MEDICAL DIRECTOR. IN 2015, 495 PATIENTS WERE SERVED THROUGH MOBILE MEDICINE OF SPOKANE. THERE CONTINUES TO BE MORE DEMAND THAN WE CURRENTLY HAVE CAPACITY FOR. THIS IS A MUCH-NEEDED PRIMARY PALLIATIVE CARE SERVICE, FOCUSED ON BRINGING PRIMARY CARE TO INDIVIDUALS IN ASSISTED LIVING AND ADULT FAMILY HOMES. |
| FORM 990, PAGE 2, PART III, LINE 4B | SECOND HOUSE INCREASES CAPACITY FOR THIS SPECIALIZED CARE TO 24 BEDS TOTAL. HOSPICE HOUSE PROVIDED 7,419 PATIENT DAYS OF CARE FOR THE YEAR ENDED DECEMBER 31, 2015 TO 929 PATIENTS AND THEIR FAMILIES. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE CEO AND THE DIRECTOR OF FINANCE, WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS, ALONG WITH THE HOSPICE OF SPOKANE BOARD FINANCE COMMITTEE. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL APPROVAL IS GIVEN TO THE PREPARER BEFORE FINALIZING THE RETURN. THE CEO SIGNS OFF ON THE FORM 8879-EO BEFORE THE RETURN IS E-FILED BY THE PREPARER. |
| FORM 990, PAGE 6, PART VI, LINE 12C | NEW EMPLOYEES, VOLUNTEERS, AND TRUSTEES RECEIVE, REVIEW, AND SIGN THE CONFLICT OF INTEREST POLICY DURING ORIENTATION. THE POLICY IS INCLUDED IN THE EMPLOYEE HANDBOOK RECEIVED BY ALL STAFF. ONGOING ENFORCEMENT OCCURS VIA ROUTINE EDUCATION AND DISCUSSION AT VARIOUS TEAM MEETINGS AND AT ALL STAFF MEETINGS. CHART AUDITS, QUALITY ASSURANCE PERFORMANCE IMPROVEMENT QUARTERLY REVIEWS, SUPERVISORY VISITS, CARE CONFERENCES, AND SELF REPORTING ALLOW FOR CONTINUED MONITORING. IF AN ISSUE ARISES, THE SITUATION IS INVESTIGATED AND DISCIPLINARY PROCESSES ARE IMPLEMENTED ACCORDING TO THE POLICY, IF NECESSARY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPETITIVE WAGE INFORMATION IS OBTAINED THROUGH A CONSULTANT, ONLINE DATA, THROUGH PARTICIPATION IN AN INDUSTRY SURVEY, AND OTHER SIMILAR ORGANIZATIONS' IRS FORM 990. THE EXECUTIVE COMMITTEE (MADE UP OF THE OFFICERS OF THE BOARD OF TRUSTEES) REVIEWS THE COMPENSATION DATA AND MAKES A RECOMMENDATION TO THE BOARD OF TRUSTEES FOR THE CEO COMPENSATION. THE BOARD OF TRUSTEES MUST THEN APPROVE AND DOCUMENT THE COMPENSATION AND NOTIFY HUMAN RESOURCES. |
| FORM 990, PAGE 6, PART VI, LINE 15B | COMPETITIVE WAGE INFORMATION IS OBTAINED THROUGH A CONSULTANT, ONLINE DATA, THROUGH PARTICIPATION IN AN INDUSTRY SURVEY, AND OTHER SIMILAR ORGANIZATIONS' IRS FORM 990. THE CEO USES THE COMPENSATION DATA OBTAINED TO MAKE COMPENSATION DECISIONS FOR OTHER OFFICERS AND EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | HOSPICE OF SPOKANE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN BENEFICIAL INTEREST IN TRUSTS 7,873 TOTAL 7,873 |
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| Software Version: |