THE CONNECTICUT HOSPICE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- THE CONNECTICUT HOSPICE INC (EIN 06-0878822)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-15
- IRS object ID
- 201312279349300481
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-15T08:19:47-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061009205 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUM SHAPIRO & COMPANY PC CPA'S | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 29 S MAIN STREET PO BOX 272000 | AddressLine1 |
| City | WEST HARTFORD | City |
| State | CT | State |
| ZIP Code | 061272000 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 060878822 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE CONNECTICUT HOSPICE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CONN | NameControl |
| Phone | 2033157500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DOUBLE BEACH ROAD | AddressLine1 |
| City | BRANFORD | City |
| State | CT | State |
| ZIP Code | 064054003 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THOMAS MCGOVERN | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 2033157500 | Phone |
| Date Signed | 2013-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ELIZABETH SOLECKI | Name |
| PTIN | P00235171 | PTIN |
| Phone | 8605614000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | THOMAS MCGOVERN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DOUBLE BEACH ROAD | AddressLine1 |
| City | BRANFORD | City |
| State | CT | State |
| ZIP Code | 064054003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 31519810 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HOSPICE.COM/CTHOSPICE | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1971 | YearFormation |
| State Legal Domicile | CT | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 365 | TotalNbrEmployees |
| Total Nbr Volunteers | 518 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5603544 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3019018 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28505044 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 28159550 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 118315 | InvestmentIncomePriorYear |
| Investment Income Current Year | 218482 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 91774 | OtherRevenuePriorYear |
| Other Revenue Current Year | 122760 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 34318677 | TotalRevenuePriorYear |
| Total Revenue Current Year | 31519810 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 18230359 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 17292341 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 249933 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13313134 | OtherExpensePriorYear |
| Other Expenses Current Year | 13354126 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 31543493 | TotalExpensesPriorYear |
| Total Expenses Current Year | 30646467 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2775184 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 873343 | RevenuesLessExpensesCY |
| Total Assets BOY | 20686017 | TotalAssetsBOY |
| Total Assets EOY | 21540952 | TotalAssetsEOY |
| Total Liabilities BOY | 9615618 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9206188 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11070399 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12334764 | NetAssetsOrFundBalancesEOY |
| Mission Description | PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12818924 | Expense |
| Revenue | 13176532 | Revenue |
| Description | PHYSICIAN DIRECTED PAIN AND SYMPTOM MANAGEMENT PROVIDED STATEWIDE TO PALLIATIVE HOSPITAL AND HOSPICE CARE ADULT AND PEDIATRIC PATIENTS AND THEIR FAMILIES | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 13704068 | Expense |
| Revenue | 14983018 | Revenue |
| Description | PHYSICIAN DIRECTED HOME MEDICAL AND HOSPICE CARE SERVICES TO ADULTS AND PEDIATRIC PATIENTS ON A STATEWIDE BASIS | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 26522992 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 22 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 365 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THOMAS MCGOVERN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2033157500 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DOUBLE BEACH ROAD | AddressLine1 |
| City | BRANFORD | City |
| State | CT | State |
| ZIP Code | 064054909 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (25 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| HON DANIEL COSGROVE | ||||||||
| OFFICER AND DIRECTOR | 5.00 | X | X | 0 | 0 | 0 | ||
| WEN-JEN HWU MD PHD | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| FREDERICK J MANCHESKI | ||||||||
| OFFICER AND DIRECTOR | 10.00 | X | X | 0 | 0 | 0 | ||
| ANTHONY J DAROS | ||||||||
| OFFICER AND DIRECTOR | 5.00 | X | X | 0 | 0 | 0 | ||
| DAVID MCDERMOTT | ||||||||
| DIRECTOR | 0.30 | X | 0 | 0 | 0 | |||
| EUGENE MICHAEL | ||||||||
| DIRECTOR | 3.00 | X | 0 | 0 | 0 | |||
| ROBERT PARKER | ||||||||
| DIRECTOR | 0.30 | X | 0 | 0 | 0 | |||
