TY 2018 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) DELEGATE SUSAN KREBS...................................................................... CHAIR	1.00 ................. 0.00	X	X	0	0	0
(2) ANN M BOLLINGER...................................................................... VICE CHAIR	1.00 ................. 0.00	X	X	0	0	0
(3) LAURA GILLEN...................................................................... SECRETARY	1.00 ................. 0.00	X	X	0	0	0
(4) JAMES R ANDERSEN ESQ...................................................................... BOARD MEMBER (PART YEAR)	1.00 ................. 0.00	X		0	0	0
(5) R WAYNE BARNES CLU CLTC...................................................................... BOARD MEMBER	1.00 ................. 1.00	X		0	0	0
(6) REGINA BODNAR...................................................................... BOARD MEMBER/EXECUTIVE DIRECTOR	40.00 ................. 0.00	X	X	219,492	0	23,941
(7) JANET BUCHANAN DD...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(8) CAROLYN BURNS...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(9) JAMES COVEY...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(10) MARY DARRELL...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(11) SHIRLYN EVANS-FORD...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(12) ELLEN FINNERTY-MYERS...................................................................... BOARD MEMBER	1.00 ................. 40.00	X		0	320,639	51,499
(13) TODD HERRING...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(14) CHRISTINA K KANTHER...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(15) GARY M MERRY...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0
(16) JOHN W MIDDLETON MD...................................................................... BOARD MEMBER	1.00 ................. 40.00	X		0	99,880	10,332
(17) JAMES MILLER PD...................................................................... BOARD MEMBER	1.00 ................. 0.00	X		0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
PC MSTR LSCO LLC 1234 WASHINGTON ROAD WESTMINSTER,MD21157	PASS THROUGH ROOM & BOARD	552,359
MM SYKESVILLE LLC 7309 SECOND AVE SYKESVILLE,MD21784	PASS THROUGH ROOM & BOARD	357,612
CITIZENS CARE & REHABILITATION CENTER 1920 ROSEMONT AVE FREDERICK,MD21702	PASS THROUGH ROOM & BOARD	228,816
CARROLL LUTHERAN VILLAGE 300 SAINT LUKE CIR WESTMINSTER,MD21158	PASS THROUGH ROOM & BOARD	166,258
LORIEN TANEYTOWN 100 ANTRIM BLVD TANEYTOWN,MD21787	PASS THROUGH ROOM & BOARD	161,120
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 7

- 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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	1,315,636	832,006	966,672	1,485,274	1,771,608	6,371,196
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	1,315,636	832,006	966,672	1,485,274	1,771,608	6,371,196
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)..						1,064,579
6	Public support. Subtract line 5 from line 4.						5,306,617

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..	1,315,636	832,006	966,672	1,485,274	1,771,608	6,371,196
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	653	2,011	5,444	61,064	6,787	75,959
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.)..	49,715	45,935	46,367	43,183	72,051	257,251
11	Total support. Add lines 7 through 10						6,704,406

Gross receipts from related activities, etc. (see instructions) ..................

42,766,849

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 2018 (line 6, column (f) divided by line 11, column (f)) .........

79.150 %

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

71.170 %

16a

33 1/3% support test—2018. 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—2017. 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—2018. 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—2017. 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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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.)..

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 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. 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—2017. 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) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2018

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) 2018

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 (explain in Part VI). 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) 2018

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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 II, LINE 10, EXPLANATION OF OTHER INCOME:	FUNDRAISING GROSS INCOME

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- 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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization CARROLL HOSPICE INC

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization CARROLL HOSPICE INC		Employer identification number 52-1565870

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization CARROLL HOSPICE INC			Employer identification number 52-1565870
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) (2018)

Additional Data

Software ID:
Software Version:

- 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.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

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 7/25/06, 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) 2018

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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)

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

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 .....
b	Buildings ....	5,624,959	1,862,881	3,762,078
c	Leasehold improvements
d	Equipment ....	25,879	9,745	16,134
e	Other .....	586,661	454,859	131,802
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				3,910,014

Schedule D (Form 990) 2018

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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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) ASSETS LIMITED AS TO USE				1,765,073
(2) DUE TO/FROM AFFILIATES				7,181
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				1,772,254

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 CARROLL AFFILIATES	714,314
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	714,314
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) 2018

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 (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
CARROLL HOSPICE INC

Employer identification number

52-1565870

Part I

Fundraising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2018

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 TASTE OF CARROLL (event type)	(b) Event #2 SEASON TO REMEMBER (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	230,103	17,650	247,753
2	Less: Contributions . . . .	172,792	2,910	175,702
3	Gross income (line 1 minus line 2) . . . . . .	57,311	14,740	72,051

4	Cash prizes . . . . .
5	Noncash prizes . . . .	550	550
6	Rent/facility costs . . . .	9,142	9,142
7	Food and beverages . . .	475	475
8	Entertainment . . . .	900	900
9	Other direct expenses . . .	4,227	4,227
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		15,294
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		56,757

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2018

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

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? .........

