Form990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
HOSPICE OF MICHIGAN INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
400 Mack Avenue
 
Room/suite
City or town, state or country, and ZIP + 4
Detroit, MI48201
D Employer identification number

38-2255529
E Telephone number

G Gross receipts $ 69,048,345
F Name and address of principal officer:
DOROTHY DEREMO
400 Mack Avenue
Detroit,MI48201
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.HOM.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1978
M State of legal domicile: MI
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: HOSPICE OF MICHIGAN, INC. ENSURES QUALITY OF LIFE, COMFORT, AND PEACE FOR OUR PATIENTS AND PROVIDES SUPPORT FOR THEIR LOVED ONES DURING THEIR END-OF-LIFE EXPERIENCE. WE WILL SERVE EVERYONE IN OUR COMMUNITY WHO NEEDS AND SEEKS OUR CARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 23
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 22
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 605
6 Total number of volunteers (estimate if necessary) ............. 6 851
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,493,488 3,765,644
9 Program service revenue (Part VIII, line 2g) ......... 54,509,312 62,695,097
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 340,882 382,543
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -4,641 -157,829
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 58,339,041 66,685,455
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 28,837,897 31,159,639
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,548,025    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 29,511,119 32,153,489
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 58,349,016 63,313,128
19 Revenue less expenses. Subtract line 18 from line 12....... -9,975 3,372,327
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 25,380,649 28,847,390
21 Total liabilities (Part X, line 26)............. 14,284,539 14,364,935
22 Net assets or fund balances. Subtract line 21 from line 20..... 11,096,110 14,482,455
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: HOSPICE OF MICHIGAN, INC. ENSURES QUALITY OF LIFE, COMFORT, AND PEACE FOR OUR PATIENTS AND PROVIDES SUPPORT FOR THEIR LOVED ONES DURING THEIR END-OF-LIFE EXPERIENCE. WE WILL SERVE EVERYONE IN OUR COMMUNITIES WHO NEEDS AND SEEKS OUR CARE AND STRIVE TO IMPROVE THE STATE OF COMFORT CARE. (CONTINUED IN SCHEDULE O)
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 51,061,395 including grants of $ 0 ) (Revenue $ 62,860,850 )
HOSPICE OF MICHIGAN (HOM) PROVIDES SERVICES TO MEET THE EMOTIONAL, SPIRITUAL, AND PHYSICAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES. HOSPICE PUTS THE FAMILY AND PATIENT AT THE CENTER OF CARE PLANNING, AND BY WORKING CLOSELY WITH PHYSICIANS AND CAREGIVERS, PROVIDES COMPREHENSIVE, COMPASSIONATE CARE FOR INDIVIDUALS NEARING THE END OF LIFE. OUR SERVICES INCLUDE: PAIN AND SYMPTOM MANAGEMENT; EMOTIONAL AND SPIRITUAL SUPPORT; HOME HEALTH AIDES AND TRAINED VOLUNTEERS; RESPITE FOR FAMILY CAREGIVERS; MEDICATIONS, EQUIPMENT, AND SUPPLIES; GRIEF SUPPORT FOR LOVED ONES. HOM PROVIDES SERVICES WHEREVER THE PATIENT IS LIVING OR RECEIVING CARE. IT MAY BE IN A HOSPITAL, NURSING HOME, ASSISTED LIVING FACILITY, OR HOME FOR THE AGED. WE WORK WITH PATIENTS, FAMILIES, AND THEIR CARE PROVIDERS TO ASSURE A SEAMLESS CONTINUUM OF QUALITY END-OF-LIFE CARE. WORKING CLOSELY WITH THE PATIENT, FAMILY, AND STAFF, THE HOM TEAM OFFERS COMPREHENSIVE SUPPORT THAT ADDRESSES THE PHYSICAL, EMOTIONAL, AND SPIRITUAL CONCERNS THAT CAN ARISE WHEN A PERSON IS AT THE END OF LIFE. (CONTINUED IN SCHEDULE O)
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet51,061,395
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II...
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
276
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
605
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
23
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
22
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletLee Ann Myers400 Mack AvenueDetroitMI48201 (313) 578-5000
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) DOROTHY E DEREMO........................................................................
PRESIDENT & CHIEF EXECUTIVE OFFICER
 40.00
.......................2.00 		X   X       569,511 0 40,036
(2) JANE MCNAMARA........................................................................
VICE CHAIR
 1.00
.......................1.00 		X   X       0 0 0
(3) JOHN R MAURER MD........................................................................
