2013-08-12T06:59:58-05:00 2012-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2012-01-01 010540180 Hospice of Southern Maine HOSP 2072893641 180 US Route 1 Scarborough ME 04074 Arlene Wing 2072893641 2013-08-02 Nicholas E Porto P01310283 2078792100 2012 2016-02-24 21:20:13Z Arlene Wing 180 US Route 1 Scarborough ME 04074 12529380 0 X www.hospiceofsouthernmaine.com X 2003 ME Hospice services: To provide compassion, care, and comfort through end of life. 19 19 166 180 0 0 718434 2237885 8414981 10231554 26461 20242 35790 -3293 9195666 12486388 0 0 0 0 5352114 6243274 0 0 268538 3439440 3899476 8791554 10142750 404112 2343638 8774788 11271962 3141748 3278573 5633040 7993389 X Hospice services 0 0 8513748 10231554 Hospice of Southern Maine (HSM) provides comprehensive hospice services through a free-standing, licensed, Medicare certified program consistent with the hospice philosophy, and consisting of physical, emotional and spiritual services to patients and their families in the setting most appropriate for the patient. HSM operates an 18-bed hospice facility to provide an alternative for those patients who are unable to remain in their homes and who require an inpatient level of care for acute pain and symptom management or occasionally for respite for their caregivers as a temporary residential alternative. HSM provides bereavement support to family members served by HSM, as well as the community at large, and volunteers are offered to patients and families at least 4 hrs per week. HSM participates in educating practitioners and multidisciplinary caregivers to better provide hospice and palliative care in the community. HSM supports the community by fostering awareness, encouraging volunteerism and advocating for an improved social framework regarding all end of life issues. HSM performs fundraising activities to support care for uninsured and unreimbursed care and program activity. In 2012, HSM cared for 1,261 patients/families primarily in York and Cumberland counties, with an average census of 138 patients each day. HSM provided approximately $230,000 in unreimbursed care in 2012. HSM volunteers provided approximately 10,000 hours of service. 8513748 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 166 1 0 0 0 0 0 0 0 0 0 0 X 19 19 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Mary Pinto 2072893640 180 US Route 1 Scarborough ME 04074 Maryanna Arsenault 0.70 X 0 0 0 Joel Botler MD 0.20 X 0 0 0 Elaine Brady RN 1.80 X 0 0 0 William Caron 1.20 X 0 0 0 Sally Daggett Esq 0.90 X 0 0 0 Roland Eon 1.20 X 0 0 0 Annette Gosnell 1.80 X 0 0 0 Laurence Gross 0.80 X 0 0 0 Daniel Hayes MD 0.70 X 0 0 0 Holly LeBlanc 1.80 X 0 0 0 Betsey McCandless Esq 1.10 X 0 0 0 Edward J McGeachey 0.80 X 0 0 0 Lucy Perkins 1.20 X 0 0 0 Bob Schools 1.90 X 0 0 0 Ann Stockbridge 1.10 X 0 0 0 David Perkins Esq 1.80 X X 0 0 0 Miriam Leonard 1.40 X X 0 0 0 Kevin Montminy 1.90 X X 0 0 0 Karl Turner 2.50 X X 0 0 0 Arlene Wing 40.00 X 135493 0 14061 Mark Wrona MD 40.00 X 268102 0 17338 403595 0 31399 2 0 1 0 0 11150 2226735 9967 2237885 Patient services 621610 10163317 10163317 Palliative Consultative Services 621610 43650 43650 Education and outreach programs 621610 17300 17300 Miscellaneous income 621610 7287 7287 10231554 20136 20136 30200 30094 106 106 106 9605 11150 12898 -3293 -3293 12486388 10231554 0 16949 434994 285439 149555 4737700 4082356 514575 140769 49444 45980 3464 493552 411025 53354 29173 527584 458998 68586 30367 30367 34450 34450 279419 184062 66214 29143 155808 155808 294374 167146 65401 61827 134948 117405 17543 366959 197694 169265 256976 251433 5346 197 56849 48215 7205 1429 141211 136975 4236 332859 317053 9806 6000 40687 35398 5289 Patient related expense 1568376 1568376 Bad debt 206193 206193 10142750 8513748 1360464 268538 18323 27596 3839008 5238384 126674 50000 861342 1601561 94969 160314 5371986 1689305 3834472 3682681 511426 8774788 11271962 718081 984271 1762386 1702746 130349 67506 530932 524050 3141748 3278573 X 5288833 6187167 74007 1536022 270200 270200 5633040 7993389 8774788 11271962 X 2343638 9829 6882 X X 0 1 X 1 0 X 556516 704525 713145 718434 2237885 4930505 556516 704525 713145 718434 2237885 4930505 2105175 2825330 54537 16836 19220 25105 20136 135834 5066339 39694446 0.55770 0.77860 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1200 0 0 0 1200 0 Explanation of Lobbying Activities: Part II-B, Line 1: National Hospice and Palliative Care Organization portion of dues paid allocated to lobbying activities was $847. Home Care and Hospice Alliance of Maine portion of dues paid allocated to lobbying activities was $353. 