Yes

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 nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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) 2018

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)
1REGINA BODNAR BOARD MEMBER/EXECUTIVE DIRECTOR	(i) (ii)	191,980 ------------- 0	26,356 ------------- 0	1,156 ------------- 0	1,121 ------------- 0	22,820 ------------- 0	243,433 ------------- 0	0 ------------- 0
2ELLEN FINNERTY-MYERS BOARD MEMBER	(i) (ii)	0 ------------- 256,863	0 ------------- 63,362	0 ------------- 414	0 ------------- 48,868	0 ------------- 2,631	0 ------------- 372,138	0 ------------- 0
3KEVIN KELBLY TREASURER/CFO	(i) (ii)	0 ------------- 363,877	0 ------------- 85,380	0 ------------- 774	0 ------------- 12,021	0 ------------- 24,014	0 ------------- 486,066	0 ------------- 0

Schedule J (Form 990) 2018

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
PART I, LINE 4B	THE FOLLOWING DIRECTORS AND OFFICERS PARTICIPATED IN A LIFEBRIDGE HEALTH SPONSORED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR: ELLEN FINNERTY-MYERS $ 43,009
PART 1, LINE 3	CARROLL HOSPICE, INC. RELIED ON A RELATED ORGANIZATION THAT USED THE FOLLOWING METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY BOARD/COMPENSATION COMMITTEE
COMPENSATION PROVIDED BY RELATED ORGANIZATIONS	MS. FINNERTY-MYERS RECEIVED COMPENSATION AS CHIEF DEVELOPMENT OFFICER OF CARROLL HOSPITAL CENTER, INC., NOT AS A DIRECTOR. DR. MIDDLETON RECEIVED COMPENSATION AS A PHYSICIAN OF A SINGLE MEMBER LLC OWNED BY LIFEBRIDGE COMMUNITY PHYSICIANS, INC., NOT AS A DIRECTOR.

Schedule J (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) CARROLL CARE PHARMACIES LLC	INDIRECT BUSINESS	475,267	CARROLL HOSPICE PAID APPROXIMATELY $475,267 FOR PHARMACEUTICAL SUPPLIES AND MEDICINE FROM CARROLL CARE PHARMACIES. ONE OF THE DIRECTORS OF CARROLL HOSPICE, JAMES MILLER P.D., IS AN OWNER OF THE BUSINESS. ALL TRANSACTIONS WERE AT FAIR MARKET VALUE AND WERE NEGOTIATED AT ARM'S LENGTH.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