IMMEDIATE PAST CHAIR
 1.00
.......................1.00 		X   X       0 0 0
(4) MARK DRUMHELLER........................................................................
SECRETARY/TREASURER
 1.00
.......................1.00 		X   X       0 0 0
(5) SANFORD J LINDEN........................................................................
CHAIRMAN
 1.00
.......................1.00 		X   X       0 0 0
(6) ALLAN NACHMAN ESQ........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(7) BRIAN CONNOLLY........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(8) DOUGLAS R WOLL MD........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(9) GERALD FITZGERALD........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(10) HESSEL BUD BOUMA III PHD........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(11) HON JUDGE STEPHEN J MURPHY III........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(12) HON JUDITH TREPECK........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(13) JAMES B FAHNER MD........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(14) JANICE WHITEHOUSE........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(15) KHAN NEDD MD........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(16) KURT LUDLOW........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(17) LAWRENCE D BOS SR........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) LLOYD HANSEN........................................................................
TRUSTEE (PARTIAL YEAR)
 1.00
.......................1.00 		X           0 0 0
(19) MARK KINSLER........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(20) MARY SANDERS........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(21) MICHAEL SALTER DPM........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(22) PHILIP H MCCORKLE JR........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(23) RUTHANN BRINTNALL PHD........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(24) WALT KOZIOL CPA........................................................................
TRUSTEE
 1.00
.......................   		X           0 0 0
(25) LEE ANN MYERS........................................................................
CHIEF FINANCIAL OFFICER
 40.00
.......................2.00 		    X       208,678 0 17,259
(26) MARCIE HILLARY........................................................................
CHIEF FUNDRAISING OFFICER
 40.00
.......................1.00 		    X       214,966 0 42,002
(27) MICHAEL JASPERSON........................................................................
CHIEF MARKETING OFFICER
 40.00
.......................   		    X       197,047 0 29,598
(28) MICHAEL PALETTA MD........................................................................
CHIEF MEDICAL OFFICER
 40.00
.......................   		    X       293,599 0 43,451
(29) PATRICK MILLER........................................................................
CHIEF OPERATING OFFICER
 40.00
.......................   		    X       260,591 0 40,436
(30) ROBERT CAHILL........................................................................
CHIEF ADMINISTRATIVE OFFICER
 40.00
.......................2.00 		    X       312,111 0 24,853
(31) ALICE EMERY........................................................................
MEDICAL DIRECTOR
 40.00
.......................   		        X   154,366 0 25,354
(32) DR DAVID MCAREE........................................................................
MEDICAL DIRECTOR
 40.00
.......................   		        X   234,260 0 30,609
(33) DR EVAN FONGER........................................................................
MEDICAL DIRECTOR
 40.00
.......................   		        X   168,329 14,602 26,896
(34) DR TERRI MACK BIGGS........................................................................
MEDICAL DIRECTOR
 40.00
.......................   		        X   170,316 0 31,548
(35) TIMOTHY MOORED........................................................................
CORPORATE DIRECTOR OF SUPPLY CHAIN MANAGEMENT
 40.00
.......................   		        X   116,881 0 15,090
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,900,655 14,602 367,132
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet26
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 46,073
b Membership dues....1b  
c Fundraising events....1c 759,785
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		2,959,786
g Noncash contributions included in lines
1a-1f:$ 		39,624
h Total. Add lines 1a-1f.......MediumBullet 3,765,644
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 623000 62,695,097 62,695,097    
b     0      
c     0      
d     0      
e     0      
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 62,695,097
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 169,494     169,494
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 2,156,567  
b Less: cost or other basis and sales expenses 1,943,518  
c Gain or (loss) 213,049 0
d Net gain or (loss)..........MediumBullet 213,049     213,049
8a Gross income from fundraising events (not including
$ 759,785
of contributions reported on line 1c). See Part IV, line 18 ..
