INSTITUTE OF MEDICAL HUMANISM INC: Form 990EZ, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- INSTITUTE OF MEDICAL HUMANISM INC (EIN 03-0371823)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-08-13
- IRS object ID
- 201242269349200784
- Schema version
- 2011v1.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-08-13T11:49:52-07:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Crossroads AccountingLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 311 North Street | AddressLine1 |
| City | Bennington | City |
| State | VT | State |
| ZIP Code | 05201 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030371823 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Institute of Medical Humanism Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | INST | NameControl |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 197 | AddressLine1 |
| City | Bennington | City |
| State | VT | State |
| ZIP Code | 05201 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Bernard M Bandman PhD | Name |
| Title | Executive Direc | Title |
| Date Signed | 2012-08-13 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Gail Mauricette | Name |
| Phone | 8024428174 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Web Site | N/A | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts Less Than25000 | X | GrossReceiptsLessThan25000 |
| Gross Receipts | 34677 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 33970 | ContributionsGiftsGrantsEtc |
| Program Service Revenue | 644 | ProgramServiceRevenue |
| Investment Income | 63 | InvestmentIncome |
| Cost Other Basis And Sales Expenses | 0 | CostOtherBasisAndSalesExpenses |
| Fundraising Gross Income | 0 | FundraisingGrossIncome |
| Special Events Direct Expenses | 0 | SpecialEventsDirectExpenses |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
| Total Revenue | 34677 | TotalRevenue |
| Salaries Other Comp Empl Benefits | 12523 | SalariesOtherCompEmplBenefits |
| Fees And Oth Pymt To Ind Contractors | 7466 | FeesAndOthPymtToIndContractors |
| Occupancy Rent Utilities And Maint | 3357 | OccupancyRentUtilitiesAndMaint |
| Printing Publications Postage | 1189 | PrintingPublicationsPostage |
| Other Expenses Total | 23484 | OtherExpensesTotal |
| Total Expenses | 48019 | TotalExpenses |
| Excess Or Deficit For Year | -13342 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 89833 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 76491 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88783 | BOY |
| EOY | 73175 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1651 | BOY |
| EOY | 3985 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90434 | BOY |
| EOY | 77160 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 601 | BOY |
| EOY | 669 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89833 | BOY |
| EOY | 76491 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | To redefine the medical encounter; to recognize the differences between the language of medicine and the language of the patient's world transformed by illness, to acknowledge the patient's voice as a cornerstone of best care, to bridge the communication between doctor and patient, and in so doing, improve quality of care. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment (6 entries)
| Description Program Service AccomDescriptionProgramServiceAccom | Grants And AllocationsGrantsAndAllocations |
|---|---|
| New website SpeakSooner.org: A new website featuring the Difficult Conversations initiative is being developed for an August 2012 launch. The Difficult Conversations Workbook & Video will be available on the site for completing writing exercises and download for office visits. The website will also offer patients, loved ones and healthcare professionals a portal to share their views and experiences about end of life care. SpeakSooner.org places an emphasis on empowering patients to open conversations with doctors and nurses about their needs, concerns and goals for care. Avoidance of talking sooner about prognosis can lead to unmet needs, unnecessary suffering and regrets. The website will serve as a platform to educate a wider audience and offer resources to support of all of those impacted by illness. | |
| Medical Humanist Program- the consultation service educates patients and families about how to effectively communicate with medical professionals. Participants learn how to document their needs and concerns in preparation for addressing these issues at medical office visits. Approximately 20 patients/family have participated in the program. | |
| Community Education Programs- "Good Communication is Good Medicine" programs educate the public about the key role of communication in improving quality of healthcare delivery and increasing patient satisfaction. The program format includes viewing films of actual patients sharing their experiences and panel discussions with experts. Audience participation is encouraged. Approximately 75 people attended the programs. | |
| Writing is Good Medicine Program-This program prescribes the pen as a tool that helps patients better understand their physical, psychosocial and spiritual needs. The program helps to empower patients to clarify and communicate their needs and goals in the planning of care. Approximately, 50 patients participated in workshops. | |
| Education and Training Programs for Medical Professionals- Voices From The Lived World of Illness includes a film and medical education guide. It continues to be used at medical institutions and conferences for education/training of physicians, nurses, social workers and hospice staff. Approximately 1200 medical professionals have participated in programs since it's release in 2005. Men Do Talk is a toolkit that includes a film and workbook. It offers perspectives of prostate cancer patients and has been used for education/training of physicians, nurses and social workers. Approximately 200 medical professionals have participated in programs since its release in 2008. Difficult Conversations: Transition to End of Life Care is a toolkit that includes and film and workbook. It offers the perspectives of patients with incurable cancer and has been used for end of life education programs for physicians, nurses and social workers.In-service educational programs on the use of the Difficult Conversations communication tool were offered at the Dartmouth Hitchcock Cancer Center (Manchester, NH) and MD Anderson Cancer Center (Houston, TX). The programs were attended by 150 physicians and nurses. | |