Return Reference	Explanation
FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	LIFE FOR PATIENTS NEEDING END-OF-LIFE HOSPICE CARE. OUR COMPREHENSIVE AND COMPASSIONATE CARE IS CENTERED AROUND A HOLISTIC PHILOSOPHY OF TREATMENT THAT ADDRESSES THE PATIENT'S PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING, ALLOWING THEM TO LIVE AS FULLY AND COMFORTABLY AS POSSIBLE IN THEIR FINAL DAYS. OUR SERVICES INCLUDE A FULL SPECTRUM OF CARE: PAIN MANAGEMENT AND SYMPTOM CONTROL, COORDINATION OF HOME AND INPATIENT SERVICES, AN INTERDISCIPLINARY TEAM INCLUDING PHYSICIANS, NURSES, SOCIAL WORKERS, CLERGY, PHARMACISTS, HOSPICE VOLUNTEERS, HOME HEALTH AIDES, AND BEREAVEMENT CARE FOR FAMILY MEMBERS FOR UP TO 13 MONTHS. CARROLL HOSPICE PROVIDES HOSPICE CARE AND SERVICES TO ALL INDIVIDUALS IN NEED. REGARDLESS OF INSURANCE COVERAGE OR FINANCIAL SITUATION, NO ONE IS REFUSED OR DENIED HOSPICE CARE AND EVERY PATIENT RECEIVES THE SAME COMPREHENSIVE HIGH-QUALITY SERVICE. INITIALLY, CARROLL HOSPICE ASSISTS FAMILIES IN DETERMINING IF THE PATIENT IS ELIGIBLE FOR ANY MEDICAL OR INSURANCE COVERAGE. HOSPICE COVERAGE IS WIDELY AVAILABLE AND IS COVERED BY MOST PRIVATE INSURANCE PLANS, MEDICARE, MEDICAID AND THE VETERANS ADMINISTRATION. IF A PERSON IN NEED DOES NOT HAVE COVERAGE, CARROLL HOSPICE WILL WORK WITH EACH FAMILY ON A CASE BY CASE BASIS. IN ADDITION, CARROLL HOSPICE HANDLES ALL BILLING OF SERVICES AND SUPPLIES AS THEY RELATE TO THE TERMINAL DIAGNOSIS.
FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	PHYSICAL, EMOTIONAL AND SPIRITUAL WELL-BEING, ALLOWING THEM TO LIVE AS FULLY AND COMFORTABLY AS POSSIBLE IN THEIR FINAL DAYS. OUR SERVICES INCLUDE A FULL SPECTRUM OF CARE: PAIN MANAGEMENT AND SYMPTOM CONTROL, COORDINATION OF HOME AND INPATIENT SERVICES, AN INTERDISCIPLINARY TEAM INCLUDING PHYSICIANS, NURSES, SOCIAL WORKERS, CLERGY, PHARMACISTS, HOSPICE VOLUNTEERS, HOME HEALTH AIDES, AND BEREAVEMENT CARE FOR FAMILY MEMBERS FOR UP TO 13 MONTHS. CARROLL HOSPICE PROVIDES HOSPICE CARE AND SERVICES TO ALL INDIVIDUALS IN NEED. REGARDLESS OF INSURANCE COVERAGE OR FINANCIAL SITUATION, NO ONE IS REFUSED OR DENIED HOSPICE CARE AND EVERY PATIENT RECEIVES THE SAME COMPREHENSIVE HIGH-QUALITY SERVICE. INITIALLY, CARROLL HOSPICE ASSISTS FAMILIES IN DETERMINING IF THE PATIENT IS ELIGIBLE FOR ANY MEDICAL OR INSURANCE COVERAGE. HOSPICE COVERAGE IS WIDELY AVAILABLE AND IS COVERED BY MOST PRIVATE INSURANCE PLANS, MEDICARE, MEDICAID AND THE VETERANS ADMINISTRATION. IF A PERSON IN NEED DOES NOT HAVE COVERAGE, CARROLL HOSPICE WILL WORK WITH EACH FAMILY ON A CASE BY CASE BASIS. IN ADDITION, CARROLL HOSPICE HANDLES ALL BILLING OF SERVICES AND SUPPLIES AS THEY RELATE TO THE TERMINAL DIAGNOSIS.
FORM 990, PART VI, SECTION A, LINE 6	CARROLL HOSPITAL CENTER, INC., A 501(C)(3) CORPORATION, IS THE SOLE MEMBER OF CARROLL HOSPICE, INC.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER OF THE CORPORATION HAS THE RIGHT TO ELECT AND REMOVE TRUSTEES OF THE CORPORATION. THE SOLE MEMBER MAY REMOVE ANY ELECTED TRUSTEE AT ANY TIME, WITH OR WITHOUT CAUSE. EX OFFICIO TRUSTEES SHALL BE DEEMED TO BE REMOVED AS OF THE TIME THEY CEASE TO HOLD THE OFFICE ON WHICH THEIR EX OFFICIO STATUS IS BASED. A VACANCY IN AN EX OFFICIO POSITION SHALL BE FILLED BY THE INDIVIDUAL APPOINTED TO THE UNDERLYING OFFICE.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER OF THE CORPORATION HAS THE RIGHT TO ELECT AND REMOVE TRUSTEES OF THE CORPORATION, THE RIGHT TO APPROVE AMENDMENTS TO THE BYLAWS, AND SUCH OTHER RIGHTS AS MAY BE CONFERRED BY LAW ON THE MEMBERS OF A NON-STOCK CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF MARYLAND.