| HON DONALD POGUE | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| ARLENE M SAYERS | ||||||||
| OFFICER AND DIRECTOR | 15.00 | X | X | 0 | 0 | 0 | ||
| WAYNE O SOUTHWICK MD | ||||||||
| OFFICER AND DIRECTOR | 1.00 | X | X | 0 | 0 | 0 | ||
| JOHN P STACK CPA | ||||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |||
| FREDERICK ULBRICH | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| CAPTAIN KAYE WILLIAMS | ||||||||
| OFFICER AND DIRECTOR | 3.00 | X | X | 0 | 0 | 0 | ||
| PETER YARROW | ||||||||
| DIRECTOR HONORARY | 0.20 | X | 0 | 0 | 0 | |||
| ROSEMARY HURZELER | ||||||||
| PRESIDENT & CEO | 55.00 | X | X | 169033 | 61467 | 23658 | ||
| DAVID R GOLDFARB | ||||||||
| SENIOR VP FINANCE/HR | 42.00 | X | 124400 | 8886 | 20357 | |||
| SANDRA J KLIMAS | ||||||||
| VP OF CLINICAL SERVICES | 40.00 | X | 120334 | 15042 | 20429 | |||
| RONNY J KNIGHT | ||||||||
| SENIOR VP REIMB/PLANNING | 43.00 | X | 132851 | 6179 | 12497 | |||
| THOMAS MCGOVERN | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | X | 105928 | 13241 | 19867 | |||
| DR JOSEPH ANDREWS | ||||||||
| CHIEF MEDICAL OFFICER | 35.00 | 163414 | 46690 | 16717 | X | |||
| JANICE MATARAZZO | ||||||||
| NIGHT RN | 54.00 | 139585 | 0 | 8634 | X | |||
| DR ANTHONY COSCIA PT | ||||||||
| PHYSICIAN | 24.00 | 125013 | 10418 | 17960 | X | |||
| MARIANNE TREANTAFILAS | ||||||||
| DIR OF EDUC AND APRN | 35.00 | 104370 | 23856 | 12328 | X | |||
| JAMES PROTA | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 104996 | 14999 | 25989 | X | |||
| JOANNE LITEVICH | ||||||||
| PHARMACIST | 40.00 | 113896 | 0 | 25777 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1403820 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 200778 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 204213 | TotalOtherCompensation |
| Number Individuals GT100 K | 39 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PEQUOT PHARM | |||||
| 1 ANNIE GEORGE DRIVE | MASHANTUCKET | CT | 06339 | PHARMACEUTICAL DIST | 892646 |
| A&B HOMEHEALTH SOLUTIONS | |||||
| 446A BLAKE STREET | NEW HAVEN | CT | 06515 | HOME HEALTH AIDES | 854056 |
| PEOPLE'S HOME HEALTHCARE | |||||
| 262 STATE STREET | NORTH HAVEN | CT | 06473 | DURABLE MEDICAL EQPT | 512960 |
| MAXIM | |||||
| 12588 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | HOME HEALTH AIDES | 419071 |
| ARCADIA HEALTH CARE | |||||
| 4639 MAIN STREET | BRIDGEPORT | CT | 06606 | HOME HEALTH AIDES | 358108 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| All Other Contributions | 3019018 | AllOtherContributions |
| Total Contributions | 3019018 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOME CARE REVENUE | 621610 | 14983018 | 14983018 |
| INPATIENT REVENUE | 623000 | 13176532 | 13176532 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 28159550 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 218482 | TotalRevenueColumn |
| Exclusion | $218,482 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| OTHER | 900099 | 67433 | $67,433 |
| FOOD SERVICE INCOME | 722210 | 55327 | $55,327 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 122760 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31519810 | TotalRevenueColumn |
| Related Or Exempt Function Income | 28159550 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $341,242 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 726330 | Total |
| Program Services | 307647 | ProgramServices |
| Management And General | 400843 | ManagementAndGeneral |
| Fundraising | 17840 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13279255 | Total |
| Program Services | 12050946 | ProgramServices |
| Management And General | 1093351 | ManagementAndGeneral |
| Fundraising | 134958 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310037 | Total |
| Program Services | 272833 | ProgramServices |
| Management And General | 34104 | ManagementAndGeneral |
| Fundraising | 3100 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1767323 | Total |
| Program Services | 1555244 | ProgramServices |
| Management And General | 194406 | ManagementAndGeneral |
| Fundraising | 17673 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1209396 | Total |
| Program Services | 1064268 | ProgramServices |
| Management And General | 133034 | ManagementAndGeneral |
| Fundraising | 12094 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4000000 | Total |
| Program Services | 4000000 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115969 | Total |
| Management And General | 115969 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135348 | Total |
| Management And General | 135348 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2507144 | Total |
| Program Services | 1964251 | ProgramServices |
| Management And General | 518029 | ManagementAndGeneral |
| Fundraising | 24864 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1826 | Total |
| Management And General | 1826 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3084929 | Total |
| Program Services | 2498793 | ProgramServices |
| Management And General | 555287 | ManagementAndGeneral |
