2025-09-22T10:06:12-05:00 2024-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-01-01 311243376 HOSPICE OF FAYETTE COUNTY INC HOSP 9372569507 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 ROBERT MORRIS CFO 9372569507 2025-09-18 1 1 AMY CIMINELLO P00796388 6148493000 2025-09-01 2024 2025-03-06 01:10:19Z GAIL STOKES 222 N OAKLAND AVE WASHINGTON COURTHOUSE OH 43160 2661592 0 X WWW.HOSPICEOFFAYETTECOUNTY.ORG X 1988 OH OUR MISSION IS TO CELEBRATE THE LIVES OF THOSE WE HAVE THE PRIVILEGE OF SERVING BY PROVIDING SUPERIOR CARE AND SUPERIOR SERVICES TO EACH PATIENT AND FAMILY. WE ARE A NOT-FOR-PROFIT, COMMUNITY-BASED HOSPICE. 13 13 9 50 0 0 225107 10088 5427783 2547401 70604 104103 0 0 5723494 2661592 0 0 0 0 3245172 1425559 0 0 0 2234463 1110724 5479635 2536283 243859 125309 3954063 3707981 455163 33908 3498900 3674073 X PROVIDE HOME OR NURSING HOME CARE FOR TERMINALLY ILL PATIENTS AND THEIR FAMILIES. PROVIDED EDUCATION & SUPPORT TO FAYETTE COUNTY AND SURROUNDING COMMUNITIES ABOUT QUALIFY OF LIFE ISSUES. 0 1 1885711 0 2547401 COORDINATES A PROGRAM OF HOME, OUTPATIENT, AND INPATIENT HOSPICE CARE THAT PROVIDES PALLIATIVE CARE, SUPPORTIVE MEDICAL SERVICES, AND OTHER SUPPORT SERVICES TO TERMINALLY ILL PERSONS AND THEIR FAMILIES, REGARDLESS OF ABILITY TO PAY. 1885711 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 9 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X ROBERT MORRIS 9372569507 7575 PARAGON ROAD DAYTON OH 45459 PETE HALEY CHAIR 2.00 16.00 X X 0 0 0 GARY LEROY VICE CHAIR 2.00 14.00 X X 0 0 0 GENE THORN TREASURER 2.00 14.00 X X 0 0 0 TONI SPRINKEL SECRETARY 2.00 14.00 X X 0 0 0 CHARLES BANE MD BOARD MEMBER 2.00 14.00 X 0 0 0 DAVID REYNOLDS MD BOARD MEMBER 2.00 14.00 X 0 0 0 DOUG HELMAN BOARD MEMBER - PART YEAR 2.00 14.00 X 0 0 0 KEVIN BLACK BOARD MEMBER 2.00 14.00 X 0 0 0 KEVIN HARLAN BOARD MEMBER 2.00 14.00 X 0 0 0 KIMBERLY MORRISON BOARD MEMBER 2.00 14.00 X 0 0 0 MARY JUSTICE BOARD MEMBER 2.00 14.00 X 0 0 0 MICHAEL BOLAND BOARD MEMBER 2.00 16.00 X 0 0 0 PAM GERBER BOARD MEMBER 2.00 14.00 X 0 0 0 THOMAS MANN BOARD MEMBER 2.00 16.00 X 0 0 0 KENT ANDERSON CHIEF EXECUTIVE OFFICER 2.00 58.00 X 0 600653 59881 ROBERT MORRIS CHIEF FINANCIAL OFFICER 2.00 58.00 X 0 383933 53196 MILISSA JANE KNISLEY EXECUTIVE DIRECTOR, HOFC - PART YEAR 40.00 0.00 X 28272 0 5913 28272 984586 118990 0 0 1 0 0 10088 10088 PATIENT SERVICE REVENU 624100 2547401 2547401 2547401 84887 84887 19216 0 19216 19216 19216 2661592 2547401 0 104103 34185 34185 1117010 1007216 109794 44889 41417 3472 138278 134102 4176 91197 83076 8121 425 425 5275 5275 10065 10065 49721 46811 2910 238 238 18498 8444 10054 10085 3750 6335 59677 46553 13124 84903 82325 2578 3875 1025 2850 12118 12118 9159 9159 ALLOCATED EXPENSES 413061 413061 MEDICAL SUPPLIES 216847 216847 ROOM & BOARD 109675 109675 PATIENT SERVICE 31307 30787 520 75795 61565 14230 2536283 1885711 650572 0 663858 8845 0 0 0 427463 0 2048371 2192242 250000 250000 555526 1265739 3954063 3707981 315956 33908 139207 0 