FORM 990, PART VI, SECTION B, LINE 11B	THE ORGANIZATION'S FORM 990 IS REVIEWED IN DETAIL BETWEEN THE PREPARER, AN OUTSIDE ACCOUNTING FIRM, AND THE FINANCE DEPARTMENT OF CARROLL HOSPITAL CENTER AND LIFEBRIDGE HEALTH. PRIOR TO FILING THE ORGANIZATION'S FORM 990, THE ORGANIZATION PROVIDES A COPY OF THE FORM 990 TO EACH MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS FOR THEIR REVIEW. QUESTIONS, COMMENTS AND FEEDBACK ARE THEN INCORPORATED INTO THE FILED FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C	ALL DIRECTORS, OFFICERS, EMPLOYEES, MEDICAL STAFF MEMBERS, AND VOLUNTEERS ARE EXPECTED TO RECOGNIZE AND DISCLOSE AT THE EARLIEST POSSIBLE TIME ACTUAL AND POTENTIAL CONFLICTS OF INTEREST. AN INDIVIDUAL IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH REGARD TO A MATTER OR TRANSACTION IF THE INDIVIDUAL OR A FAMILY MEMBER OF THE INDIVIDUAL HAS A PERSONAL OR FINANCIAL INTEREST THAT HAS THE POTENTIAL TO INFLUENCE THE ACTION TAKEN BY THE INDIVIDUAL ON BEHALF OF LIFEBRIDGE HEALTH. ADDITIONAL INFORMATION REGARDING WHAT CONSTITUTES A CONFLICT OF INTEREST AND HOW TO DISCLOSE A CONFLICT IS OUTLINED BELOW. LIFEBRIDGE AND ALL OF ITS SUBSIDIARIES SHALL REQUIRE ALL EMPLOYEES, MEDICAL STAFF, AND MEMBERS OF THE BOARD TO DISCLOSE ANY ACTIVITIES THAT COULD RESULT IN A POSSIBLE CONFLICT OF INTEREST. IF A CONFLICT IS IDENTIFIED, THE PERSON INVOLVED WOULD RECUSE HIM/HERSELF FROM DELIBERATIONS REGARDING THE TRANSACTIONS. AN INDIVIDUAL IS CONSIDERED TO HAVE A CONFLICT OF INTEREST WITH REGARD TO A MATTER OR TRANSACTION IF THE INDIVIDUAL HAS A PERSONAL OR FINANCIAL INTEREST THAT HAS THE POTENTIAL TO INFLUENCE THE ACTION TAKEN BY THE INDIVIDUAL ON BEHALF OF LIFEBRIDGE OR ANY OF ITS SUBSIDIARIES. AN INDIVIDUAL IS CONSIDERED TO HAVE A "PERSONAL INTEREST" IN A MATTER IF IT IS LIKELY TO HAVE A DIRECT AND MATERIAL IMPACT ON THE INDIVIDUAL'S RELATIONSHIP WITH LIFEBRIDGE OR ANY OF ITS SUBSIDIARIES (E.G., THE INDIVIDUAL'S CONTINUED MEMBERSHIP ON A SUBSIDIARY HOSPITAL'S MEDICAL STAFF), OR ON THE INDIVIDUAL'S OWN HEALTH CARE, OR THE INDIVIDUAL IS PERSONALLY INVOLVED IN A SUBSTANTIAL WAY (E.G., SERVES AS AN OFFICER, DIRECTOR, TRUSTEE, OR KEY EMPLOYEE) WITH ANOTHER ORGANIZATION THAT HAS A SIGNIFICANT INTEREST IN THE MATTER. AN INDIVIDUAL IS CONSIDERED TO HAVE A "FINANCIAL INTEREST" IN A TRANSACTION IF THE INDIVIDUAL, OR THEIR FAMILY MEMBER, (I) IS A PARTY TO THE TRANSACTION, (II) WILL BENEFIT PERSONALLY FROM THE TRANSACTION, OR (III) HAS, DIRECTLY OR INDIRECTLY, A CURRENT OR ANTICIPATED OWNERSHIP OR INVESTMENT IN, OR COMPENSATION ARRANGEMENT WITH, A PARTY TO THE TRANSACTION. AN OWNERSHIP INTEREST OF LESS THAN 5% IN AN ENTITY WILL NOT, IN AND OF ITSELF, GENERALLY BE CONSIDERED A FINANCIAL INTEREST; HOWEVER, TO THE EXTENT THE INDIVIDUAL'S COMPENSATION FROM THE ENTITY IS DIRECTLY LINKED TO THE ENTITY'S BUSINESS WITH LIFEBRIDGE HEALTH, SUCH COMPENSATION WILL CONSTITUTE A FINANCIAL INTEREST. FOR THE PURPOSES OF THIS POLICY, A "FAMILY MEMBER" INCLUDES SPOUSE OR DOMESTIC PARTNER, PARENTS, BROTHERS AND SISTERS, CHILDREN (WHETHER NATURAL OR ADOPTED), GRANDPARENTS, GRANDCHILDREN, GREAT-GRANDCHILDREN, AND IN-LAWS, SPOUSES OF BROTHERS, SISTERS, CHILDREN, GRANDCHILDREN, AND GREAT-GRANDCHILDREN, AND ANY OTHER MEMBER OF A HOUSEHOLD OF THE INDIVIDUAL. CONFLICTS OF INTEREST ARE TO BE REPORTED BY EMPLOYEES TO THEIR SUPERVISOR, WHO WILL BE RESPONSIBLE FOR DETERMINING WHETHER FURTHER DISSEMINATION IS NECESSARY. MEMBERS OF THE MEDICAL STAFF SHOULD REPORT CONFLICTS TO THE CHIEF OF THEIR DEPARTMENT, AND MEMBERS OF THE BOARD SHOULD REPORT THEM TO THE CHIEF COMPLIANCE OFFICER. QUESTIONNAIRES ARE SENT OUT TO MEMBERS OF THE BOARD ON AN ANNUAL BASIS. IF QUESTIONS ARISE OR FURTHER GUIDANCE IS SOUGHT, INDIVIDUALS CAN CONTACT THE CHIEF COMPLIANCE OFFICER (410-601-4832) OR CONFIDENTIAL COMPLIANCE HOTLINE (1-844-732-6233). NOTHING IN THIS DEFINITION IS INTENDED TO RELIEVE ANY PERSON OF ANY ADDITIONAL OBLIGATIONS THAT MAY BE IMPOSED BY STATE OR FEDERAL LAW.
FORM 990, PART VI, SECTION C, LINE 19	IT IS THE POLICY OF LIFEBRIDGE HEALTH INC. AND ITS SUBSIDIARIES TO MAKE AVAILABLE UPON REQUEST THE AUDITED FINANCIAL STATEMENTS TO THE GENERAL PUBLIC. THE LIFEBRIDGE HEALTH INC. AND SUBSIDIARY GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST OR VIA A WEBSITE. THE CONFLICT OF INTEREST POLICY IS INCLUDED ON SCHEDULE O.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 537,718. MANAGEMENT AND GENERAL EXPENSES 140,929. FUNDRAISING EXPENSES 3,532. TOTAL EXPENSES 682,179. HOSPICE ADMINISTRATIVE FEE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 385,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 385,000. DME RENTAL FEES: PROGRAM SERVICE EXPENSES 516,252. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 516,252.
PART XII, LINE 2C	THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