a 95,790
b Less: direct expenses ...b 419,372
c Net income or (loss) from fundraising events..MediumBullet -323,582   -323,582
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a MISCELLANEOUS 900099 165,753 165,753    
b     0      
c     0      
d All other revenue .... 0 0 0 0
e Total. Add lines 11a–11d ...... MediumBullet 165,753
12 Total revenue. See Instructions......MediumBullet 66,685,455 62,860,850 0 58,961
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,824,662 454,456 1,283,849 86,357
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 22,966,275 18,508,010 3,930,781 527,484
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 1,055,685 801,721 226,972 26,992
9 Other employee benefits ....... 3,655,260 2,691,658 872,355 91,247
10 Payroll taxes ........... 1,657,757 1,257,787 357,700 42,270
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 62,007 5,260 53,034 3,713
c Accounting ........... 127,930 0 127,930 0
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 20,395   20,395  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 1,743,177 1,057,983 619,643 65,551
12 Advertising and promotion .... 184,900 1,568 183,018 314
13 Office expenses ....... 4,359,762 3,504,796 693,293 161,673
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 1,462,035 1,099,579 362,456 0
17 Travel ............ 2,254,671 1,867,631 375,296 11,744
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 147,677 72,011 61,159 14,507
20 Interest ........... 218,677 37,305 181,372 0
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 884,394 38,711 845,683 0
23 Insurance .............. 127,061 340 126,721 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a CONTRACTED ROOM & BOARD 14,902,116 14,902,116 0 0
b PHARMACY 3,109,418 3,109,418 0 0
c CONTRACTED INPATIENT & RESPITE 1,127,920 1,127,920 0 0
d BAD DEBT 5,417 5,417 0 0
e All other expenses 1,415,932 517,708 382,051 516,173
25 Total functional expenses. Add lines 1 through 24e 63,313,128 51,061,395 10,703,708 1,548,025
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 31,379 1 62,326
2 Savings and temporary cash investments ......... 1,408,808 2 2,217,836
3 Pledges and grants receivable, net ........... 935,834 3 624,149
4 Accounts receivable, net ............. 5,486,561 4 6,407,973
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6 0
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 53,099 8 69,852
9 Prepaid expenses and deferred charges .......... 381,970 9 555,861
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 17,032,854
b Less: accumulated depreciation ..... 10b 8,909,412 8,330,053 10c 8,123,442
11 Investments—publicly traded securities .......... 6,259,260 11 6,931,352
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 2,493,685 15 3,854,599
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 25,380,649 16 28,847,390
Liabilities 17 Accounts payable and accrued expenses ......... 8,219,224 17 7,936,272
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 4,190,000 20 3,620,000
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22 0
23 Secured mortgages and notes payable to unrelated third parties .. 1,500,000 23 2,350,000
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 375,315 25 458,663
26 Total liabilities. Add lines 17 through 25......... 14,284,539 26 14,364,935
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 4,763,829 27 7,969,770
28 Temporarily restricted net assets ........... 2,239,533 28 2,419,937
29 Permanently restricted net assets ........... 4,092,748 29 4,092,748
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 11,096,110 33 14,482,455
34 Total liabilities and net assets/fund balances ........ 25,380,649 34 28,847,390
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
66,685,455
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
63,313,128
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
3,372,327
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
11,096,110
5
Net unrealized gains (losses) on investments ...............
5
14,018
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
0
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
14,482,455
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 3,896,007 3,267,837 3,083,008 3,493,488 3,765,644 17,505,984
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 62,218,807 61,721,217 60,338,222 54,509,312 62,695,097 301,482,655
3 Gross receipts from activities that are not an unrelated trade or business under section 513.. 374,170 32,156 90,320 23,250 95,790 615,686
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
6 Total. Add lines 1 through 5. 66,488,984 65,021,210 63,511,550 58,026,050 66,556,531 319,604,325
7a Amounts included on lines 1, 2, and 3 received from disqualified persons... 0 0 0 0 0 0
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. 0 0 0 0 0 0
c Add lines 7a and 7b.. 0 0 0 0 0 0
8 Public support (Subtract line 7c from line 6.)           319,604,325
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6... 66,488,984 65,021,210 63,511,550 58,026,050 66,556,531 319,604,325
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 230,135 130,602 145,243 176,810 169,494 852,284
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 230,135 130,602 145,243 176,810 169,494 852,284
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.           0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) .. 177,776 185,986 14,287 139,104 165,753 682,906
13 Total support. (Add lines 9, 10c, 11, and 12.).. 66,896,895 65,337,798 63,671,080 58,341,964 66,891,778 321,139,515
14
Section C. Computation of Public Support Percentage
15
15
99.520 %
16
16
99.440 %
Section D. Computation of Investment Income Percentage
17
17
0.260 %
18
18
0.360 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - MISCELLANEOUS INCOME, COLUMN A - 177776, COLUMN B - 185986, COLUMN C - 14287, COLUMN D - 139104, COLUMN E - 165753, COLUMN F - 682906;,
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
HOSPICE OF MICHIGAN INC
  		Employer identification number

38-2255529
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
HOSPICE OF MICHIGAN INC
  		Employer identification number

38-2255529
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
HOSPICE OF MICHIGAN INC
  		Employer identification number

38-2255529
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
2,897
j
Total. Add lines 1c through 1i ...............................
