2011-08-15T13:27:17-05:00 2010-09-30 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2009-10-01 060878822 THE CONNECTICUT HOSPICE INC CONN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 DAVID R GOLDFARB 2033157500 2011-07-21 1 LOUIS B OBERMEIER 8605614000 2009 2016-02-24 21:20:13Z DAVID R GOLDFARB 100 DOUBLE BEACH ROAD BRANFORD CT 064054003 32198046 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. 14 12 401 510 0 0 2538730 2179615 31186203 29855209 87049 90749 148760 72473 33960742 32198046 0 0 18951053 18384459 0 255551 14941077 13727857 33892130 32112316 68612 85730 17351717 17707834 9172188 9342959 8179529 8364875 PROVIDE ADULT AND PEDIATRIC CARE TO IRREVERSIBLY ILL PATIENTS AND THEIR FAMILIES AT HOME AND AT HOSPITAL-HOSPICE. 0 0 13665276 15962304 PHYSICIAN DIRECTED PAIN AND SYMPTOM MANAGEMENT PROVIDED STATEWIDE TO PALLIATIVE HOSPITAL AND HOSPICE CARE ADULT AND PEDIATRIC PATIENTS AND THEIR FAMILIES 14070215 13892905 PHYSICIAN DIRECTED HOME MEDICAL AND HOSPICE CARE SERVICES TO ADULTS AND PEDIATRIC PATIENTS ON A STATEWIDE BASIS 27735491 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 1 401 1 0 0 0 0 0 0 0 0 0 14 12 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 1 0 0 X MR THOMAS MCGOVERN 2033157500 100 DOUBLE BEACH ROAD BRANFORD CT 064054909 HON DANIEL COSGROVE 5.00 X X 0 0 0 WEN-JEN HWU MD PHD 2.00 X 0 0 0 FREDERICK J MANCHESKI 10.00 X X 0 0 0 ANTHONY J DAROS 5.00 X X 0 0 0 DAVID MCDERMOTT 0.30 X 0 0 0 EUGENE MICHAEL 3.00 X 0 0 0 ROBERT PARKER 0.30 X 0 0 0 HON DONALD POGUE 2.00 X 0 0 0 ARLENE M SAYERS 20.00 X X 0 0 0 WAYNE O SOUTHWICK MD 1.00 X X 0 0 0 JOHN P STACK CPA 0.50 X 0 0 0 FREDERICK ULBRICH 1.00 X 0 0 0 CAPTAIN KAYE WILLIAMS 3.00 X X 0 0 0 PETER YARROW 0.20 X 0 0 0 ROSEMARY HURZELER 60.00 X X 183545 45886 17522 DAVID R GOLDFARB 52.00 X 166892 9628 16976 SANDRA J KLIMAS 50.00 X 121121 24224 15894 RONNY J KNIGHT 47.00 X 138124 5878 13886 GARY SULLIVAN 52.00 X 134886 12970 10935 DR JOSEPH ANDREWS 40.00 X 167096 41774 8647 JANICE MATARAZZO 53.00 X 144927 0 13467 DR ANTHONY COSCIA 24.00 X 139326 0 15698 DR MARIA RENNA 42.00 X 150069 0 9234 MARIANNE TREANTAFILAS 45.00 X 134989 0 10539 JOHN BIMONTE 39.00 X 117380 3010 10034 1598355 143370 142832 25 0 1 0 PEQUOT PHARM 1 ANNIE GEORGE DRIVE MASHANTUCKET CT 06339 HEALTHCARE/CONSULTING 872217 A&B HOMEHEALTH SOLUTIONS 419 WHALLEY AVE NEW HAVEN CT 06511 HEALTHCARE/CONSULTING 577190 MAXIM 12588 COLLECTIONS CENTER DR CHICAGO IL 60693 HEALTHCARE/CONSULTING 495281 ABM JANITORIALONE SOURCE PO BOX 1534 NEW YORK NY 100081534 HEALTHCARE/CONSULTING 238601 CT STAFFING WORKS 136 BERLIN ROAD CROMWELL CT 06416 HEALTHCARE/CONSULTING 218843 12 2179615 2179615 HOME CARE REVENUE 621610 15962304 15962304 INPATIENT REVENUE 623000 13892905 13892905 29855209 90749 90749 FOOD SERVICE INCOME 722210 60379 60379 OTHER 900099 12094 12094 72473 32198046 29855209 0 163222 959536 330719 605826 22991 14038805 12360881 1552070 125854 336227 284515 48375 3337 1850152 1565599 266192 18361 1199739 1015220 172613 