CARROLL HOSPICE INC

Employer identification number

52-1565870

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

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)CARROLL HOSPITAL CENTER INC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 52-1452024	HOSPITAL	MD	501(C)3	LINE 3	CARROLL COUNTY HEALTH SERVICES CORPORATION		No
(2)CARROLL HOSPITAL CENTER FOUNDATION INC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 52-1115038	FOUNDATION	MD	501(C)3	LINE 12A, I	CARROLL HOSPITAL CENTER INC		No
(3)CARROLL COUNTY HEALTH SERVICES INC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 52-0691413	HEALTH SERVICE	MD	501(C)3	LINE 12B, II	LIFEBRIDGE HEALTH INC		No
(4)PARTNERSHIP FOR A HEALTHIER CARROLL COUNTY 535 OLD WESTMINSTER PIKE SUITE 102 WESTMINSTER,MD21157 52-2156892	HEALTH SERVICE	MD	501(C)3	LINE 7	CARROLL HOSPITAL CENTER INC		No
(5)LIFEBRIDGE HEALTH INC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-1402373	TO SUPPORT THE CHARITABLE MISSION OF ITS SUBSIDARIES	MD	501(C)3	LINE 12C, III-FI	N/A		No
(6)LEVINDALE HEBREW GERIATRIC CENTER AND HOSPITAL 2434 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-0607913	GERIATRIC HOSPITAL DEDICATED TO PROVIDING SERVICE TO THE AGED	MD	501(C)3	LINE 3	LIFEBRIDGE HEALTH INC		No
(7)SINAI HOSPITAL OF BALTIMORE INC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-0486540	PROVIDE MEDICAL CARE, EDUCATE STUDENTS, PERFORM MEDICAL RESEARCH	MD	501(C)3	LINE 3	LIFEBRIDGE HEALTH INC		No
(8)COURTLAND GARDENS NURSING AND REHABILITATION CENTER 2343 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-0607907	SKILLED NURSING CARE FOR THE ELDERLY AND DISABLED	MD	501(C)3	LINE 10	LIFEBRIDGE HEALTH INC		No
(9)NORTHWEST HOSPITAL CENTER INC 5401 OLD COURT ROAD RANDALLSTOWN,MD21133 52-1372665	A HOSPITAL ASPIRING TO IMPROVE THE WELLBEING OF THE COMMUNITY IT SERVES	MD	501(C)3	LINE 3	LIFEBRIDGE HEALTH INC		No
(10)CHILDREN'S HOSPITAL OF BALTIMORE CITY 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-0591592	CHARITY SUPPORT FOR SINAI HOSPITAL OF BALTIMORE, INC.	MD	501(C)3	LINE 12B, II	LIFEBRIDGE HEALTH INC		No
(11)CHILDREN'S HOSPITAL AT SINAI FOUNDATION 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-2167587	CHARITY SUPPORT FOR SINAI HOSPITAL OF BALTIMORE, INC.	MD	501(C)3	LINE 12B, II	LIFEBRIDGE HEALTH INC		No
(12)THE BALTIMORE JEWISH ELDERCARE FOUNDATION 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-2337669	CHARITY SUPPORT FOR LEVINDALE HEBREW GERIATRIC CENTER HOSPITAL	MD	501(C)3	LINE 12B, II	LIFEBRIDGE HEALTH INC		No
(13)THE BALTIMORE JEWISH HEALTH FOUNDATION INC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-2111541	CHARITY SUPPORT FOR SINAI HOSPITAL OF BALTIMORE, INC.	MD	501(C)3	LINE 12B, II	LIFEBRIDGE HEALTH INC		No
(14)THE BALTIMORE CHILD ABUSE CENTER INC CHILD ADVOCACY NETWORK 2300 NORTH CHARLES STREET BALTIMORE,MD21218 52-1681279	CHILD ABUSE SUPPORT, TREATMENT, AND PREVENTION	MD	501(C)3	LINE 7	LIFEBRIDGE HEALTH INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