2,897
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THROUGH MEMBERSHIP DUES TO THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION AND THE MICHIGAN HOSPICE AND PALLIATIVE CARE ORGANIZATION, HOSPICE OF MICHIGAN HAS INDIRECTLY PARTICIPATED IN LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 5,358,105 4,983,348 4,551,695 4,502,893  
b Contributions ........ 0 283,000 253,025 262,932  
c Net investment earnings, gains, and losses 219,376 157,916 257,068 -157,359  
d Grants or scholarships .....       0  
e Other expenditures for facilities
and programs ........ 		71,638 66,159 78,440 56,771  
f Administrative expenses ....       0  
g End of year balance ...... 5,505,843 5,358,105 4,983,348 4,551,695  
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet24.950 %
b
Permanent endowment SchDMd Bullet74.330 %
c
Temporarily restricted endowment SchDMd Bullet0.720 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................     0
b Buildings ................   9,009,626 2,925,896 6,083,730
c Leasehold improvements ............   743,643 419,631 324,012
d Equipment ................   7,279,585 5,563,885 1,715,700
e Other .................       0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 8,123,442
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATE - SUPPORTIVE CARE SERVICES OF MICHIGAN 3,736,438
(2) BOND ISSUE COSTS, NET 21,078
(3) CHARITABLE GIFT ANNUITY 19,469
(4) SECURITY DEPOSITS 13,153
(5) OTHER ASSETS 64,461




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 3,854,599
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
CAPITAL LEASE OBLIGATIONS 458,663








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 458,663
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 66,803,728
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 14,018
b Donated services and use of facilities ......... 2b 124,650
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 0
e Add lines 2a through 2d ..................... 2e 138,668
3 Subtract line 2e from line 1..................... 3 66,665,060
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a 20,395
b Other (Describe in Part XIII.) ........... 4b 0
c Add lines 4a and 4b....................... 4c 20,395
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 66,685,455
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 63,417,383
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a 124,650
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 0
e Add lines 2a through 2d...................... 2e 124,650
3 Subtract line 2e from line 1..................... 3 63,292,733
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 20,395
b Other (Describe in Part XIII.) ............ 4b 0
c Add lines 4a and 4b....................... 4c 20,395
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 63,313,128
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

ERNIE THE PLAY
(event type) 		(b) Event #2

CRYSTAL ROSE BALL
(event type) 		(c) Other events

2
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 465,976 166,534 223,065 855,575
2 Less: Contributions . . 381,866 154,854 223,065 759,785
3 Gross income (line 1
minus line 2) . . . 		84,110 11,680 0 95,790