455163 33908 X 3498900 3674073 3498900 3674073 3954063 3707981 125309 49864 0 X X 0 1 X 1 0 X 291996 140478 178390 225107 10088 846059 291996 140478 178390 225107 10088 846059 846059 43145 36613 38858 68646 84887 272149 390 390 1118598 25616866 0.75640 0.80140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 RELATED PARTY RECEIVABLES 1265739 1265739 1 0 0 0 0 0 0 0 0 KENT ANDERSON CHIEF EXECUTIVE OFFICER 0 468653 0 132000 0 0 0 28750 0 31131 0 660534 0 0 ROBERT MORRIS CHIEF FINANCIAL OFFICER 0 307854 0 76079 0 0 0 18965 0 34231 0 437129 0 0 PART I, LINE 3 THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. PART I, LINE 4A MILISSA KNISLEY RECEIVED SEVERANCE OF $7,912. PART I, LINE 7 THE BOARD OF DIRECTORS CONDUCTS AN ANNUAL PERFORMANCE REVIEW TO DETERMINE THE COMPENSATION AND BENEFITS OF THE CEO. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS MAY ALSO AWARD BONUS COMPENSATION TO THE CEO BASED UPON THE ANNUAL PERFORMANCE REVIEW. THE CEO CONDUCTS AN ANNUAL PERFORMANCE REVIEW OF THE OTHER OFFICERS AND EMPLOYEES TO DETERMINE THEIR COMPENSATION AND BENEFITS. IN ADDITION TO NORMAL COMPENSATION AND BENEFITS, THE CEO, WITH THE APPROVAL OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, MAY ALSO AWARD BONUS COMPENSATION TO THE OTHER OFFICERS AND EMPLOYEES BASED UPON THEIR ANNUAL PERFORMANCE REVIEW. FORM 990, PART III, LINE 3 HOSPICE OF FAYETTE COUNTY IS CURRENTLY IN THE PROCESS OF TRANSITIONING ITS OPERATIONS AS PART OF AN INTERNAL CONSOLIDATION WITH RELATED EXEMPT ORGANIZATION, HOSPICE OF DAYTON. AS PART OF THIS TRANSITION, PATIENT CARE RESPONSIBILITIES HAVE BEEN SHIFTED TO HOSPICE OF DAYTON. THESE OPERATIONAL ADJUSTMENTS HAVE RESULTED IN A DECREASE IN OVERALL ACTIVITY. FORM 990, PART VI, SECTION A, LINE 6 OHIO'S HOSPICE, INC ("OHI") BECAME THE SOLE MEMBER OF HOSPICE OF FAYETTE COUNTY WITH AN AFFILIATION AGREEMENT SIGNED IN NOVEMBER 2017. FORM 990, PART VI, SECTION A, LINE 7A OHI HAS THE POWER TO APPOINT THE BOARD OF DIRECTORS. THE BOARD SHALL RECOMMEND INDIVIDUALS TO FILL ANY OPENINGS. OHI HAS THE RIGHT TO ELECT FROM THESE INDIVIDUALS OR OTHER INDIVIDUALS AT ITS DISCRETION. FORM 990, PART VI, SECTION A, LINE 7B OHI RETAINS THE POWER TO AMEND THE ARTICLES OF INCORPORATION, CODE OF REGULATIONS, ETC. OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND REVIEWED BY THE CFO PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS SENT VIA EMAIL TO THE FULL BOARD AND WILL BE REVIEWED IN SESSION BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AT THEIR NEXT MEETING. FORM 990, PART VI, SECTION B, LINE 12C IN THE EVENT ANY DIRECTOR, OFFICER OR EXECUTIVE OF THE ORGANIZATION SHALL HAVE ANY DIRECT OR INDIRECT INTEREST IN OR RELATIONSHIP WITH ANY INDIVIDUAL OR ORGANIZATION THAT PROPOSES TO ENTER INTO ANY TRANSACTION WITH THE ORGANIZATION FOR THE SALE, PURCHASE, LEASE OR RENTAL OF PROPERTY OR TO RENDER OR EMPLOY SERVICES, PERSONAL OR OTHERWISE, SUCH DIRECTOR, OFFICER OR EXECUTIVE SHALL FORTHWITH GIVE THE BOARD OF DIRECTORS, CHAIR OF THE