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
(1) LIFEBRIDGE NEUROSCIENCES LLC (FORMALLY ORTHOPEDIC SPECIALISTS LLC) 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 45-0719598	MEDICAL SERVICES	MD	N/A
(2) LIFEBRIDGE GYNECOLOGY OF PIKESVILLE LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-2949092	MEDICAL SERVICES	MD	N/A
(3) LIFEBRIDGE MEDICAL ASSOCIATES LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-2941505	MEDICAL SERVICES	MD	N/A
(4) LIFEBRIDGE COMMUNITY PEDIATRICS LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-2842468	MEDICAL SERVICES	MD	N/A
(5) LIFEBRIDGE COMMUNITY PULMONOLOGY LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-1401312	MEDICAL SERVICES	MD	N/A
(6) LIFEBRIDGE COMMUNITY GASTROENTEROLOGY LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-2863298	MEDICAL SERVICES	MD	N/A
(7) LIFEBRIDGE CARDIOLOGY PARKVILLE LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-3742313	MEDICAL SERVICES	MD	N/A
(8) HOMECARE MARLYAND LLC 8028 RITCHIE HIGHWAY SUITE 210B PASADENA,MD21122 26-1378175	MEDICAL SERVICES	MD	N/A
(9) LIFEBRIDGE REHABILITATION SERVICES LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 81-1504380	MEDICAL SERVICES	MD	N/A
(10) CARDIOVASCULAR ASSOCIATES OF MARYLAND LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 46-2935110	MEDICAL SERVICES	MD	N/A
(11) CARROLL OCCUPATIONAL HEALTH LLC 7001 CORPORATE CENTER COURT WESTMINSTER,MD21157 20-2769332	OCCUPATIONAL	MD	N/A
(12) CARROLL COUNTY RADIOLOGY LLC 7253 AMBASSADOR ROAD BALTIMORE,MD21244 52-2190849	RADIOLOGY	MD	N/A
(13) LIFEBRIDGE PRIMARY CARE OF ELDERSBURG LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 38-3897702	MEDICAL SERVICES	MD	N/A
(14) LIFEBRIDGE PRIMARY CARE OF NORTH CARROLL LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 80-0883321	MEDICAL SERVICES	MD	N/A
(15) ELLICOTT CITY ASC MANAGEMENT LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-2331663	MEDICAL SERVICES	MD	N/A
(16) SURGICENTER OF BALTIMORE LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-1658841	MEDICAL SERVICES	MD	N/A
(17) MOUNT AIRY MED-SERVICES LLC 46-5632176 200 MEMORIAL AVENUE WESTMINSTER MARY 200 MEMORIAL AVENUE WESTMINSTER,MD21157 46-5632176	MEDICAL SERVICES	MD	N/A
(18) SPRINGWELL PARTNERS LLC 2200 PINE HILL FARMS LANE HUNT VALLEY,MD21030 27-1971171	ASSISTED LIVING	MD	N/A
(19) LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC 5401 OLD COURT ROAD RANDALLSTOWN,MD21133 81-4209029	MEDICAL SERVICES	MD	N/A
(20) LIFEBRIDGE LAB MANAGEMENT LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 82-1113874	LABORATORY SERVICES	MD	N/A
(21) LIFEBRIDGE METROPOLITAN PHYSICIAN GROUP II LLC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 81-4223537	MEDICAL SERVICES	MD	N/A
(22) LIFEBRIDGE MULTI-SPECIALTY LLC 41 MAGNA WAY SUITE 100 WESTMINSTER,MD21157 46-3753120	MEDICAL SERVICES	MD	N/A
(23) BRINTON WOODS HEALTH CARE CENTER LLC 9515 DEERECO ROAD SUITE 407 TIMONIUM,MD21093 26-0107427	REHABILITATION CENTER	MD	N/A
(24) BRINTON WOODS SENIOR LIVING LLC 9515 DEERECO ROAD SUITE 407 TIMONIUM,MD21093 74-3137876	ASSISTED LIVING	MD	N/A
(25) ELLICOTT CITY AMBULATORY SURGERY CENTER LLLP 2850 NORTH RIDGE ROAD ELLICOTT CITY,MD21043	MEDICAL SERVICES	MD	N/A
(26) OAK FARM SOLUTIONS LLC 1122 KENILWORTH DRIVE SUITE 307 TOWSON,MD21204 47-4944865	HOME HEALTH SERVICES	MD	N/A

