2014-08-14T13:19:58-05:00 2013-09-30 061009205 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2012-10-01 060878822 THE CONNECTICUT HOSPICE INC CONN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 THOMAS MCGOVERN 2033157500 2014-08-13 1 ELIZABETH SOLECKI P00235171 8605614000 2012 2015-11-30 17:44:51Z THOMAS MCGOVERN 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 32850224 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 11 363 525 0 0 3019018 2668015 28159550 28733139 218482 38729 122760 89774 31519810 31529657 0 0 0 0 17292341 17567105 0 0 274764 13354126 15476208 30646467 33043313 873343 -1513656 21540952 21530709 9206188 10574686 12334764 10956023 PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. 0 0 13739122 12798236 PHYSICIAN DIRECTED PAIN AND SYMPTOM MANAGEMENT PROVIDED STATEWIDE TO PALLIATIVE HOSPITAL AND HOSPICE CARE ADULT AND PEDIATRIC PATIENTS AND THEIR FAMILIES 14802375 15934903 PHYSICIAN DIRECTED HOME MEDICAL AND HOSPICE CARE SERVICES TO ADULTS AND PEDIATRIC PATIENTS ON A STATEWIDE BASIS 28541497 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 21 0 363 1 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 5.00 5.00 X X 0 0 0 WEN-JEN HWU MD PHD 2.00 2.00 X 0 0 0 FREDERICK J MANCHESKI 5.00 1.00 X X 0 0 0 ANTHONY J DAROS 5.00 5.00 X X 0 0 0 EUGENE MICHAEL 3.00 3.00 X 0 0 0 ROBERT PARKER 0.30 0.30 X 0 0 0 HON DONALD POGUE 2.00 2.00 X 0 0 0 ARLENE M SAYERS 15.00 5.00 X X 0 0 0 WAYNE O SOUTHWICK MD 1.00 1.00 X X 0 0 0 JOHN P STACK CPA 0.50 0.50 X 0 0 0 CAPTAIN KAYE WILLIAMS 3.00 3.00 X X 0 0 0 PETER YARROW 0.20 0.20 X 0 0 0 MRS MARC A HURZELER 65.00 25.00 X X 166808 64157 14346 SANDRA J KLIMAS 40.00 5.00 X 128964 16121 18501 RONNY J KNIGHT 43.00 2.00 X 137982 6418 11809 THOMAS MCGOVERN 40.00 5.00 X 110401 13800 17882 DR JOSEPH ANDREWS 35.00 10.00 X 167230 47780 7652 JANICE MATARAZZO 52.00 0.00 X 137140 0 11683 DR ANTHONY COSCIA PT 22.00 2.00 X 123748 11250 9857 JAMES PROTA 35.00 5.00 X 110590 15799 22530 JOANNE LITEVICH 40.00 0.00 X 114733 0 22108 DEBORAH A ROSLER 47.00 0.00 X 128015 0 3840 1325611 175325 140208 10 0 1 0 A&B HOMEHEALTH SOLUTIONS LLC 446A BLAKE STREET 3RD FLOOR NEW HAVEN CT 06515 HOME HEALTH AIDES 762639 MAXIM HEALTHCARE SERVICES 12588 COLLECTIONS CENTER DR CHICAGO IL 60693 HOME HEALTH AIDES 478745 ATB LLC PO BOX 510 EAST BERLIN CT 06023 HOME HEALTH AIDES 401479 ARCADIA HEALTH CARE 4639 MAIN STREET BRIDGEPORT CT 06606 HOME HEALTH AIDES 355277 ABM JANITORIAL SERV NORTHEAST PO BOX 1534 NEW YORK NY 100081534 HOUSEKEEPING 317354 10 2668015 2668015 HOME CARE REVENUE 621610 15934903 15934903 INPATIENT REVENUE 623000 12798236 12798236 28733139 171098 171098 1188198 1320567 -132369 -132369 -132369 FOOD SERVICE INCOME 722210 50289 50289 OTHER 900099 39485 39485 89774 31529657 28733139 0 128503 X 720412 307327 395432 17653 13708035 12341071 1227922 139042 321688 283085 35386 3217 1593895 1402628 175328 15939 1223075 1076306 134538 12231 4500000 4500000 84263 84263 132430 132430 4445690 3412067 994697 38926 15490 12406 1484 1600 3204814 2646215 521744 36855 -1906 -1906 268267 217967 50300 272609 251727 20681 201 12668 7105 5563 61218 61218 151714 151714 509412 435904 73508 HOSPITALIZATION EXPENSE 942037 942037 HOUSEKEEPING 516333 477350 38983 OTHER 182001 63700 109201 9100 GROCERIES 179168 164602 14566 33043313 28541497 4227052 274764 221853 449195 2728443 2379145 198440 208043 4058310 3222662 704915 835648 5224710 5170260 12462591 12488418 21540952 21530709 6977829 7751909 604474 416980 1395036 2169151 228849 154515 0 82131 9206188 10574686 X 10112537 9039435 1653835 1148196 568392 768392 12334764 10956023 21540952 21530709 -1513656 134915 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 116579 116579 0 EXPLANATION OF LOBBYING ACTIVITIES: 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. 568392 200000 21103 21103 768392 1628392 220000 1280000 568392 1408392 220000 14073 14073 1628392 1228392 180000 90304 90304 1408392 1026081 220000 77538 95227 1228392 0 0 4058310 3222662 835648 835648 DUE FROM J.D. THOMPSON INSTITUTE, NET 12199122 OTHER CURRENT ASSETS 289296 12488418 LIABILITY UNDER CAPITAL LEASE 82131 82131 31664572 134915 134915 31529657 0 31529657 33043313 0 33043313 0 33043313 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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 296597 296597 0.00900 1336537 1162206 174331 0.00530 1633134 1162206 470928 0.01430 55000 55000 0.00170 55000 55000 0.00170 1688134 1162206 525928 0.01600 55000 55000 0.00170 55000 55000 0.00170 0 257910 25826317 29700264 -3873947 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 I, LINE 3C: THE HOSPITAL PROVIDES SERVICES BASED ON PATIENT NEED REGARDLESS OF INCOME OR ABILITY TO PAY. COMMUNITY BUILDING ACTIVITIES PART II A) PROVIDED OUTDOOR POOL FACILITY TO PROMOTE PHYSICAL WELLNESS TO COMMUNITYB) PROVIDED MEMORIAL SERVICES FOR EMOTIONAL SUPPORT TO COMMUNITY 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. NEEDS ASSESSMENT 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 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 166808 64157 0 0 0 0 4679 1800 5682 2185 177169 68142 0 0 SANDRA J KLIMAS 128964 16121 0 0 0 0 3869 484 12576 1572 145409 18177 0 0 RONNY J KNIGHT 137982 6418 0 0 0 0 4139 193 7145 332 149266 6943 0 0 DR JOSEPH ANDREWS 167230 47780 0 0 0 0 0 0 5952 1700 173182 49480 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 416980 0 1 1 416980 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. OTHER FEES FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 3,412,067. MANAGEMENT AND GENERAL EXPENSES 994,697. FUNDRAISING EXPENSES 38,926. TOTAL EXPENSES 4,445,690. VALUE OF CONTRIBUTED SERVICES PART VIII, STATEMENT OF REVENUE, LINE 2 DURING THE YEAR ENDED SEPTEMBER 30, 2013, THE ESTIMATED VALUE OF CONTRIBUTED SERVICES WAS $2,058,000. 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