2012-08-06T08:58:02-05:00 2011-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2011-01-01 010540180 Hospice of Southern Maine HOSP 2072893641 180 US Route 1 Scarborough ME 04074 Arlene Wing 2072893641 2012-08-06 E Drew Cheney P00182972 2078792100 2011 2016-02-24 21:20:13Z Arlene Wing 180 US Route 1 Scarborough ME 04074 9228690 0 X www.hospiceofsouthernmaine.com X 2003 ME Hospice services: To provide compassion, care, and comfort through end of life. 20 20 134 180 0 0 713145 718434 7822771 8414981 20105 26461 -24169 35790 8531852 9195666 0 0 0 0 4885849 5352114 0 0 192236 3171310 3439440 8057159 8791554 474693 404112 8538449 8774788 3117108 3141748 5421341 5633040 X Hospice services 0 0 7571095 8429673 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 a 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 2011, HSM cared for 1,194 patients/families primarily in York and Cumberland counties, with an average census of 109 patients each day. HSM provided approximately $215,000 in unreimbursed care in 2011. HSM volunteers provided approximately 10,000 hours of service. 7571095 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 0 1 31 0 1 134 1 0 0 0 0 0 0 0 0 0 0 X 20 20 1 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X Mary Pinto 2072893640 180 US Route 1 Scarborough ME 04074 Maryanna Arsenault 0.80 X 0 0 0 Joel Botler MD 0.80 X 0 0 0 Edward J McGeachey 1.10 X 0 0 0 Elaine Brady RN 2.00 X 0 0 0 Karl Turner 2.60 X X 0 0 0 Laurence Gross 0.80 X 0 0 0 Daniel Hayes MD 0.90 X 0 0 0 Holly LeBlanc 2.90 X X 0 0 0 Sally Daggett Esq 1.10 X 0 0 0 Miriam Leonard 0.90 X 0 0 0 Theresa Desfosses 2.00 X 0 0 0 Lucy Perkins 1.00 X 0 0 0 William Caron 0.90 X 0 0 0 Ann Stockbridge 0.80 X 0 0 0 David Perkins Esq 1.70 X X 0 0 0 Albert Swallow 1.80 X X 0 0 0 Roland Eon 1.20 X 0 0 0 Annette Gosnell 1.30 X 0 0 0 Betsey McCandless Esq 1.10 X 0 0 0 Bob Schools 1.30 X 0 0 0 Arlene Wing 40.00 X 130930 0 13248 Mark Wrona MD 40.00 X 230199 0 13027 361129 0 26275 2 0 1 0 0 30680 687754 9801 718434 Patient services 621610 8414981 8414981 8414981 25105 25105 8160 6804 1356 1356 1356 47318 30680 26220 21098 21098 14692 14692 14692 9195666 8429673 0 47559 144178 144178 4300844 3827992 391069 81783 44045 40946 2224 875 506001 445672 50807 9522 357046 308402 42055 6589 5840 5840 18700 18700 284328 196747 56218 31363 108490 108490 213038 112103 40628 60307 109607 96454 13153 261827 146623 115204 195661 191357 4304 40972 36055 4917 150862 146336 4526 327510 317685 9825 135845 117963 16085 1797 Patient related expense 1370939 1370939 Bad debt 215821 215821 8791554 7571095 1028223 192236 24624 18323 3238759 3839008 224842 126674 903461 861342 93311 94969 5190918 1356446 4053452 3834472 8538449 8774788 617492 718081 2309554 1762386 190062 130349 0 530932 3117108 3141748 X 5059589 5288833 71656 74007 290096 270200 5421341 5633040 8538449 8774788 X 404112 -192413 X X 0 1 1 X 0 X 704748 556516 704525 713145 718434 3397368 704748 556516 704525 713145 718434 3397368 629989 2767379 41401 54537 16836 19220 25105 157099 3554467 33018210 0.77860 0.79040 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 598 598 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: National Hospice and Palliative Care Organization portion of dues paid allocated to lobbying activities was $243. Home Care and Hospice Alliance of Maine portion of dues paid allocated to lobbying activities was $355. 361752 239503 109 257157 344207 454893 153052 68 246261 361752 351905 211462 41 108515 454893 330200 136970 33 115298 351905 0.00000 0.78500 0.21500 0 0 440000 440000 3842280 878905 2963375 908638 477541 431097 3834472 Interest rate swap liability 530932 530932 9195666 8791554 404112 -192413 -192413 211699 9221886 26220 26220 9195666 0 9195666 8817774 26220 26220 8791554 0 8791554 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: 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, 2011. The Organization's tax years from 2008 through 2011 are open and subject to examination. Part XI, Line 8 - Other Adjustments: Change in fair value of interest rate swap -192,413. Part XII, Line 2d - Other Adjustments: Special events expense 26,220. Part XIII, Line 2d - Other Adjustments: Special events expense 26,220. Twilight in the Park 24186 13180 11006 7653 Annual celebration 53812 17500 36312 7267 2309 2950 6041 77998 30680 47318 7267 2309 2950 13694 26220 21098 X X 0 0 0 0 0 0 0 0 0 Mark Wrona MD 230199 0 0 0 0 0 0 0 13027 0 243226 0 0 0 Form 990, Part VI, Section A, line 2 Directors William Caron and Al Swallow have a business relationship with each other. Directors Elaine Brady and Edward McGeachey have a business relationship with each other. Directors William Caron and Maryanna Arsenault have a business relationship with each other. Form 990, Part VI, Section A, line 4 The substantive By-Law changes are: Article III Section 1: Number and Term - (Adds term limits for Directors and allows those serving as officers to exclude their officer time in the term limit calculation) Article III Section 2: Types of Directors - (Removes the right of Ex-Officio Directors to vote on Board matters) Article Section 3: Election of Directors - (Reduces the number of named supporting organizations for five to four and increases the community at large members from 15 to 16) Article IV Section 1: Committees - (Provides for seven standing committees and the creation of special purpose committees) Article IV Section 2: Executive Committee - (Outlines committee composition and responsibilities) Article IV Section 3: Governance Committee - (Folds Nomination Committee responsibilities into this committee and adds governance accountabilities to the committee's charge) Article IV Section 5: Quality and Clinical Operations Committee - Folds Professional Advisory Committee responsibilities in this committee) Article IV Section 6: Development Committee - (Creates Development Committee and outlines committee responsibilities) Article IV Section 7: Audit Committee - (Creates Audit Committee and outlines committee responsibilities) Article IV Section 8: Ethics Committee - (Creates Ethics Committee and outlines committee responsibilities) Article IV Section 9: Ad Hoc Committees - (Provides for the creation special purpose committees of limited duration) Article VI Section 1: Executive Management - (Creates new article and names the executive management position) Article VI Section 2: Chief Exec. Officer - (Moves CEO from Officer Section and outlines responsibilities) Article VI Section 3: Medical Director - (Moves Medical Director from Officer Section and outlines responsibilities and reporting lines of the position) Form 990, Part VI, Section A, line 6 The organization has members. 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 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 board, with the exception of the identity of a donor who preferred to remain anonymous. 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 5: Change in fair value of interest rate swap -192,413. Total to Form 990, Part XI, Line 5: -192,413. 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.