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
(1) CARROLL COUNTY MED SERVICES INC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 52-1891102	MEDICAL SERVICE	MD	N/A	C				No
(2) LIFEBRIDGE INVESTMENTS INC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-1483166	INVESTMENTS	MD	N/A	C				No
(3) HEALTHSTAR MEDICAL SERVICES INC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 52-1829098	HEALTHCARE	MD	N/A	C				No
(4) PRACTICE DYNAMICS INC 124 BUSINESS CENTER DRIVE REISTERSTOWN,MD21136 52-1960319	MANAGEMENT	MD	N/A	C				No
(5) LIFEBRIDGE INSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMANKY1-1102 CJ 98-0415396	INSURANCE	CJ	N/A	C				No
(6) LIFEBRIDGE COMMUNITY PHYSICIANS INC 2401 WEST BELVEDERE AVENUE BALTIMORE,MD21215 80-0719005	HEALTHCARE	MD	N/A	C				No
(7) CARROLL BILLING SERVICES INC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 30-0026598	HEALTHCARE SERVICES	MD	N/A	C				No
(8) CARROLL COUNTY GENERAL HOSPITAL SOUTH CARROLL MEDICAL CENTER CONDOMINIUM 200 MEMORIAL AVENUE WESTMINSTER,MD21157	REAL ESTATE	MD	N/A	C				No
(9) MED-SERVICES HOLDINGS INC 200 MEMORIAL AVENUE WESTMINSTER,MD21157	MEDICAL SERVICE	MD	N/A	C				No
(10) CARROLL HEALTH GROUP LLC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 27-1956453	HEALTHCARE	MD	N/A	C				No
(11) CARROLL URGENT CARE LLC 200 MEMORIAL AVENUE WESTMINSTER,MD21157 46-5739154	HEALTHCARE	MD	N/A	C				No
(12) LIFEBRIDGE HEALTH ISRAEL LTD 16 ABBA HILLEL ROAD RAMAT GAN 5250608 IS 51-5804516	HEALTHCARE CALL CENTER	IS	N/A	C				No

Schedule R (Form 990) 2018

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

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

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

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

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

Yes

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
(1) CARROLL HOSPITAL CENTER FOUNDATION INC	C	56,000	FMV
(2) CARROLL HOSPITAL CENTER INC	P	6,234,490	FMV
(3) BRINTON WOODS SENIOR LIVING LLC	M	95,778	FMV

Schedule R (Form 990) 2018

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) 2018

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) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CARROLL HOSPICE, AN AFFILIATE OF CARROLL HOSPITAL CENTER, IS DEDICATED TO IMPROVING THE QUALITY OF
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	17
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 2018 (Part V, line 2a) ......	5	123
6	Total number of volunteers (estimate if necessary) .............	6	177
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) .........	1,485,274	1,771,608
9	Program service revenue (Part VIII, line 2g) .........	10,514,121	12,346,328
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	61,064	6,787
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	28,289	57,628
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	12,088,748	14,182,351
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	6,022,311	7,115,743
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 243,722
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	2,837,021	3,247,537
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	8,859,332	10,363,280
19	Revenue less expenses. Subtract line 18 from line 12.......	3,229,416	3,819,071
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	12,005,204	15,754,034
21	Total liabilities (Part X, line 26).............	950,850	880,609
22	Net assets or fund balances. Subtract line 21 from line 20.....	11,054,354	14,873,425

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 7,281,871 including grants of $ ) (Revenue $ 10,826,785 )
	HOME HOSPICE CARROLL HOSPICE PROVIDES HOSPICE CARE IN THE PATIENTS HOME, NURSING HOME OR ASSISTED LIVING FACILITY. NUMBER OF PATIENTS SERVICED IN FY2019 - 896. DAYS OF CARE PROVIDED IN FY2019 - 67,764 PROGRAMS PROVIDED - GENERAL INPATIENT HOSPICE CARE, RESIDENTIAL.

4b	(Code: ) (Expenses $ 1,800,290 including grants of $ ) (Revenue $ 1,520,414 )
	INPATIENT HOSPICE (DOVE HOUSE) PATIENTS IN THE DOVE HOUSE RECEIVE CARE 24 HOURS A DAY FROM AN EXPERT MEDICAL TEAM DEDICATED TO HELPING THEM LIVE AS COMFORTABLE AND SUPPORTED AS POSSIBLE. NUMBER OF PATIENTS SERVED IN FY2019 - 491. DAYS OF CARE PROVIDED FY2019 - 2,383. PROGRAMS PROVIDED - HOSPICE EDUCATION TO NURSING FACILITIES, GENERAL HOSPICE PATIENT CARE, PALLIATIVE CARE.