VerticalDirectExpenses 4 Cash prizes . . .       0
5 Noncash prizes . .       0
6 Rent/facility costs . .       0
7 Food and beverages .       0
8 Entertainment . . .       0
9 Other direct expenses . 304,035 83,449 31,888 419,372
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 419,372
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow -323,582
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)LEE ANN MYERSCHIEF FINANCIAL OFFICER (i)
(ii)		 162,593
0 		30,188
0 		15,897
0 		11,869
0 		5,390
0 		225,937
0 		0
0
(2)DR DAVID MCAREEMEDICAL DIRECTOR (i)
(ii)		 227,133
0 		6,989
0 		138
0 		13,847
0 		16,762
0 		264,869
0 		0
0
(3)MICHAEL PALETTA MDCHIEF MEDICAL OFFICER (i)
(ii)		 233,021
0 		42,875
0 		17,703
0 		16,974
0 		26,477
0 		337,050
0 		0
0
(4)DOROTHY E DEREMOPRESIDENT & CHIEF EXECUTIVE OFFICER (i)
(ii)		 437,046
0 		86,063
0 		46,402
0 		26,101
0 		13,935
0 		609,547
0 		0
0
(5)DR TERRI MACK BIGGSMEDICAL DIRECTOR (i)
(ii)		 161,796
0 		8,382
0 		138
0 		10,585
0 		20,963
0 		201,864
0 		0
0
(6)ROBERT CAHILLCHIEF ADMINISTRATIVE OFFICER (i)
(ii)		 244,296
0 		44,250
0 		23,565
0 		17,475
0 		7,378
0 		336,964
0 		0
0
(7)PATRICK MILLERCHIEF OPERATING OFFICER (i)
(ii)		 204,989
0 		36,656
0 		18,946
0 		16,367
0 		24,069
0 		301,027
0 		0
0
(8)MARCIE HILLARYCHIEF FUNDRAISING OFFICER (i)
(ii)		 165,841
0 		31,531
0 		17,594
0 		12,447
0 		29,555
0 		256,968
0 		0
0
(9)MICHAEL JASPERSONCHIEF MARKETING OFFICER (i)
(ii)		 150,694
0 		27,563
0 		18,790
0 		10,434
0 		19,164
0 		226,645
0 		0
0
(10)ALICE EMERYMEDICAL DIRECTOR (i)
(ii)		 147,711
0 		6,655
0 		0
0 		9,455
0 		15,899
0 		179,720
0 		0
0
(11)DR EVAN FONGERMEDICAL DIRECTOR (i)
(ii)		 161,369
14,602 		6,912
0 		48
0 		10,107
0 		16,789
0 		195,225
14,602 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Travel for companions Schedule J, Part I, Line 1a THE CEO'S SPOUSE PARTICIPATES IN VARIOUS EVENTS, AND HIS TRAVEL EXPENSES WERE PAID BY HOSPICE OF MICHIGAN. THESE EXPENSES WERE TREATED AS TAXABLE COMPENSATION AND INCLUDED IN THE CEO'S FORM W-2.
Tax indemnification and gross-up payments Schedule J, Part I, Line 1a HOSPICE OF MICHIGAN PROVIDES A GROSS UP FOR OFFICERS' LONG-TERM DISABILITY (LTD) BENEFITS; THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION AND INCLUDED IN THE INDIVIDUALS' FORMS W-2.
Health or social club dues or initiation fees Schedule J, Part I, Line 1a DUES WERE PAID TO THE ECONOMIC CLUB OF DETROIT AND THE DETROIT ATHLETIC CLUB FOR DOROTHY DEREMO, ROBERT CAHILL AND MARCIE HILLARY. USE IS SOLELY FOR BUSINESS PURPOSES, WHICH IS REQUIRED TO BE DOCUMENTED BY EACH INDIVIDUAL, AND WAS THEREFORE NOT CONSIDERED A TAXABLE BENEFIT TO THE RECIPIENTS.
Schedule J (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) OAKWOOD HEALTH SYSTEM
  		ENTITY OF WHICH CEO DOROTHY DEREMO SERVED AS DIRECTOR 973,854 SERVICE CONTRACT FOR DME, INFUSION AND HOSPITAL SERVICES AT FAIR MARKET VALUE   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles ..... X 3 2,606 OPINIONS OF EXPERTS
19 Food inventory ... X 7 2,974 COST
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( TICKETS ) X 6 16,655 FACE VALUE
26 Other Right pointing arrow large image ( EQUIPMENT ) X 5 5,948 COST