| Fundraising | 30849 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1875 | Total |
| Management And General | 1875 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 597016 | Total |
| Program Services | 465672 | ProgramServices |
| Management And General | 131344 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 278588 | Total |
| Program Services | 247943 | ProgramServices |
| Management And General | 30645 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12100 | Total |
| Program Services | 6736 | ProgramServices |
| Management And General | 5364 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 84116 | Total |
| Management And General | 84116 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 184892 | Total |
| Management And General | 184892 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 624560 | Total |
| Program Services | 533999 | ProgramServices |
| Management And General | 90561 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| HOSPITALIZATION EXPENSE | 870249 | 870249 | ||
| HOUSEKEEPING | 505400 | 454860 | 50540 | |
| GROCERIES | 193803 | 174423 | 19380 | |
| OTHER | 156311 | 55128 | 92628 | 8555 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30646467 | Total |
| Program Services | 26522992 | ProgramServices |
| Management And General | 3873542 | ManagementAndGeneral |
| Fundraising | 249933 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 173906 | BOY |
| EOY | 221853 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1331774 | BOY |
| EOY | 2728443 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 738139 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 196548 | BOY |
| EOY | 198440 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3777105 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3072190 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 829599 | BOY |
| EOY | 704915 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5462581 | BOY |
| EOY | 5224710 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26371 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11927099 | BOY |
| EOY | 12462591 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20686017 | BOY |
| EOY | 21540952 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6535973 | BOY |
| EOY | 6977829 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 592799 | BOY |
| EOY | 604474 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2477346 | BOY |
| EOY | 1395036 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 228849 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9500 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9615618 | BOY |
| EOY | 9206188 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8797385 | BOY |
| EOY | 10112537 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 644622 | BOY |
| EOY | 1653835 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1628392 | BOY |
| EOY | 568392 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11070399 | BOY |
| EOY | 12334764 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20686017 | BOY |
| EOY | 21540952 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 873343 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 391022 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $101,508 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 101508 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1628392 | BeginningOfYearBalance |
| Contributions | 220000 | Contributions |
| Other Expenditures | 1280000 | OtherExpenditures |
| End Of Year Balance | 568392 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1408392 | BeginningOfYearBalance |
| Contributions | 220000 | Contributions |
| Investment Earnings Or Losses | 14073 | InvestmentEarningsOrLosses |
| Other Expenditures | 14073 | OtherExpenditures |
| End Of Year Balance | 1628392 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1228392 | BeginningOfYearBalance |
| Contributions | 180000 | Contributions |
| Investment Earnings Or Losses | 90304 | InvestmentEarningsOrLosses |
| Other Expenditures | 90304 | OtherExpenditures |
| End Of Year Balance | 1408392 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1026081 | BeginningOfYearBalance |
| Contributions | 220000 | Contributions |
| Investment Earnings Or Losses | 77538 | InvestmentEarningsOrLosses |
| Other Expenditures | 95227 | OtherExpenditures |
| End Of Year Balance | 1228392 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3777105 | OtherCostOrOtherBasis |
| Depreciation | 3072190 | Depreciation |
| Book Value | 704915 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 704915 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM J.D. THOMPSON INSTITUTE, NET | 12251258 |
| OTHER CURRENT ASSETS | 211333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 12462591 | TotalBookValueOtherAssets |
| Total Revenue | 31519810 | TotalRevenue |
| Total Expenses | 30646467 | TotalExpenses |
| Excess Or Deficit For Year | 873343 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 391022 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 391022 | TotalAdjustments |