4c	(Code: ) (Expenses $ 1,851 including grants of $ ) (Revenue $ )
	BEREAVEMENT SERVICES CARROLL HOSPICE BEREAVEMENT PROGRAM HELPS FAMILIES TO BETTER UNDERSTAND AND COPE WITH THEIR GRIEF, WHILE RESPECTING THEIR UNIQUE GRIEVING STYLE. SERVED 1,603 FAMILY MEMBERS IN FY2019. SERVED 5,016 COMMUNITY MEMBERS IN VARIOUS BV SUPPORT GROUPS IN FY2019. PROGRAMS PROVIDED - PATHWAYS, BV LUNCHEON, WIDOW SUPPORT, WIDOWER SUPPORT, GRIEF SPEAKER AT HOSPICE, REMEMBRANCE SERVICE, PET LOSS SUPPORT, HEALING HEARTS DAY CAMP.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses9,084,012

(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) TODD MITCHELL........................................................................ BOARD MEMBER	1.00 .......................0.00	X			0	0	0
(19) KEVIN KELBLY........................................................................ TREASURER/CFO	1.00 .......................40.00		X		0	450,031	36,035
(20) JILL ENGLAR........................................................................ DIRECTOR SUPPORT SERVICES	40.00 .......................0.00			X	115,053	0	1,157
(21) ROBIN ELZA........................................................................ HOSPICE NURSE	40.00 .......................0.00			X	108,706	0	10,935
(22) TRACEY BEYER........................................................................ HOSPICE NURSE	40.00 .......................0.00			X	104,059	0	24,002
(23) MICHELE SIPES........................................................................ HOSPICE NURSE	40.00 .......................0.00			X	103,646	0	10,254
(24) KATHY MILLER........................................................................ HOSPICE NURSE	40.00 .......................0.00			X	103,168	0	22,353

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	754,124	870,550	190,508

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	175,702
d	Related organizations		1d	56,000
e	Government grants (contributions)		1e	650,000

f	All other contributions, gifts, grants, and similar amounts not included above		1f	889,906

g	Noncash contributions included in lines 1a - 1f:$ 18,267
h Total. Add lines 1a-1f.......		1,771,608

		Business Code
2a	MEDICARE/MEDICAID	623000	11,717,792	11,717,792
b	PRIVATE	623000	411,927	411,927
c	PHYSICIAN SERVICE	623000	197,384	197,384
d	PROGRAM SERVICE RENTAL	623000	19,225	19,225
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		12,346,328

3 Investment income (including dividends, interest, and othersimilar amounts) ......			6,787			6,787
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)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ 175,702of contributions reported on line 1c). See Part IV, line 18 ....
	a		72,051
b	Less: direct expenses ...b		15,294
c	Net income or (loss) from fundraising events..			56,757			56,757
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
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	MEDICAL RECORDS COPY		623000	871	871
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			871
12	Total revenue. See Instructions......			14,182,351	12,347,199	0	63,544

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to domestic individuals. See Part IV, line 22
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	214,432	42,886	171,546
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	5,727,996	5,562,094		165,902
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	830,977	810,848		20,129
10	Payroll taxes ...........	342,338	329,287		13,051
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
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)	1,583,431	1,053,970	525,929	3,532
12	Advertising and promotion ....	43,148		43,148
13	Office expenses .......	36,122		32,335	3,787
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	115,842		115,842
17	Travel ............	228,979	228,956		23
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	24,169	21,942		2,227
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	174,909	104,945	69,964
23	Insurance ...	30,000		30,000
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	MEDICAL SUPPLIES	929,084	929,084
b	TELEPHONES	46,782		46,782
c	FUNDRAISING EXPENSES	35,071			35,071
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	10,363,280	9,084,012	1,035,546	243,722
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 ........			4,713,508	1	7,685,920
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......			214,438	3	978,342
4	Accounts receivable, net .............			1,477,066	4	1,388,256
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
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 ..............
					6
7	Notes and loans receivable, net ....				7
8	Inventories for sale or use ........				8
9	Prepaid expenses and deferred charges ......			22,613	9	19,248
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	6,237,499
b	Less: accumulated depreciation	10b	2,327,485	3,963,918	10c	3,910,014
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,613,661	15	1,772,254
16	Total assets. Add lines 1 through 15 (must equal line 34)...			12,005,204	16	15,754,034

17	Accounts payable and accrued expenses .....	173,850	17	166,295
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 ..		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	777,000	25	714,314
26	Total liabilities. Add lines 17 through 25..	950,850	26	880,609

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	9,362,985	27	12,196,011
28	Temporarily restricted net assets ...........	1,691,369	28	2,677,414
29	Permanently restricted net assets		29
	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 ...........	11,054,354	33	14,873,425
34	Total liabilities and net assets/fund balances ........	12,005,204	34	15,754,034