27 Other Right pointing arrow large image ( SUPPLIES ) X 15 8,066 COST
28 Other Right pointing arrow large image ( GIFT CARDS ) X 6 3,375 COST
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Explanations of reporting method for number of contributions Schedule M, Part I OTHER: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS FOOD INVENTORY: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS COLLECTIBLES: NUMBER OF CONTRIBUTIONS OTHER: NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed. Schedule M, part I, column (b), Line other=TICKETS NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed. Schedule M, part I, column (b), Line other=EQUIPMENT NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed. Schedule M, part I, column (b), Line 19 NUMBER OF CONTRIBUTIONS
Number of contributions or items contributed. Schedule M, part I, column (b), Line other=SUPPLIES NUMBER OF CONTRIBUTIONS
Schedule M (Form 990) (2012)
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE O
(Form 990 or 990-EZ)

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 to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 CONTINUED FROM PART III: OUR VISION IS THAT HOSPICE OF MICHIGAN WILL BE MICHIGAN'S LEADING PROVIDER OF COMFORT CARE SERVICES TO INDIVIDUALS AND FAMILIES COPING WITH A LIFE-LIMITING ILLNESS. OUR VALUES INCLUDE: (1) QUALITY SERVICE - TO PROVIDE THE HIGHEST QUALITY SERVICE; RESPOND TO OUR PATIENTS' AND FAMILIES' NEEDS; AND AFFIRM PATIENT SELF-DETERMINATION, EMPOWERMENT, AND CHOICE; (2) TEAMWORK - TO TREAT EVERYONE WITH RESPECT AND ENCOURAGE STAFF'S PERSONAL AND PROFESSIONAL DEVELOPMENT; (3) RESOURCE STEWARDSHIP - TO DEMONSTRATE GOOD STEWARDSHIP OF OUR RESOURCES; (4) MISSION OUTREACH - TO ACKNOWLEDGE AND EMBRACE RELIGIOUS, ETHNIC, AND CULTURAL DIVERSITY; AND (5) SACRED SPACE - TO HONOR LIFE TO THE END, VALUING EVERY FORM OF HEALING; BE WITNESS TO THE SPIRIT OF LIFE; BE PRIVILEGED TO PROTECT THE SACREDNESS OF LEAVING, HONORING THE FEELING OF LOSS; AND ASSURE THAT PATIENTS AND FAMILIES ACHIEVE THEIR QUALITY OF LIFE GOAL WHILE UNDER OUR CARE.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A CONTINUED FROM PART III: WHEN WE PROVIDE HOSPICE CARE IN A FACILITY, WE WORK WITH THE FACILITY'S STAFF TO ESTABLISH A COLLABORATIVE PLAN OF CARE. WE CONSIDER FACILITY STAFF PART OF THE CARE-GIVING TEAM AND PROVIDE TRAINING IN END-OF-LIFE CARE, BASED ON THE NEED OF EACH FACILITY. DURING THE YEAR ENDED DECEMBER 31, 2012, HOM PROVIDED $302,310 IN CHARITY CARE. ADDITIONAL 2012 SERVICE ACCOMPLISHMENTS INCLUDE: (I) HOM MAINTAINED 851 VOLUNTEERS WHICH RESULTED IN OVER 41,000 VOLUNTEER HOURS AND A COST SAVINGS OF $761,000. A BEDSIDE VIGIL PROGRAM WAS ESTABLISHED IN THE NORTHEAST REGION WHERE 10% OF DEATHS HAD THE PRESENCE OF A VOLUNTEER. (II) THROUGH SUPPORT FROM THE MAGGIE ALLESEE CENTER (MAC) AND MARKETING STAFF, EACH HOSPICE OF MICHIGAN CLINICAL TEAM HAS ACHIEVED LEVEL 4, THE HIGHEST LEVEL, IN THE "WE HONOR VETERANS" PROGRAM SPONSORED BY THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION AND THE U.S. DEPARTMENT OF VETERANS AFFAIRS (VA). THIS PIONEERING CAMPAIGN IS DESIGNED TO IMPROVE THE SERVICES VETERANS RECEIVE FROM HOSPICE AND PALLIATIVE CARE PROVIDERS. STAFF