BOARD OR PRESIDENT OF THE ORGANIZATION NOTICE OF SUCH INTEREST OR RELATIONSHIP AND SHALL THEREAFTER NOT BE COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM AND SHALL REFRAIN FROM VOTING OR OTHERWISE ATTEMPTING TO AFFECT ITS DECISION TO PARTICIPATE IN SUCH TRANSACTION. IN THE EVENT THAT A CHALLENGE OR QUESTION IS RAISED WHETHER CONFLICT OR DUALITY OF INTEREST EXISTS, THE BOARD OR CHAIR OF THE BOARD OF THE ORGANIZATION SHALL DETERMINE THAT A DUALITY OF INTEREST EXISTS (BY A 2/3 VOTE OF THE BODY). MINUTES OF APPROPRIATE MEETINGS SHOULD REFLECT THAT SUCH DISCLOSURE WAS MADE, AND THAT SUCH DIRECTOR REMOVED HIMSELF/HERSELF FROM THE ROOM AND DID NOT PARTICIPATE IN THE FINAL DISCUSSION, AND WAS NOT COUNTED FOR THE PURPOSE OF DETERMINING A QUORUM. THE CONFLICT OF INTEREST STATEMENT SHALL BE REVIEWED ANNUALLY FOR THE INFORMATION AND GUIDANCE OF DIRECTORS, OFFICERS OR EXECUTIVES AND THAT ANY NEW DIRECTORS, OFFICERS OR EXECUTIVES BE ADVISED OF THE POLICY UPON UNDERTAKING THE DUTIES OF SUCH OFFICE. FORM 990, PART VI, SECTION B, LINE 15B THE EXECUTIVE COMMITTEE OF THE OHI BOARD OF TRUSTEES UTILIZED LOCAL MARKET KNOWLEDGE, ANNUAL PERFORMANCE EVALUATIONS AND BENCHMARK DATA TO ESTABLISH COMPENSATION FOR THE CEO. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO UNDER GUIDELINES ESTABLISHED BY OHI AND AFFILIATE BOARDS OF TRUSTEES AS PART OF THE BUDGET PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. OHI HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 371495725 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF CENTRAL OHIO 2269 CHERRY VALLEY ROAD NEWARK OH 43055 311059756 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 10 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE FOUNDATION 7575 PARAGON ROAD DAYTON OH 45459 311769696 TO PROVIDE FINANCIAL SUPPORT TO ITS PARENT, OHIO'S HOSPICE, INC OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 HOSPICE OF DAYTON INC 324 WILMINGTON AVE DAYTON OH 45420 310933339 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 10 OHIO'S HOSPICE INC 1 HOSPICE OF MIAMI COUNTY INC 3230 N COUNTY RD 25A TROY OH 45373 311031277 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 OHIO'S HOSPICE INC 7575 PARAGON ROAD DAYTON OH 45459 463215586 TO PROVIDE MANAGEMENT SERVICES AS A SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12A, I N/A 0 LIFECARE HOSPICE 1900 AKRON ROAD WOOSTER OH 44691 341352875 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 LOVING CARE HOSPICE 779 LONDON AVENUE MARYSVILLE OH 43040 311370625 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 10 OHIO'S HOSPICE INC 1 HOSPICE OF TUSCARAWAS COUNTY INC 716 COMMERCIAL AVENUE SW NEW PHILADELPHIA OH 44663 341522329 TO PROVIDE HOSPICE CARE OH 501(C)(3) LINE 7 OHIO'S HOSPICE INC 1 NATIONAL HOSPICE COOPERATIVE 7575 PARAGON RD DAYTON OH 45459 832087147 BUSINESS SUPPORT OH N/A C 1 CENTRAL OHIO GERIATRICS 7575 PARAGON RD DAYTON OH 45459 264273198 PHYSICIAN OFFICE OH N/A S 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0