2017-08-15T19:28:51-05:00 2016-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2015-10-01 060878822 THE CONNECTICUT HOSPICE INC CONN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 2033157500 2017-08-15 1 ELIZABETH SOLECKI P00235171 8605614000 2017-08-15 2015 2021-01-29 14:40:06Z THOMAS MCGOVERN 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 31961184 0 X WWW.HOSPICE.COM/CTHOSPICE X 1971 CT PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. 16 15 355 495 0 0 2475196 1907017 28269537 27036579 227036 202174 68979 75595 31040748 29221365 0 0 0 0 16128223 16655771 0 0 287110 14538152 13962632 30666375 30618403 374373 -1397038 23504617 22355772 12492160 12540686 11012457 9815086 PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. 0 0 12888504 11386727 PHYSICIAN DIRECTED PAIN AND SYMPTOM MANAGEMENT PROVIDED STATEWIDE TO PALLIATIVE HOSPITAL AND HOSPICE CARE ADULT AND PEDIATRIC PATIENTS AND THEIR FAMILIES 14030044 15649852 PHYSICIAN DIRECTED HOME MEDICAL AND HOSPICE CARE SERVICES TO ADULTS AND PEDIATRIC PATIENTS ON A STATEWIDE BASIS 26918548 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 355 1 0 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 0 1 0 0 X THOMAS MCGOVERN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054909 HON DANIEL COSGROVE OFFICER EMERITUS 0.00 0.00 X X 0 0 0 WEN-JEN HWU MD PHD DIRECTOR 5.00 5.00 X 0 0 0 FREDERICK J MANCHESKI OFFICER EMERITUS 0.00 0.00 X X 0 0 0 ANTHONY J DAROS OFFICER AND DIRECTOR 5.00 5.00 X X 0 0 0 EUGENE MICHAEL OFFICER AND DIRECTOR 2.00 1.00 X X 0 0 0 CHIEF WILLIAM FARRELL DIRECTOR 2.00 1.00 X 0 0 0 HON DONALD POGUE DIRECTOR 2.00 2.00 X 0 0 0 ARLENE M SAYERS OFFICER AND DIRECTOR 2.00 1.00 X X 0 0 0 WAYNE O SOUTHWICK MD OFFICER AND DIRECTOR 1.00 1.00 X X 0 0 0 JOHN P STACK CPA DIRECTOR 0.50 0.50 X 0 0 0 CAPTAIN KAYE WILLIAMS OFFICER AND DIRECTOR 3.00 3.00 X X 0 0 0 MICHAEL MASSARO DIRECTOR 3.00 3.00 X 0 0 0 MRS NATALIE NIKKI O'NEIL DIRECTOR 1.00 1.00 X 0 0 0 GEORGE WALDRON DIRECTOR 2.00 1.00 X 0 0 0 THEODORE ZANKER MD DIRECTOR 2.00 2.00 X 0 0 0 PETER YARROW DIRECTOR HONORARY 0.20 0.20 X 0 0 0 MRS MARC A HURZELER PRESIDENT & CEO 65.00 25.00 X X 165958 63831 12634 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 40.00 5.00 X 123305 15413 14744 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 43.00 2.00 X 168253 7826 10978 JOSEPH SACCO SEE NOTE MEDICAL DIRECTOR 30.00 10.00 X 178445 59482 18826 DR ANTHONY COSCIA PT PHYSICIAN 20.00 4.00 X 117323 23465 7322 JAMES PROTA DIRECTOR OF PHARMACY 35.00 5.00 X 115950 16564 17129 MARY ANN FIEFFER APRN 25.00 15.00 X 82248 49349 9117 ANNE NUGENT DIRECTOR OF NURSING 40.00 5.00 X 117667 14708 5543 SUSAN FLANNIGAN VP OF HOME CARE 32.00 8.00 X 126706 31676 10383 1195855 282314 106676 35 0 1 0 A&B HOMEHEALTH SOLUTIONS LLC 446A BLAKE STREET 3RD FLOOR NEW HAVEN CT 06515 HOME HEALTH AIDES 872173 AAA NURSING CARE 3303 MAIN STREET STRATFORD CT 06614 NURSING 514548 EAST ROCK PHARMACY 767 ORANGE STREET NORTH HAVEN CT 06511 SUPPLY AND DELIVERY OF DRUGS 376668 ARCADIA HEALTH CARE 4639 MAIN STREET BRIDGEPORT CT 06606 HOME HEALTH AIDES 365777 ABM JANITORIAL SERV NORTHEAST PO BOX 1534 NEW YORK NY 100081534 HOUSEKEEPING 333413 14 1907017 1907017 HOME CARE REVENUE 621610 15649852 15649852 INPATIENT