EDUCATION AND TRAINING ARE MAJOR REQUIREMENTS FOR AN ORGANIZATION TO REACH EACH LEVEL. (III) HOM PROVIDES OUR PATIENTS, OUR PATIENTS' FAMILIES AND FAMILIES IN THE COMMUNITIES WE SERVE GRIEF SUPPORT SERVICES THROUGH ONE-ON-ONE COUNSELING OR GROUP SESSIONS. GRIEF SUPPORT IS NOT REIMBURSED BY ANY INSURANCE, AND IN 2012 HOM DEDICATED APPROXIMATELY $862,000 TOWARD PROVIDING THIS SERVICE. HOM GRIEF SUPPORT MEMORIAL PROGRAMS CONTINUE TO BE A SUBSTANTIAL BENEFIT FOR OUR COMMUNITIES AND FAMILIES. IN 2012 ALONE, THE ATTENDANCE WAS APPROXIMATELY 5,900; OF THIS, 58% WERE CONNECTED TO HOM WITH THE OTHER 42% COMING FROM ELSEWHERE IN THE COMMUNITY WITH NO TIES TO HOM. MEMORIAL SERVICES HONOR SACRED SPACE AND ALLOW THE BEREAVED TO EMBRACE OPPORTUNITIES TO REMEMBER. GRIEF SUPPORT SERVICE MANAGERS IN THE PAST HAVE PROVIDED DIVERSE MEMORIAL PROGRAMS FOR THEIR COMMUNITIES. IN 2012, THE HOM GRIEF SUPPORT DEPARTMENT ENDEAVORED TO BE INNOVATIVE IN MEETING THE NEEDS OF A CHANGING SOCIETY. VARIOUS INNOVATIVE IDEAS INCLUDED: - FLY AND REMEMBER IS WHERE ALL ATTENDEES DESIGNED AND FLEW A MEMORIAL KITE SIMULTANEOUSLY - THIS WAS HELD IN 10 COMMUNITIES IN 2012, THIS IS UP FROM 3 IN 2011. - A TALL SHIP SAILING MEMORIAL SERVICE FOR GRIEVING FAMILIES ON THE WATERS OF TRAVERSE BAY. - CAMP GOOD GRIEF IS A DAY CAMP THAT WAS OFFERED TO CHILDREN AGES 12-15 WHO HAD EXPERIENCED A LOSS. THIS WAS HELD IN JUNE AND THE CHILDREN SPENT THE DAY DOING TEAM BUILDING ACTIVITIES AS WELL AS MEMORIAL CRAFTS AND GROUP REFLECTION THAT INCORPORATED GRIEF EDUCATION AND SUPPORT THROUGHOUT EACH ACTIVITY. - PROGRAMS INCORPORATING SELF-CARE, MEMORIAL RITUALS, AND STAFF PARTICIPATION USING THEIR OWN UNIQUE TALENTS (SINGING, INSTRUMENT PLAYING, POETRY, EVEN COOKING). (IV) HOSPICE OF MICHIGAN LAUNCHED A MOBILE APP WHICH OFFERS SOLUTIONS TO: - ENHANCE COMFORT, CARE, AND COMMUNICATIONS BY CREATING A "SOCIAL NETWORK" AROUND THE PATIENT. WHETHER IN A PATIENT'S HOME OR ANYWHERE IN THE NATION, FAMILIES WILL BE CONNECTED TO "SEE" THE WORK OF HOM CLINICIANS. - USE A FREE MOBILE APPLICATION FOR FAMILIES TO GET UPDATES ON DAILY VISITS MADE TO THEIR LOVED ONES. - FOSTER INTERACTION AMONG FAMILY MEMBERS AND HOM (INCLUDING GRIEF SUPPORT SERVICES) THAT WILL CONTINUE AS LONG AS THEY WISH. HOSPICE OF MICHIGAN'S MOBILE APPLICATION IS REVOLUTIONARY AND A "FIRST OF ITS KIND" FOR PATIENTS AND FAMILIES. BY LEVERAGING TECHNOLOGY THAT PEOPLE CARRY EVERY DAY, THIS MOBILE APPLICATION EMPOWERS SMART PHONE USERS IN AN ENTIRELY NEW WAY -- GIVING THEM THE ABILITY TO STAY IN TOUCH WITH THEIR PARENTS, GRANDPARENTS, CHILDREN, FRIENDS, AND EXTENDED FAMILY MEMBERS WHEN A LOVED ONE IS BEING CARED FOR BY HOM. IT WILL CHANGE THE WAY THAT PEOPLE ARE INFORMED AND PROVIDE THEM WITH A REAL-TIME AVENUE OF INFORMATION THAT IS OF UTMOST IMPORTANCE. IT WILL ENABLE CAREGIVERS, FAMILY, AND FRIENDS TO COMMUNICATE REGARDLESS OF GEOGRAPHICAL LOCATION. IT WILL SERVE THE NEEDS OF HOSPICE PATIENTS AND FAMILIES WHEREVER THEY MAY BE -- AT ANY TIME AND AT ANY PLACE. (V) ONE AREA THAT CONTINUES TO BE UNIQUE TO HOSPICE OF MICHIGAN IS OUR PEDIATRIC PROGRAM, WHICH INCLUDES A PEDIATRIC HOSPICE PROGRAM, A PEDIATRIC EARLY CARE PROGRAM, AND A PERINATAL PROGRAM. IN 2012 HOSPICE OF