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 060878822 THE CONNECTICUT HOSPICE INC CONN 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 2016-02-25 16:41:14Z THOMAS MCGOVERN 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 33559897 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. 12 11 368 539 0 0 2668015 3489511 28733139 27001825 38729 86543 89774 76807 31529657 30654686 0 0 0 0 17567105 16561438 0 0 254213 15476208 14146275 33043313 30707713 -1513656 -53027 21530709 21547320 10574686 10363367 10956023 11183953 PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. 0 0 11955055 12540351 PHYSICIAN DIRECTED PAIN AND SYMPTOM MANAGEMENT PROVIDED STATEWIDE TO PALLIATIVE HOSPITAL AND HOSPICE CARE ADULT AND PEDIATRIC PATIENTS AND THEIR FAMILIES 13922618 14461474 PHYSICIAN DIRECTED HOME MEDICAL AND HOSPICE CARE SERVICES TO ADULTS AND PEDIATRIC PATIENTS ON A STATEWIDE BASIS 25877673 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 19 0 1 368 1 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 X 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 WEN-JEN HWU MD PHD DIRECTOR 2.00 2.00 X 0 0 0 FREDERICK J MANCHESKI OFFICER AND DIRECTOR 5.00 1.00 X X 0 0 0 ANTHONY J DAROS OFFICER AND DIRECTOR 5.00 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 15.00 5.00 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 65.00 25.00 X X 165732 63743 14257 SANDRA J KLIMAS SR VP OF CLINICAL SERVICES 35.00 5.00 X 94460 13494 10836 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 43.00 2.00 X 141900 6600 11709 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 40.00 5.00 X 160728 20091 19395 DR JOSEPH ANDREWS CHIEF MEDICAL OFFICER 35.00 10.00 X 173091 49455 7774 ANDREA PETERSON ASSISTANT MEDICAL DIRECTOR 35.00 10.00 X 158847 45385 24804 DR ANTHONY COSCIA PT PHYSICIAN 20.00 4.00 X 115493 23099 17956 JAMES PROTA DIRECTOR OF PHARMACY 35.00 5.00 X 104996 14999 21985 JOANNE LITEVICH PHARMACIST 40.00 0.00 X 114733 0 21594 SYLVIA VANHEERDEN CHIEF OF QUALITY ASSURANCE 32.00 8.00 X 103927 25982 11138 MARY ANN FIEFFER DIRECTOR OF CLINICAL EDUCATION 25.00 15.00 X 82895 49737 17729 1416802 312585 179177 11 0 1 0 A&B HOMEHEALTH SOLUTIONS LLC 446A BLAKE STREET 3RD FLOOR NEW HAVEN CT 06515 HOME HEALTH AIDES 876642 ARCADIA HEALTH CARE 4639 MAIN STREET BRIDGEPORT CT 06606 HOME HEALTH AIDES 604479 PEQUOT PHARMACEUTICAL NETWORK 1 ANNIE GEORGE DRIVE MASHANTUCKET CT 063390049 PHARMACEUTICAL DISTR 584455 AAA NURSING CARE LLC 3303 MAIN STREET STRATFORD CT 06614 HOME HEALTH AIDES 333383 ABM JANITORIAL SERV NORTHEAST PO BOX 1534 NEW YORK NY 100081534 HOUSEKEEPING 324458 19 3489511 3489511 HOME CARE REVENUE 621610 14461474 14461474 INPATIENT REVENUE 623000 12540351 12540351 27001825 146502 146502 2845252 2905211 -59959 -59959 -59959 FOOD SERVICE INCOME 722210 49698 49698 OTHER 900099 27109 27109 76807 30654686 27001825 0 163350 780682 349497 412902 18283 13163749 11304047 1718963 140739 177980 149503 26697 1780 1223647 1027864 183547 12236 1215380 1020919 182307 12154 4500000 4500000 108016 108016 158698 158698 3023084 2351959 625174 45951 3589 3589 3004885 2456493 531743 16649 3074 3074 744865 551541 193324 268233 246246 21823 164 5734 1129 4605 71794 71794 147325 147325 758964 696349 62615 HOSPITALIZATION EXPENSE 599835 599835 HOUSEKEEPING 460323 428791 31532 GROCERIES 162721 149703 13018 OTHER 125135 43797 75081 6257 30707713 25877673 4575827 254213 449195 1066312 2379145 963167 208043 203907 4596791 3369987 835648 1226804 5170260 5074177 12488418 13012953 21530709 21547320 7751909 6239159 416980 425156 2169151 2321778 154515 1315232 82131 62042 10574686 10363367 X 9039435 9254070 1148196 961491 768392 968392 10956023 11183953 21530709 21547320 -53027 280957 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. 768392 200000 57174 57174 968392 568392 200000 21103 21103 768392 1628392 220000 1280000 568392 1408392 220000 14073 14073 1628392 1228392 180000 90304 90304 1408392 1.00000 0 0 4596791 3369987 1226804 1226804 DUE FROM J.D. THOMPSON INSTITUTE, NET 12053592 OTHER CURRENT ASSETS 194355 ASSETS HELD FOR SALE 332200 DUE FROM THIRD PARTY 432806 13012953 LIABILITY UNDER CAPITAL LEASE 62042 62042 30935643 280957 280957 30654686 0 30654686 30707713 0 30707713 0 30707713 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 164522 164522 0.00540 1038773 919445 119328 0.00390 1203295 919445 283850 0.00930 20000 20000 0.00070 20000 20000 0.00070 1223295 919445 303850 0.01000 0 145595 23850762 27428838 -3578076 X 1 0 1 NOT APPLICABLE 1 1 THE CONNECTICUT HOSPICE INC 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 X X HOSPITAL, SPECIAL, HOSPICE THE CONNECTICUT HOSPICE INC 1 1 X X X X X X X X 12 1 0 0 X X X 1 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: NONE 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. 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 MRS MARC A HURZELER PRESIDENT & CEO 165732 63743 0 0 0 0 4647 1787 5650 2173 176029 67703 0 0 RONNY J KNIGHT SENIOR VP REIMB/PLANNING 141900 6600 0 0 0 0 4257 198 6932 322 153089 7120 0 0 THOMAS MCGOVERN CHIEF FINANCIAL OFFICER 160728 20091 0 0 0 0 4822 603 12418 1552 177968 22246 0 0 DR JOSEPH ANDREWS CHIEF MEDICAL OFFICER 173091 49455 0 0 0 0 0 0 6046 1728 179137 51183 0 0 ANDREA PETERSON ASSISTANT MEDICAL DIRECTOR 158847 45385 0 0 0 0 4765 1362 14527 4150 178139 50897 0 0 DR ANTHONY COSCIA PT PHYSICIAN 115493 23099 0 0 0 0 3465 693 11498 2300 130456 26092 0 0 MARY ANN FIEFFER DIRECTOR OF CLINICAL EDUCATION 82895 49737 0 0 0 0 2487 1492 8594 5156 93976 56385 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 425156 0 1 1 425156 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 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, 2014, THE ESTIMATED VALUE OF CONTRIBUTED SERVICES WAS $2,092,000. 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 4500000 FAIR VALUE OF SERVICES