SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Hospice of Southern Maine
 
Employer identification number

01-0540180
Return Reference Explanation
Form 990, Part VI, Section A, line 2 Donna DeBlois, Chris Coon, Nathan Wilson, Heidi Hansen, Frank McGinty and Laura Madigan-McCown have a business relationship with each other through their affiliation with Maine Health, a 501(c)(3) public charity, and its affiliates.
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 response for Form 990, Part VI, line 7a.
Form 990, Part VI, Section B, line 11b The Form 990 was reviewed by the finance committee. Then a complete copy of the Form 990 was distributed to the full Board of Directors before filing with the IRS.
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 their 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 public financial and governing documents are made available upon request.
Form 990, Part XI, line 9: Present Value Discount on Pledges Receivable 10,098.
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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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