Public Disclosure Statement of Sangre de Cristo Hospice & Palliative Care
Date issued: 06/28/2017
Sangre de Cristo Hospice & Palliative Care is a nonprofit 501(c)(3) professional medical organization. Our mission is to enhance the quality of life and to maintain the integrity of individuals and their families in need of supportive or end-of-life services by offering them symptom management, support, comfort, and compassion.
Sangre de Cristo Hospice & Palliative Care will annually complete a written public disclosure statement signed by the CEO/President. Sangre de Cristo Hospice & Palliative Care will comply with the reporting requirements of Part 420, Subpart C of Title 42 in the Code of Federal Regulations as they apply to the agency.
Upon request, the following information will be made available to the patients of Sangre de Cristo Hospice & Palliative Care, or the public:
A. Names and, addresses of individuals or corporations having direct/indirect ownership or controlling interest of 5% or more in agency or in any subcontractor in which the agency has direct/indirect ownership interest of 5% or more.
B. Name and addresses of those persons directly related (spouse, parent, child, sibling) to individuals named in “A”.
C. Names and addresses of individuals in “A” or “B” with an ownership or controlling interest in a Medicare or Medicaid facility.
D. When the organization is a corporation, the names and addresses of the Board of Directors, officers or partners as applicable.
E. Description of any criminal offense conviction involving title V, XVIII, XIX or XX brought against any persons listed in A, B, C or D (of any person or organization, agent or managing employee.)
F. Names and addresses of any individual currently employed in a managerial, accounting, auditing, or similar capacity who were employed by the organization’s fiscal intermediary within the previous 12 months.
G. Changes in the Administrator, Director of Patient Care Services, or Medical Director during the previous 12 months.
H. The dates of any of the following :
I. Agency mission statement
J. Proof of license/accreditation status
K. Policies and procedures regarding patient rights
Public Disclosure Statement will be made available to the public upon request and/or as required (i.e.: Medicaid/Medicare regulations). Such circumstances include but are not limited to:
Sangre de Cristo Hospice & Palliative Care