REVENUE 623000 11386727 11386727 27036579 172773 172773 2769220 2739819 29401 29401 29401 FOOD SERVICE INCOME 722210 53644 53644 OTHER 900099 21951 21951 75595 29221365 27036579 0 277769 630308 206751 393017 30540 13273304 12347458 771440 154406 292945 263651 26365 2929 1222145 1099931 109993 12221 1237069 1113361 111336 12372 4000000 4000000 81199 81199 123200 123200 2679375 2184227 444508 50640 9913 9913 3672313 2993670 660965 17678 825083 626113 198970 261421 239451 21924 46 6208 6208 67939 67939 168334 57144 111190 713502 597006 116496 HOSPITALIZATION EXPENSE 613960 613960 HOUSEKEEPING 474524 420144 54380 GROCERIES 168888 155681 13207 OTHER 96773 90495 6278 30618403 26918548 3412745 287110 143991 141992 1860146 1658893 198755 213532 3626687 2558036 1197541 1068651 6430200 4368246 13673984 14904458 23504617 22355772 7078681 7075822 433332 341508 2286887 2421442 2651852 2681699 41408 20215 12492160 12540686 X 8883320 7481020 960745 965674 1168392 1368392 11012457 9815086 23504617 22355772 -1397038 199667 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 100750 100750 0 PART II-B, LINE 1: THE CONNECTICUT HOSPICE'S MISSION OF PROVIDING INTERDISCIPLINARY, QUALITY CARE, BOTH IN THE SPECIALTY HOSPITAL AND AT HOME, REQUIRES THE ONGOING APPLICATION OF STANDARDS THROUGH REGULATIONS AS IT RELATES TO HOSPICE AND PALLIATIVE CARE. IN PARTICULAR, WITH THE HOSPITAL'S RELOCATION, IT IS IMPORTANT TO ENABLE ALL CONNECTICUT PHYSICIANS THE OPPORTUNITY TO BE KNOWLEDGEABLE OF THE ENVIRONMENT OF CARE AND THESE STANDARDS. 1168392 200000 111868 111868 1368392 968392 200000 1168392 768392 200000 57174 57174 968392 568392 200000 21103 21103 768392 1628392 220000 1280000 568392 1.00000 0 0 3626687 2558036 1068651 1068651 DUE FROM J.D. THOMPSON INSTITUTE, NET 12461333 OTHER CURRENT ASSETS 209908 ASSETS HELD FOR SALE 332200 DUE FROM THIRD PARTY 1901017 14904458 LIABILITY UNDER CAPITAL LEASE 20215 20215 29421032 199667 199667 29221365 0 29221365 30618403 0 30618403 0 30618403 PART V, LINE 4: TEMPORARY FUNDS ARE AVAILABLE TO SUPPORT OPERATIONS AND REPAYMENT OF LONG TERM DEBT. THE INCOME FROM PERMANENT FUNDS IS AVAILABLE TO SUPPORT HEALTH CARE SERVICES. 1 0 0 0 1 0 1 0 449140 449140 0.01470 1217687 1048826 168861 0.00550 1666827 1048826 618001 0.02020 70000 70000 0.00230 70000 70000 0.00230 1736827 1048826 688001 0.02250 70000 70000 0.00230 70000 70000 0.00230 0 387190 24199594 27829533 -3629939 X 1 0 1 NOT APPLICABLE 1 1 THE CONNECTICUT HOSPICE INC 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 X HOSPITAL, SPECIAL, HOSPICE THE CONNECTICUT HOSPICE INC 1 0 0 1 X X X X X X X X 13 1 0 0 0 1 13 0 0 0 0 0 0 0 0 0 X 0 X 0 0 PART V, SECTION B THE CONNECTICUT HOSPICE, INC. ASSESSES THE HEALTHCARE NEEDS IN THE COMMUNITIES IT SERVES THROUGH PATIENT/FAMILY SATISFACTION SURVEYS, COMMUNITY PHYSICIAN FEEDBACK, HOSPITAL AND OTHER PATIENT CARE FACILITY COLLABORATION AND DIRECT COMMUNICATION WITH COMMUNITY LEADERSHIP. PART I, LINE 3C: THE HOSPITAL PROVIDES SERVICES BASED ON PATIENT NEED REGARDLESS OF INCOME OR ABILITY TO PAY. PART II A) PROVIDED OUTDOOR POOL FACILITY TO PROMOTE PHYSICAL WELLNESS TO COMMUNITYB) PROVIDED MEMORIAL SERVICES FOR EMOTIONAL SUPPORT TO COMMUNITYC) PROMOTED PUBLIC POLICY DISCOURSE ON INSTITUTIONAL RESEARCH USE OF