2016-08-15T14:24:42-05:00 2015-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2014-10-01 060878822 THE CONNECTICUT HOSPICE INC CONN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 2033157500 2016-08-15 1 ELIZABETH SOLECKI P00235171 8605614000 2016-08-15 2014 2016-09-27 15:27:22Z THOMAS MCGOVERN 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 32703481 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. 15 14 368 525 0 0 3489511 2475196 27001825 28269537 86543 227036 76807 68979 30654686 31040748 0 0 0 0 16561438 16128223 0 0 269739 14146275 14538152 30707713 30666375 -53027 374373 21547320 23504617 10363367 12492160 11183953 11012457 PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. 0 0 11631956 12582224 PHYSICIAN DIRECTED PAIN AND SYMPTOM MANAGEMENT PROVIDED STATEWIDE TO PALLIATIVE HOSPITAL AND HOSPICE CARE ADULT AND PEDIATRIC PATIENTS AND THEIR FAMILIES 14502535 15687313 PHYSICIAN DIRECTED HOME MEDICAL AND HOSPICE CARE SERVICES TO ADULTS AND PEDIATRIC PATIENTS ON A STATEWIDE BASIS 26134491 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 20 0 1 368 1 0 0 0 0 0 0 0 0 0 0 X 15 14 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 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 40.00 5.00 X 129782 16223 13938 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 43.00 2.00 X 190947 8881 8107 MRS MARC A HURZELER PRESIDENT & CEO 65.00 25.00 X X 165732 63743 8184 DR JOSEPH ANDREWS CHIEF MEDICAL OFFICER 35.00 10.00 X 164684 47053 5968 ANDREA PETERSON ASSISTANT MEDICAL DIRECTOR 35.00 10.00 X 114831 32809 9522 DR ANTHONY COSCIA PT PHYSICIAN 20.00 4.00 X 115493 23099 8184 JAMES PROTA DIRECTOR OF PHARMACY 35.00 5.00 X 104996 14999 19789 SYLVIA VANHEERDEN CHIEF OF QUALITY ASSURANCE 32.00 8.00 X 103927 25982 11519 MARCEL BLANCHET CHIEF INFORMATION OFFICER 35.00 5.00 X 112700 16100 15722 1203092 248889 100933 25 0 1 0 A&B HOMEHEALTH SOLUTIONS LLC 446A BLAKE STREET 3RD FLOOR NEW HAVEN CT 06515 HOME HEALTH AIDES 829511 ARCADIA HEALTH CARE 4639 MAIN STREET BRIDGEPORT CT 06606 HOME HEALTH AIDES 516965 ABM JANITORIAL SERV NORTHEAST PO BOX 1534 NEW YORK NY 100081534 HOUSEKEEPING 324150 PEOPLE'S HOME HEALTHCARE 375 WASHINGTON AVENUE NORTH HAVEN CT 06473 HOME HEALTH AIDES 269448 AAA NURSING CARE 3303 MAIN STREET STRATFORD CT 06614 NURSING 233766 11 2475196 2475196 HOME CARE REVENUE 621610 15687313 15687313 INPATIENT REVENUE 623000 12582224 12582224 28269537 187750 187750 1702019 1662733 39286 39286 39286 FOOD SERVICE INCOME 722210 54789 54789 OTHER 900099 14190 14190 68979 31040748 28269537 0 296015 651793 250885 368180 32728 13001568 11470965 1395367 135236 112463 96718 14620 1125 1136472 977366 147741 11365 1225927 1054297 159371 12259 5000000 5000000 68968 68968 143690 143690 100658 100658 2408435 1992220 365359 50856 39918 39918 3443051 2733782 687362 21907 4311 4311 825883 597436 228447 266871 230470 36401 13161 13161 72378 72378 175143 50004 125139 681627 526447 155180 HOSPITALIZATION EXPENSE 537601 537601 HOUSEKEEPING 440822 402691 38131 GROCERIES 172580 161380 11200 OTHER 143055 52229 86563 4263 30666375 26134491 4262145 269739 1066312 143991 963167 1860146 203907 198755 3588425 2390884 1226804 1197541 5074177 6430200 13012953 13673984 21547320 23504617 6239159 7078681 425156 433332 2321778 2286887 1315232 2651852 62042 41408 10363367 12492160 X 9254070 8883320 961491 960745 968392 1168392 11183953 11012457 21547320 23504617 374373 -545869 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 100658 100658 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. 968392 200000 1168392 768392 200000 57174 57174 968392 568392 200000 21103 21103 768392 1628392 220000 1280000 568392 1408392 220000 14073 14073 1628392 1.00000 0 0 3588425 2390884 1197541 1197541 DUE FROM J.D. THOMPSON INSTITUTE, NET 11699176 OTHER CURRENT ASSETS 211984 ASSETS HELD FOR SALE 332200 DUE FROM THIRD PARTY 1430624 13673984 LIABILITY UNDER CAPITAL LEASE 41408 41408 30494879 -545869 -545869 31040748 0 31040748 30666375 0 30666375 0 30666375 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 315344 315344 0.01030 1492133 1389323 102810 0.00340 1807477 1389323 418154 0.01370 20000 20000 0.00070 20000 20000 0.00070 1827477 1389323 438154 0.01440 20000 20000 0.00070 20000 20000 0.00070 0 294714 24192541 27821422 -3628881 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 0 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. 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. 1 X X X X 0 1 0 0 0 0 0 0 0 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 129782 16223 0 0 0 0 1394 174 10996 1374 142172 17771 0 0 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 190947 8881 0 0 0 0 1909 89 5837 272 198693 9242 0 0 MRS MARC A HURZELER PRESIDENT & CEO 165732 63743 0 0 0 0 1549 596 4362 1677 171643 66016 0 0 DR JOSEPH ANDREWS CHIEF MEDICAL OFFICER 164684 47053 0 0 0 0 0 0 4642 1326 169326 48379 0 0 ANDREA PETERSON ASSISTANT MEDICAL DIRECTOR 114831 32809 0 0 0 0 1148 328 6258 1788 122237 34925 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. F J MANCHESKI OFFICER AND DIRECTOR X 800000 433332 0 1 1 433332 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, 2015, THE ESTIMATED VALUE OF CONTRIBUTED SERVICES WAS $2,052,000. 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 5000000 FAIR VALUE OF SERVICES