344207 1752246 19606 309837 1806222 361752 239503 109 257157 344207 454893 153052 68 246261 361752 351905 211462 41 108515 454893 330200 136970 33 115298 351905 0.00000 0.14960 0.85040 0 0 440000 440000 3856946 1078295 2778651 1075040 611010 464030 3682681 Interest rate swap liability 524050 524050 X 12515997 9829 19780 29609 12486388 0 12486388 10155648 12898 12898 10142750 0 10142750 Description of Intended Use of Endowment Funds: Part V, Line 4: To ensure the long-term financial viability of the organization Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The organization is exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The Organization has evaluated the positions taken on its filed tax returns. The Organization has concluded no uncertain income tax positions exist at December 31, 2012. The Organization's tax years from 2009 through 2012 are open and subject to examination. Part XI, Line 2d - Other Adjustments: Special Events Expense 12,898. Interest Rate Swap 6,882. Part XII, Line 2d - Other Adjustments: Special Events Expense 12,898. Twilight in the Park 19535 11150 8385 5026 385 437 6243 19535 11150 8385 5026 385 437 6243 12091 -3706 X X 0 0 0 0 0 0 0 0 0 Mark Wrona MD 268102 0 0 0 0 0 3675 0 13663 0 285440 0 0 0 Form 990, Part VI, Section A, line 2 --Directors William Caron and Edward McGeachey have a business relationship with each other; --Directors William Caron and Maryanna Arseneault have a business relationship with each other; --Directors William Caron and Kevin Montminy have a business relationship with each other; and --Directors William Caron and Miriam Leonard have a business relationship with each other. Form 990, Part VI, Section A, line 6 Initial Members of the Corporation were established in 2003. Thereafter, Members shall include all other persons who may be admitted to membership from time to time by vote of the Members at an annual or special meeting. The Governance Committee of the Board of Directors shall present a report to propose new Members to be admitted for membership. Form 990, Part VI, Section A, line 7a Provisions in bylaws pertaining to Members of the Corporation: -individuals may be admitted to membership from time to time by vote of Members at annual or special meetings -Nominating Committee of the Board of Directors proposes new members -Members must have an interest in, and ability to contribute to, the advancement of the mission and goals of the Corporation -powers include election of Board of Directors, election of new members, changes in the corporate structure, and action on any matters brought to them by the BOD, at the annual meeting or at special meetings Purpose: to strengthen links to the community, and ensure that effective governing bodies are elected Responsibilities: -understanding and affirmation of HSM's mission, principles and objectives. -advocacy in the community, fostering of public awareness and support for the Organization's goals and programs and its fundraising efforts -attendance at the annual meeting, election of Board and Members of the Corporation, and action on any other matters brought by the Board. Form 990, Part VI, Section A, line 7b See line 7a Form 990, Part VI, Section B, line 11 The 990 was reviewed by the finance committee. Then a complete copy of the 990 was distributed to the full Board of Directors. Form 990, Part VI, Section B, line 12c Annually all persons are required to review and sign the conflict of interest policy statement, which is then kept on file. Form 990, Part VI, Section B, line 15a The process for determining compensation for the CEO was as follows: Review of candidate's current responsibilities and compensation, and her expectations and performance as CEO of HSM Review of national and regional market data Discussion and decision by the Executive Committee of the Board Form 990, Part VI, Section C, line 19 All documents that are required to be made available are made available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in fair value of interest rate swap 6,882. Form 990, Part XI, line 2c: The responsibility of the audit committee for overseeing the audit and selecting the independent accountant has not changed from prior years.