11906 4000000 4000000 154844 154844 145320 145320 2516470 2006885 498261 11324 11684 1458 10226 3135755 3375640 -301402 61517 9492 9492 750458 511908 238550 292920 244207 48452 261 19359 6008 13351 78907 78907 198624 198624 703876 605333 98543 HOSPITALIZATION EXPENSE 774813 774813 0 HOUSEKEEPING 435734 221863 213871 OTHER 292145 292138 7 GROCERIES 207456 138304 69152 32112316 27735491 4121274 255551 2723720 941652 105877 3576786 1630440 515234 691816 233289 201362 3601692 2688539 913120 913153 1113798 2250528 26371 26371 8143522 11052512 17351717 17707834 8362688 6105929 800000 800000 2427530 9500 9500 9172188 9342959 X 5733670 6014281 1217467 942202 1228392 1408392 8179529 8364875 17351717 17707834 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 100000 100000 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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. 1228392 180000 90304 90304 1408392 1026081 220000 77538 95227 1228392 0 0 3601692 2688539 913153 913153 DUE FROM J.D. THOMPSON INSTITUTE, NET 10858856 OTHER CURRENT ASSETS 193656 11052512 LIABILITY UNDER SPLIT INTEREST AGREEMENT 9500 9500 32198046 32112316 85730 99616 99616 185346 32297662 99616 99616 32198046 0 32198046 32112316 0 32112316 0 32112316 Part V, Line 4: Description of Intended Use of Endowment Funds: 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 0 0 642782 597937 44845 0.00140 642782 597937 44845 0.00140 642782 597937 44845 0.00140 0 51537 0 26034645 28001965 -1967320 X 1 0 NOT APPLICABLE THE CONNECTICUT HOSPICE

100 DOUBLE BEACH ROAD BRANFORD CT 064054003

X Part I, Line 3c: THE HOSPITAL RESPONDS TO THE NEEDS AS IDENTIFIED BY PHYSICIANS AND HOSPITAL REFERERS. 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. Part VI, Line 2: THE HOSPITAL RESPONDS TO THE NEEDS AS IDENTIFIED BY PHYSICIANS AND HOSPITAL REFERERS. Part VI, Line 3: 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 ROSEMARY HURZELER 183545 45886 0 0 0 0 5146 1287 8871 2218 197562 49391 0 0 DAVID R GOLDFARB 166892 9628 0 0 0 0 5007 289 11043 637 182942 10554 0 0 SANDRA J KLIMAS 121121 24224 0 0 0 0 3633 727 9612 1922 134366 26873 0 0 RONNY J KNIGHT 138124 5878 0 0 0 0 4144 176 9176 390 151444 6444 0 0 GARY SULLIVAN 134886 12970 0 0 0 0 4047 389 5929 570 144862 13929 0 0 DR JOSEPH ANDREWS 167096 41774 0 0 0 0 0 0 6918 1729 174014 43503 0 0 JANICE MATARAZZO 144927 0 0 0 0 0 4348 0 9119 0 158394 0 0 0 DR ANTHONY COSCIA 139326 0 0 0 0 0 4180 0 11518 0 155024 0 0 0 DR MARIA RENNA 150069 0 0 0 0 0 0 0 9234 0 159303 0 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 X 800000 800000 0 1 1 800000 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. PART VIII, STATEMENT OF REVENUE, LINE 2 VALUE OF CONTRIBUTED SERVICES DURING THE YEAR ENDED SEPTEMBER 30, 2010, THE ESTIMATED VALUE OF CONTRIBUTED SERVICES WAS $1,899,000. 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 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 FACILITY LEASE J 284160 MANAGEMENT SERVICES L 4000000 LOAN PAYABLE E 2530000