Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 6,217 | 5,880 | 31,374 | 65,897 | 50,571 | 159,939 |
| 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 | 1,532,897 | 1,728,105 | 1,561,847 | 1,554,740 | 1,918,518 | 8,296,107 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 1,539,114 | 1,733,985 | 1,593,221 | 1,620,637 | 1,969,089 | 8,456,046 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 8,456,046 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,539,114 | 1,733,985 | 1,593,221 | 1,620,637 | 1,969,089 | 8,456,046 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 15,220 | 4,759 | 345 | 665 | 223 | 21,212 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 15,220 | 4,759 | 345 | 665 | 223 | 21,212 |
| 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.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 1,554,334 | 1,738,744 | 1,593,566 | 1,621,302 | 1,969,312 | 8,477,258 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 6 | VOLUNTEERS: HOSPICE VOLUNTEERS ASSIST PATIENTS AND THEIR FAMILIES IN MANY WAYS. A VOLUNTEER MAY SIT WITH A PATIENT FOR AN HOUR TO GIVE THE FAMILY A BREAK; THE VOLUNTEER MAY VISIT WITH THE PATIENT OR THEIR FAMILY AS A FORM OF COMPANIONSHIP. ANOTHER ASPECT OF VOLUNTEER SERVICES INCLUDES RUNNING ERRANDS OR DOING LIGHT HOUSECLEANING TO A PATIENT'S HOME. VOLUNTEERING AT HOMETOWN HOMECARE IS A REWARDING, ENRICHING EXPERIENCE THAT BENEFITS NOT ONLY THE PATIENT AND THEIR FAMILY BUT ALSO THE VOLUNTEER. THE DIRECTORS OF THE ORGANIZATION ARE ALSO VOLUNTEERS OF THE ORGANIZATION. |
| FORM 990, PART III, LINE 4A | PROGRAM SERVICES: HOME HEALTH SERVICES AVAILABLE TO PATIENTS INCLUDE: - SKILLED NURSING SERVICES - PEDIATRICS AND MOM/BABY CARE - THERAPY (PHYSICAL, SPEECH, AND OCCUPATIONAL) - JOINT REPLACEMENT REHAB - SOCIAL WORK SERVICES - HOME HEALTH AIDE SERVICES THESE SERVICES ARE GIVEN BY A VARIETY OF SKILLED HEALTH CARE PROFESSIONALS AT THE PATIENT'S HOME. ALONG WITH THE DOCTOR, HOME HEALTH STAFF CREATES A CARE PLAN, WHICH INCLUDES A PLAN FOR THE PATIENT'S CARE. THE PLAN DESCRIBES WHICH SERVICES THE PATIENT WILL GET TO REACH AND KEEP HIS OR HER MAXIMUM MENTAL AND SOCIAL WELL-BEING. THE HOME HEALTH STAFF KEEPS THE PATIENT'S DOCTOR UP-TO-DATE ABOUT HOW HE OR SHE IS DOING AND UPDATES THE CARE PLAN AS NEEDED. HOSPICE CARE INCLUDES: - SPECIALIZED CARE TO THE TERMINALLY ILL PATIENTS AND THEIR FAMILY - INTERDISCIPLINARY TEAM PROVIDING ASSISTANCE IN DEVELOPING A COMPREHENSIVE PLAN OF ACTION TO MEET INDIVIDUAL NEEDS AND CHALLENGES - REGISTERED NURSES, LICENSED PRACTICAL NURSES, NURSES AIDES, MEDICAL SOCIAL WORKERS, A REGISTERED DIETICIAN, AND VOLUNTEERS ARE TRAINED IN CARING FOR PATIENTS AND FAMILIES LIVING WITH A TERMINAL ILLNESS AND ARE INVOLVED IN HOSPICE PATIENTS' CARE - SPIRITUAL COUNSELORS ARE AVAILABLE TO ADDRESS ISSUES AND OFFER SUPPORT SYSTEM MANAGEMENT HOSPICE CARE BY OUR TEAM FOCUSES ON SYMPTOM MANAGEMENT. AS SYMPTOMS ARISE, THEY ARE TREATED ON THOROUGH ASSESSMENTS AND PHYSICIAN APPROVED PROTOCOLS. PROTOCOLS ARE DEVELOPED FOR PAIN, NAUSEA AND