| Patient Education Programs:Difficult Conversations: Transition to End of Life Care-the Difficult Conversations film and workbook are components of a toolkit that help patients with incurable cancer better understand and communicate their needs and goals to doctors and nurses. The toolkit is being used in a pilot study with 10 patients at the VA Hospital in Vermont and offered by oncologists at MD Anderson (Houston TX) and Massachusetts General Hospital (Boston, MA) to select patients to help refine the workbook prior to distribution. A program at the Stowe Weekend of Hope for patients and families introduced the Difficult Conversations Workbook as a tool to identify needs, preferences and goals for end of life care planning. There were 30 participants. Surveys showed that the program was very well receivedMen Do Talk-the Men Do Talk film and workbook were presented at a program for prostate cancer patients and families at the Stowe Weekend of Hope in Vermont. The program offered the 25 participants an opportunity to gain a better understanding of the complicated process of decision-making and the adjustment to the physical, psychological and emotional effects of treatment. And, in so doing men are better prepared to communicate these issues to their doctors and nurses. The Men Do Talk Toolkit will be available for distribution in 2011. | 44089 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 44089 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|---|---|---|---|
| Carol Salazar | ||||||
| Memorial Drive | Bennington | VT | 05201 | Trustee | 0 | 0 |
| Joseph O'Donnell | ||||||
| Dartmouth Medical School | Hanover | NH | 03755 | Trustee | 0 | 0 |
| Dan Klores | ||||||
| 386 Park Avenue S 10th Floor | New York | NY | 10016 | Trustee | 0 | 0 |
| Lidia Schapira | ||||||
| 55 Fruit Street | Boston | MA | 02114 | Trustee | 0 | 0 |
| Gary Goldberg | ||||||
| PO Box 337 | Arlington | VT | 05250 | Vice President | 0 | 0 |
| Anne L Gatling | ||||||
| 2802 NW Starview Drive | Bend | OR | 97701 | Secretary/Treas | 10.00 | 0 |
| David L Schroedel | ||||||
| 487 Munroe Avenue | Sleepy Hollow | NY | 10591 | President | 10.00 | 0 |
| Bernard M Bandman PhD | ||||||
| 1808 South Stream Road | Bennington | VT | 05201 | Executive Direc | 20.00 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | false | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | false | OrganizationHadUBI |
| Organization Filed990 T | false | OrganizationFiled990T |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Organization Dissolved Etc | false | OrganizationDissolvedEtc |
| Did Org File Form1120 POL This Year | false | DidOrgFileForm1120POLThisYear |
| Made Loans To From Officers | false | MadeLoansToFromOfficers |
| Initiation Fees And Capital Contri | 0 | InitiationFeesAndCapitalContri |
| Gross Receipts For Public Use | 0 | GrossReceiptsForPublicUse |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTrans |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Bernard M Bandman PhD | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 359 Main Street | AddressLine1 |
| City | Bennington | City |
| State | VT | State |
| ZIP Code | 05201 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8024425800 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccount |
| Foreign Office | false | ForeignOffice |
| Maintain Any Donor Advised Funds | false | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | false | DoesOrgHaveHospital |
| Tanning Services Provided | false | TanningServicesProvided |
| Form720 Filed | false | Form720Filed |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction With Control Entity | false | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | false | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | false | EngageInLobbyingActivities |
| Operating School | false | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | false | TrnsfrsExemptNonCharRelatedOrg |
| Related Org Section527 Org | false | RelatedOrgSection527Org |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | true | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 180324 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 190891 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 154488 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 71907 | CurrentTaxYearMinus1Year |
| Current Tax Year | 33970 | CurrentTaxYear |
| Total | 631580 | Total |
Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 180324 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 190891 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 154488 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 71907 | CurrentTaxYearMinus1Year |
| Current Tax Year | 33970 | CurrentTaxYear |
| Total | 631580 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 206520 | AmountsSubstContributorsTotal |
| Public Support Total170 | 425060 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 696 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 456 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 91 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 98 | CurrentTaxYearMinus1Year |
| Current Tax Year | 63 | CurrentTaxYear |
| Total | 1404 | Total |
Net UBI NetUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 632984 | TotalSupport |
| Gross Receipts From Admissions Etc | 7719 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.67150 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.56370 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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 O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990-EZ, Part II, Line 26.1001 | Total Liabilities.1001 | Accounts Payable and Accrued Expenses - Beginning $601 Accounts Payable and Accrued Expenses - Ending $669 |
| Form 990-EZ, Part II, Line 24.1 | Other Assets.1 | Deposits - Beginning $256 Deposits - Ending $256 |
| Form 990-EZ, Part II, Line 24.1003 | Other Assets.1003 | Machinery and Equipment - Beginning $1395 Machinery and Equipment - Ending $3729 |
| Form 990-EZ, Part I, Line 16.6 | Other Expenses.6 | DVD Replication & Editing $235 |
| Form 990-EZ, Part I, Line 16.5 | Other Expenses.5 | Books, subscriptions $508 |
| Form 990-EZ, Part I, Line 16.4 | Other Expenses.4 | Computer Services $928 |
| Form 990-EZ, Part I, Line 16.2 | Other Expenses.2 | Website $2655 |
| Form 990-EZ, Part I, Line 16.1 | Other Expenses.1 | Telephone $3443 |
| Form 990-EZ, Part I, Line 16.1012 | Other Expenses.1012 | Insurance $2250 |
| Form 990-EZ, Part I, Line 16.1009 | Other Expenses.1009 | Depreciation $1244 |
| Form 990-EZ, Part I, Line 16.1007 | Other Expenses.1007 | Conferences, Conventions, and Meetings $5186 |
| Form 990-EZ, Part I, Line 16.1005 | Other Expenses.1005 | Travel $5091 |
| Form 990-EZ, Part I, Line 16.1002 | Other Expenses.1002 | Office Expenses $1944 |
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