MEDICINAL MARIJUANA FOR PAIN AND SYMPTOM RELIEF PART III, LINE 4: FINANCIAL STATEMENTS DO NOT CONTAIN ANY REFERENCE TO BAD DEBTS IN THE FOOTNOTES TO THE FINANCIAL STATEMENTS. BAD DEBTS ARE RECORDED AT ACTUAL UNCOLLECTED REVENUE AS THE ESTIMATED COSTS. PART III, LINE 8: ALL OF THE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. COSTING METHODOLOGY USED WAS COST TO CHARGE RATIO PER MEDICARE COST REPORT. PART III, LINE 9B: THE ORGANIZATION HAS ESTABLISHED A WRITTEN POLICY STATING THAT CARE IS PROVIDED REGARDLESS OF ABILITY TO PAY. NO COLLECTION ACTIVITY IS PURSUED FOR INDIGENT PATIENTS IDENTIFIED AS SUCH BY LICENSED CLINICAL SOCIAL WORKERS. ALL PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE EXCLUDED FROM COLLECTION ACTIVITIES. PART VI, LINE 2 THE HOSPITAL RESPONDS TO THE NEEDS OF ITS COMMUNITY PHYSICIANS AND REFERRING HOSPITALS. PART VI, LINE 3 PATIENTS AND THEIR FAMILIES ARE INFORMED OF ALL REIMBURSEMENT OPTIONS BOTH VERBALLY AND IN WRITING UPON ADMISSION. PART VI, LINE 4 ALL COMMUNITIES AND DEMOGRAPHIC CONSTITUENCIES ARE SERVED INCLUDING URBAN, RURAL AND SUBURBAN. PART VI, LINE 5 SEE PART II RESPONSE. X X X X 0 1 0 0 0 0 0 0 0 MRS MARC A HURZELER PRESIDENT & CEO 165958 63831 0 0 0 0 4875 1875 4249 1635 175082 67341 0 0 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 123305 15413 0 0 0 0 3699 462 9407 1176 136411 17051 0 0 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 168253 7826 0 0 0 0 5048 235 5442 253 178743 8314 0 0 JOSEPH SACCO SEE NOTE MEDICAL DIRECTOR 178445 59482 0 0 0 0 5353 1784 8767 2922 192565 64188 0 0 SUSAN FLANNIGAN VP OF HOME CARE 126706 31676 0 0 0 0 3801 950 4506 1126 135013 33752 0 0 PART I, LINE 4B COMPENSATION AWARDED BUT NOT GIVEN TO THE PRESIDENT/CEO (DUE TO FINANCIAL CONDITION OF THE HOSPITAL). THE AVERAGE SALARY FOR THIS POSITION HAS BEEN $130,000. NO ACCUMULATED LIABILITY WAS GIVEN IN THE CURRENT YEAR. PART II, LINE 4: THE EXECUTIVE EMPLOYEE'S STATED COMPENSATION REPRESENTS 9 MONTHS OF COMPENSATION. IF ANNUALIZED, THE COMPENSATION IS $330,000. F J MANCHESKI OFFICER AND DIRECTOR X 800000 341508 0 1 1 341508 FORM 990, PART VI, SECTION A, LINE 7A A NOMINATING COMMITTEE CONSISTING OF TWO MEMBERS OF THE BOARD OF DIRECTORS MAY ELECT A BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS PRESENTED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS REVIEWS THE ANNUAL ELIGIBILITY TEST OF ALL BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15A A COMMITTEE OF TWO OR MORE DIRECTORS OF THE BOARD MEETS PERIODICALLY TO REVIEW THE PERFORMANCE AND COMPARABILITY DATA OF SIMILARLY SIZED HOSPITALS IN THE STATE OF CONNECTICUT. THEY DELIBERATE AND A FINAL DECISION IS MADE. FORM 990, PART VI, SECTION C, LINE 19 INFORMATION IS NOT AVAILABLE TO THE PUBLIC. PART VIII, STATEMENT OF REVENUE, LINE 2 DURING THE YEAR ENDED SEPTEMBER 30, 2016, THE ESTIMATED VALUE OF CONTRIBUTED SERVICES WAS $2,063,000. THE JOHN D THOMPSON HOSPICE INSTITUTE FOR EDUCATION TRAINING AND RESEARCH 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 061003712 PROGRAMS ON EDUCATION, TRAINING AND RESEARCH; MANAGEMENT SERVICES CT 501(C)(3) BOX 9 N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 FACILITY LEASE K 284160 OPERATING LEASE MANAGEMENT SERVICES M 4000000 FAIR VALUE OF SERVICES