| Excess Or Deficit Per FS | 1264365 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 31910832 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 391022 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 391022 | RevenueNotRptdF990 |
| Revenue Subtotal | 31519810 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 31519810 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 30646467 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 30646467 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 30646467 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | Identifier |
| Return Reference | PART V, LINE 4: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 0 | WrittenPolicy |
| FPG Reference Free Care | 0 | FPGReferenceFreeCare |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 271187 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 271187 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00830 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 71591 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 71591 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 342778 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 342778 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01030 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 20000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 20000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 362778 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 362778 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01090 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $254,301 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 24820415 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 28518733 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3698318 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 NOT APPLICABLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE CONNECTICUT HOSPICE INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DOUBLE BEACH ROAD | AddressLine1 |
| City | BRANFORD | City |
| State | CT | State |
| ZIP Code | 064054003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 0 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 0 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)
| ExplanationExplanation | Return ReferenceReturnReference |
|---|---|
| PART I, LINE 3C: THE HOSPITAL PROVIDES SERVICES BASED ON PATIENT NEED REGARDLESS OF INCOME OR ABILITY TO PAY. | |
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 254301. | |
| 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. | |
| THE HOSPITAL RESPONDS TO THE NEEDS OF ITS COMMUNITY PHYSICIANS AND REFERRING HOSPITALS. | PART VI, LINE 2 |
| PATIENTS AND THEIR FAMILIES ARE INFORMED OF ALL REIMBURSEMENT OPTIONS BOTH VERBALLY AND IN WRITING UPON ADMISSION. | PART VI, LINE 3 |
| ALL COMMUNITIES AND DEMOGRAPHIC CONSTITUENCIES ARE SERVED INCLUDING URBAN, RURAL AND SUBURBAN. | PART VI, LINE 4 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROSEMARY HURZELER | |||||||||||||
| 169033 | 61467 | 0 | 0 | 0 | 0 | 5071 | 1844 | 12278 | 4465 | 186382 | 67776 | 0 | 0 |
| DAVID R GOLDFARB | |||||||||||||
| 124400 | 8886 | 0 | 0 | 0 | 0 | 3732 | 267 | 15268 | 1090 | 143400 | 10243 | 0 | 0 |
| SANDRA J KLIMAS | |||||||||||||
| 120334 | 15042 | 0 | 0 | 0 | 0 | 3610 | 451 | 14549 | 1819 | 138493 | 17312 | 0 | 0 |
| RONNY J KNIGHT | |||||||||||||
| 132851 | 6179 | 0 | 0 | 0 | 0 | 3986 | 185 | 7956 | 370 | 144793 | 6734 | 0 | 0 |
| DR JOSEPH ANDREWS | |||||||||||||
| 163414 | 46690 | 0 | 0 | 0 | 0 | 0 | 0 | 13002 | 3715 | 176416 | 50405 | 0 | 0 |
| DR ANTHONY COSCIA PT | |||||||||||||
| 125013 | 10418 | 0 | 0 | 0 | 0 | 3750 | 313 | 12828 | 1069 | 141591 | 11800 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | 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. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | F J MANCHESKI | NamePerson |
| Loan To Organization | X | LoanToOrganization |
| Original Principal | $800,000 | OriginalPrincipalAmount |
| Balance Due | 604474 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 604474 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 391,022. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| PART VIII, STATEMENT OF REVENUE, LINE 2 | DURING THE YEAR ENDED SEPTEMBER 30, 2012, THE ESTIMATED VALUE OF CONTRIBUTED SERVICES WAS $2,043,000. | VALUE OF CONTRIBUTED SERVICES |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE JOHN D THOMPSON HOSPICE INSTITUTE FOR EDUCATION TRAINING AND RESEARCH | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 DOUBLE BEACH ROAD | AddressLine1 |
| City | BRANFORD | City |
| State | CT | State |
| ZIP Code | 064054003 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 061003712 | EIN |
| Primary Activities | PROGRAMS ON EDUCATION, TRAINING AND RESEARCH; MANAGEMENT SERVICES | PrimaryActivities |
| Legal Domicile State | CT | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | BOX 9 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| FACILITY LEASE | ||
| J | 284160 | OPERATING LEASE |
| MANAGEMENT SERVICES | ||
| L | 4000000 | FAIR VALUE OF SERVICES |
Comments