TY 2015 Form 990 Schedule O

efile Public Visual Render ObjectId: 201602249349302045 - Submission: 2016-08-11 TIN: 26-3651313

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.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

HOSPICE OF THE VALLEY INC

Employer identification number

26-3651313

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	Process to Review the Form 990: THE 990 IS PREPARED BY A THIRD PARTY PREPARER AND REVIEWED BY THE EXECUTIVE DIRECTOR AND CFO. ONCE REVIEWED, THE BOARD IS PROVIDED A COPY OF THE FULL 990 FOR REVIEW PRIOR TO FILING THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C	PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ANY DIRECTOR, OFFICER, OR KEY EMPLOYEE OF THE CORPORATION IS COVERED UNDER THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE POLICY COVERS ANY PERSONAL INTEREST WHICH HE OR SHE MAY HAVE A MATTER PENDING BEFORE THE ORGANIZATION AND SHALL REFRAIN FROM PARTICIPATION IN ANY DECISION ON THE MATTER. ADDITIONALLY, ANY MEMBER OF HOSPICE OF THE VALLEY'S BOARD OF DIRECTORS OR STAFF SHALL REFRAIN FROM OBTAINING ANY LIST OF HOSPICE OF THE VALLEY'S CLIENTS FOR PERSONAL OR PRIVATE SOLICITATION PURPOSES AT ANY TIME DURING THEIR TERM OF EMPLOYMENT OR BOARD SERVICE. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE BOARD OF DIRECTORS WILL VOTE AS TO WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. CONFLICT IS DEEMED TO EXIST BY 75% OF THE BOARD OF DIRECTORS, SUCH PERSON SHALL NOT VOTE ON, NOR USE THEIR PERSONAL INFLUENCE ON, NOR PARTICIPATE IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO THE RELATE CONTRACT OF TRANSACTION. RELATED CONTRACT OF TRANSACTION.
FORM 990, PART VI, SECTION B, LINE 15A	REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION: THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE REVIEWS INFORMATION GATHERED BY THE HR DIRECTOR REGARDING SIMILAR POSITIONS IN THE REGION. THE COMMITTEE REVIEWS THIS INFORMATION ALONG WITH PERFORMANCE AND DETERMINES THE EXECUTIVE DIRECTOR'S SALARY. THE SALARY IS USED IN THE BUDGET PROCESS AND APPROVED BY THE ENTIRE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT OUR OFFICE AT 1901 GRAND AVENUE, SUITE 206, GLENWOOD SPRINGS, CO, 81601.
ADDITIONAL INFORMATION REGARDING EVENTS	The gross income of $7,725 on Schedule O, attachment 2, for the Savour the Journey Event represents the value of services provided to participants and excludes the contributions generated from the event. Combined contributions from both the Savour the Journey and Trees of Hospice events were $119,065 for total proceeds of $126,790, resulting in a net gain of $61,215 after expenses.

Return Reference

Explanation

FORM 990, PART VI, SECTION B, LINE 11B

Process to Review the Form 990: THE 990 IS PREPARED BY A THIRD PARTY PREPARER AND REVIEWED BY THE EXECUTIVE DIRECTOR AND CFO. ONCE REVIEWED, THE BOARD IS PROVIDED A COPY OF THE FULL 990 FOR REVIEW PRIOR TO FILING THE RETURN.

FORM 990, PART VI, SECTION B, LINE 12C

PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ANY DIRECTOR, OFFICER, OR KEY EMPLOYEE OF THE CORPORATION IS COVERED UNDER THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE POLICY COVERS ANY PERSONAL INTEREST WHICH HE OR SHE MAY HAVE A MATTER PENDING BEFORE THE ORGANIZATION AND SHALL REFRAIN FROM PARTICIPATION IN ANY DECISION ON THE MATTER. ADDITIONALLY, ANY MEMBER OF HOSPICE OF THE VALLEY'S BOARD OF DIRECTORS OR STAFF SHALL REFRAIN FROM OBTAINING ANY LIST OF HOSPICE OF THE VALLEY'S CLIENTS FOR PERSONAL OR PRIVATE SOLICITATION PURPOSES AT ANY TIME DURING THEIR TERM OF EMPLOYMENT OR BOARD SERVICE. IN THE EVENT A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE BOARD OF DIRECTORS WILL VOTE AS TO WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. CONFLICT IS DEEMED TO EXIST BY 75% OF THE BOARD OF DIRECTORS, SUCH PERSON SHALL NOT VOTE ON, NOR USE THEIR PERSONAL INFLUENCE ON, NOR PARTICIPATE IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO THE RELATE CONTRACT OF TRANSACTION. RELATED CONTRACT OF TRANSACTION.

FORM 990, PART VI, SECTION B, LINE 15A

REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION: THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD. THE EXECUTIVE COMMITTEE REVIEWS INFORMATION GATHERED BY THE HR DIRECTOR REGARDING SIMILAR POSITIONS IN THE REGION. THE COMMITTEE REVIEWS THIS INFORMATION ALONG WITH PERFORMANCE AND DETERMINES THE EXECUTIVE DIRECTOR'S SALARY. THE SALARY IS USED IN THE BUDGET PROCESS AND APPROVED BY THE ENTIRE BOARD OF DIRECTORS.

FORM 990, PART VI, SECTION C, LINE 19

GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC AT OUR OFFICE AT 1901 GRAND AVENUE, SUITE 206, GLENWOOD SPRINGS, CO, 81601.

ADDITIONAL INFORMATION REGARDING EVENTS

The gross income of $7,725 on Schedule O, attachment 2, for the Savour the Journey Event represents the value of services provided to participants and excludes the contributions generated from the event. Combined contributions from both the Savour the Journey and Trees of Hospice events were $119,065 for total proceeds of $126,790, resulting in a net gain of $61,215 after expenses.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

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