2015-08-17T07:27:44-05:00 2014-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2013-10-01 061003712 THE JOHN D THOMPSON HOSPICE INSTITUTE FOR EDUCATION TRAINING AND RESEARCH JOHN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 2033157500 2015-08-14 1 ELIZABETH SOLECKI P00235171 8605614000 2015-08-14 2013 2016-03-07 17:11:31Z THOMAS MCGOVERN 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 4831707 0 X WWW.HOSPICE.COM X 1978 CT TO EXTEND THE PRINCIPLES OF PALLIATIVE CARE AND HOSPICE SERVICES INTO THE MAINSTREAM OF MEDICAL PRACTICE AND EDUCATION REGIONALLY, NATIONALLY AND INTERNATIONALLY THROUGH EDUCATION, TRAINING AND RESEARCH. 12 11 1 15 0 0 68898 47275 4513030 4500272 0 0 284160 284160 4866088 4831707 0 0 0 0 2891336 3047375 0 0 5435 2317533 2048553 5208869 5095928 -342781 -264221 21168488 20761906 12199122 12056761 8969366 8705145 TO EXTEND THE PRINCIPLES OF PALLIATIVE CARE AND HOSPICE SERVICES INTO THE MAINSTREAM OF MEDICAL PRACTICE AND EDUCATION REGIONALLY, NATIONALLY AND INTERNATIONALLY THROUGH EDUCATION, TRAINING AND RESEARCH. 0 0 1845815 272 THE INSTITUTE OFFERS PROGRAMS ON EDUCATION, TRAINING AND RESEARCH PERTAINING TO THE CARE OF ADULT AND PEDIATRIC PATIENTS WITH IRREVERSIBLE ILLNESSES AND THEIR FAMILIES. 3031848 4500000 PROVIDING MANAGEMENT SERVICES AND FACILITIES TO CT HOSPICE. 4877663 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 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 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 1 0 0 CT X MR THOMAS MCGOVERN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054909 HON DANIEL COSGROVE OFFICER AND DIRECTOR 5.00 5.00 X X 0 0 0 ANTHONY J DAROS OFFICER AND DIRECTOR 5.00 5.00 X X 0 0 0 WEN-JEN HWU MD PHD DIRECTOR 2.00 2.00 X 0 0 0 FREDERICK J MANCHESKI OFFICER AND DIRECTOR 1.00 5.00 X X 0 0 0 EUGENE MICHAEL DIRECTOR 3.00 3.00 X 0 0 0 ROBERT PARKER DIRECTOR 0.30 0.30 X 0 0 0 HON DONALD POGUE DIRECTOR 2.00 2.00 X 0 0 0 ARLENE M SAYERS OFFICER AND DIRECTOR 5.00 15.00 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 PETER YARROW DIRECTOR HONORARY 0.20 0.20 X 0 0 0 MRS MARC A HURZELER PRESIDENT & CEO 25.00 65.00 X X 63743 165732 14257 SANDRA J KLIMAS SR VP OF CLINICAL SERVICES 5.00 35.00 X 13494 94460 10836 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 2.00 43.00 X 6600 141900 11709 THOMAS MCGOVERN CHIEF FINACIAL OFFICER 5.00 40.00 X 20091 160728 19395 DR JOSEPH ANDREWS CHIEF MEDICAL OFFICER 10.00 35.00 X 49455 173091 7774 ANDREA PETERSON ASSISTANT MEDICAL DIRECTOR 10.00 35.00 X 45385 158847 24804 198768 894758 88775 0 0 1 0 0 47275 47275 LEASE AND MGT SERVICES 532000 4500000 4500000 EDUCATIONAL 611600 272 272 4500272 284160 0 284160 284160 284160 4831707 4500272 0 284160 X 175525 93879 76211 5435 2357592 2292727 64865 514258 484944 29314 667912 656023 11889 62313 62313 5302 5302 577782 577782 NON MEDICAL INTERCOMPAN 730904 700571 30333 NON MEDICAL GENERAL EXP 4340 4122 218 5095928 4877663 212830 5435 22221 31900 500000 500000 28278380 8048374 20646267 20230006 21168488 20761906 3167 12199122 12053594 12199122 12056761 X 8469366 8205145 500000 500000 8969366 8705145 21168488 20761906 -264221 0 X 0 1 X 1 0 X 125994 114089 58732 68898 47275 414988 4004023 4017802 4007641 4513030 4500272 21042768 4130017 4131891 4066373 4581928 4547547 21457756 0 0 0 21457756 303643 284160 284160 284160 284160 1440283 303643 284160 284160 284160 284160 1440283 4433660 4416051 4350533 4866088 4831707 22898039 0.93710 0.93650 0.06290 0.06350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 PART II-B, LINE 1: THE JOHN D. THOMPSON HOSPICE INSTITUTE FOR EDUCATION, TRAINING AND RESEARCH'S MISSION IS TO EDUCATE AND TRAIN CAREGIVERS AND CONDUCT RESEARCH. THIS REQUIRES THE ONGOING DEVELOPMENT OF REGULATIONS THAT WOULD SUPPORT THIS EFFORT. IN PARTICULAR, WITH THE RELOCATION OF THE INSTITUTE, ALTHOUGH WITHIN THE SAME PROVINCE, IT IS IMPORTANT TO MAINTAIN THESE STANDARDS. 6433345 6433345 21845035 8048374 13796661 20230006 DUE TO CT HOSPICE, NET 12053594 12053594 4831707 0 4831707 0 4831707 5095928 0 5095928 0 5095928 X X X X 0 1 0 0 0 0 0 0 0 MRS MARC A HURZELER PRESIDENT & CEO 63743 165732 0 0 0 0 1787 4647 2173 5650 67703 176029 0 0 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 6600 141900 0 0 0 0 198 4257 322 6932 7120 153089 0 0 THOMAS MCGOVERN CHIEF FINACIAL OFFICER 20091 160728 0 0 0 0 603 4822 1552 12418 22246 177968 0 0 DR JOSEPH ANDREWS CHIEF MEDICAL OFFICER 49455 173091 0 0 0 0 0 0 1728 6046 51183 179137 0 0 ANDREA PETERSON ASSISTANT MEDICAL DIRECTOR 45385 158847 0 0 0 0 1362 4765 4150 14527 50897 178139 0 0 PART I, LINE 4B COMPENSATION RELATED TO THE RELATED ORGANIZATIONS BUT NOT GIVEN DUE TO THE FINANCIAL CONDITIONS OF THE ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 7A A NOMINATING COMMITTEE CONSISTING OF FOUR 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 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE EXECUTIVE COMMITTEE OF 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 THE 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. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 656,023. MANAGEMENT AND GENERAL EXPENSES 11,889. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 667,912. THE CONNECTICUT HOSPICE INC 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 060878822 TEACHING PALLIATIVE HOSPITAL AND HOSPICE CARE CT 501(C)(3) BOX 3 N/A 0 0 0 0 0 1 0 0 0 0 1 0 1 0 1 0 0 0 0 0 RENTAL INCOME J 284160 OPERATING LEASE MANAGEMENT SERVICES M 4500000 FAIR VALUE OF SERVICES