VOMITING, PREVENTION OF CONSTIPATION, ANXIETY, AGITATION, SHORTNESS OF BREATH, AND DEPRESSION. UNIQUE APPROACHES TO SYMPTOM MANAGEMENT ARE UTILIZED SUCH AS SPECIALLY FORMULATED, PHYSICIAN ORDERED MEDICATION COMBINATIONS THAT ARE APPLIED TO THE SKIN. THE USE OF NEEDLES TO ADMINISTER MEDICATION TO OUR HOSPICE PATIENTS IS VERY RARE. OUR ULTIMATE GOAL IS TO MANAGE THE PAIN AND/OR SYMPTOMS EXPERIENCED TO ENSURE THE PATIENT'S COMFORT AND PEACE OF MIND. IN ADDITION, BEREAVEMENT SERVICES ARE A BENEFIT PROVIDED TO EACH OF OUR HOSPICE FAMILIES. OUR BEREAVEMENT STAFF INCLUDES SOCIAL WORKERS AND CHAPLAINS. EACH ONE IS TRAINED IN ASSISTING OUR HOSPICE FAMILIES WITH GRIEF AND LOSS ISSUES. WE HAVE TAILORED OUR BEREAVEMENT PROGRAM TO MEET A WIDE VARIETY OF INTERESTS AND NEEDS. PRIVATE DUTY SERVICES: THESE SERVICES INCLUDE PERSONAL AIDE CARE, HOMEMAKER/CHORE, COMPANIONSHIP, IN-HOME RESPITE, AND TRANSPORTATION SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 2 | FAMILY RELATIONSHIP: KATIE BOEGER, CHIEF OPERATING OFFICER, AND BEVERLY STOWERS, VP-CHARITON COUNTY, HAVE A FAMILY RELATIONSHIP. KATIE BOEGER RESIGNED IN JUNE 2019. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 IS DISTRIBUTED TO ALL BOARD MEMBERS VIA EMAIL OR IN PERSON AT THE BOARD MEETING, ALLOWING FOR QUESTIONS, COMMENTS OR OTHER CHANGES TO THE RETURN BEFORE THE FINAL FORM 990 IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL EMPLOYEES, VOLUNTEERS, AND BOARD MEMBERS ARE COVERED BY THE CONFLICT OF INTEREST POLICY AND REQUIRED TO REPORT ANY CONFLICTS OF INTEREST. ALL COVERED MEMBERS COMPLETE A SEPARATE QUESTIONNAIRE EACH YEAR DEVELOPED TO HELP ANSWER THE FORM 990 QUESTIONS. IN THE EVENT THAT A CONFLICT OF INTEREST EXISTS, IT IS REVIEWED BY THE BOARD. IF THE CONFLICT INVOLVES A BOARD MEMBER, THAT BOARD MEMBER ABSTAINS FROM VOTING ON THE TOPICS RELATED TO THAT CONFLICT OF INTEREST. THE BOARD HAS DELEGATED THE CEO AUTHORITY TO MONITOR DAY TO DAY EMPLOYEE CONFLICTS OF INTEREST, INCLUDING POTENTIAL CONFLICTS CREATED BY EMPLOYEES WHICH ARE EMPLOYED AT MULTIPLE AND COMPETING AGENCIES, EMPLOYEE FAMILIAL RELATIONSHIP, ETC. IF AN UNUSUAL SITUATION OCCURS, THE CEO PRESENTS THE ISSUE TO THE BOARD FOR A DECISION OF THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | COMPENSATION REVIEW: IN 2019, A COST OF LIVING RAISE OF $0.85 PER HOUR WAS AWARDED. PRIOR TO THAT, ANNUAL RAISES HAD NOT BEEN GIVEN SINCE 2008, SO NO SALARY COMPARABILITY REVIEWS HAVE BEEN PERFORMED SINCE PRIOR TO 2008. THE BOARD-DETERMINED COMPENSATION FOR ALL EMPLOYEES, INCLUDING CEO AND OTHER OFFICERS, WAS DETERMINED BY CONSULTING THE NAHC SALARY SURVEY AS WELL AS JOB POSTINGS OF AREA HOSPITALS FOR SIMILAR POSITIONS. A SUMMARY OF THE 2008 BOARD DISCUSSION AND APPROVAL REGARDING COMPENSATION IS IN THE BOARD OF DIRECTOR MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENT DISCLOSURE: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO BE VIEWED AT THE ORGANIZATION'S LOCATION OF BUSINESS UPON WRITTEN REQUEST. |
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| Software Version: |