MICHIGAN CONTRIBUTED $144,000 TO SUPPORT THESE THREE PROGRAMS DUE TO THE FACT THAT THERE IS NO REIMBURSEMENT FOR PEDS EARLY CARE OR PERINATAL SERVICES. WE CURRENTLY SUPPORT OVER 100 PATIENTS AND FAMILIES THROUGH THE PEDIATRIC EARLY CARE PROGRAM AND HAVE SUPPORTED 5 FAMILIES THROUGH PERINATAL IN WEST MICHIGAN. IN COLLABORATION WITH AN ESTABLISHED HOSPICE THAT SERVES PEDIATRICS IN SE MICHIGAN, A PEDIATRIC EARLY CARE PROGRAM WAS ESTABLISHED IN SE MICHIGAN AT THE END OF 2012. (VI) IN 2012, HOSPICE OF MICHIGAN EMPLOYEES EXCEEDED OUR FINANCIAL GOAL OF $65,000 BY 13%, WITH CLOSE TO 60% PARTICIPATING IN THE ANNUAL APPEAL TO SUPPORT A NUMBER OF THE ORGANIZATION'S SIGNIFICANT PROGRAMS OF EXCELLENCE, INCLUDING: - OPEN ACCESS - HEART FROM HOME - HOME HEALTH AIDE CERTIFICATION - ST. LUKE'S AFRICAN HOSPICE - QUALITY OF LIFE IN ADDITION, 176 HOURS OF VACATION AND FLOAT TIME WERE DONATED TO THE HEART FROM HOME PROGRAM TO SUPPORT THE EMERGENCY TIME-OFF BANK FOR EMPLOYEES. (VII) IN 2012 HOSPICE OF MICHIGAN'S CENSUS INCREASED 13% OVER 2011 DUE TO THE STABILIZATION AND REBUILDING OF THE MARKETING DEPARTMENT AS WELL AS A CONSISTENT PRESCRIPTIVE MARKETING PLAN ACROSS THE STATE.
Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON, THE SECRETARY-TREASURER, THE IMMEDIATE PAST CHAIRPERSON OF THE BOARD, THE PRESIDENT AND THE CHAIRS OF THE CLINICAL SERVICES AND ORGANIZATIONAL QUALITY, FINANCE AND AUDIT, BOARD DEVELOPMENT AND EVALUATION, AND NOMINATING COMMITTEES AS WELL AS THE CHAIRPERSON OF THE HOSPICE OF MICHIGAN FOUNDATION BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE SHALL POSSESS AND EXERCISE THE AUTHORITY AND POWERS OF THE BOARD OF TRUSTEES IN THE MANAGEMENT AND DIRECTION OF THE CORPORATION IN THE INTERIM PERIODS BETWEEN MEETINGS OF THE BOARD AND SHALL DISCHARGE THE DUTIES OF SAID BOARD DURING SUCH INTERIM PERIODS, EXCEPT THAT THE EXECUTIVE COMMITTEE SHALL NOT HAVE POWER OR AUTHORITY TO: (A) AMEND THE ARTICLES OF INCORPORATION; (B) DISSOLVE THE CORPORATION OR REVOKE A DISSOLUTION; (C) AMEND THE BYLAWS OF THE CORPORATION; OR (D) FILL VACANCIES IN THE BOARD.
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b A FINAL DRAFT OF THE FULL FORM 990 IS REVIEWED WITH OUR TAX ADVISORS AND APPROVED BY AN EXECUTIVE COMMITTEE OF THE BOARD, AND THEN A COPY OF THE FULL FORM 990 DRAFT IS SENT OUT TO EACH VOTING MEMBER OF THE GOVERNING BODY. THESE REVIEWS TAKE PLACE PRIOR TO FILING THE FORM 990 WITH THE IRS.
Conflict of interest policy Form 990, Part VI, Section B, Line 12c PROCEDURE: EMPLOYEES, BOTH PAID AND UNPAID (FROM HERE FORWARD REFERRED TO AS "EMPLOYEE"), AND BOARD MEMBERS, HAVE A FUNDAMENTAL OBLIGATION TO ACT IN THE BEST INTEREST OF PATIENT CARE AND HOSPICE OF MICHIGAN (HOM). EVERY BOARD MEMBER AND EMPLOYEE IS RESPONSIBLE FOR ACTING CONSISTENT WITH THIS OBLIGATION WHEN ENGAGING IN ACTIVITIES, AND SHOULD NOT LET OTHER PERSONAL AND FINANCIAL INTERESTS INTERFERE WITH THIS OBLIGATION. GENERAL PRACTICE GUIDELINES: (1) HOSPICE OF MICHIGAN REQUIRES THAT ALL MEMBERS OF ITS BOARDS OF TRUSTEES AND EMPLOYEES DISCLOSE INTERESTS THAT COULD RESULT IN A CONFLICT. ANNUALLY, ALL BOARD MEMBERS SIGN OFF ON A CONFLICT OF INTEREST POLICY AND DISCLOSE ANY SITUATION WHICH MAY REPRESENT A CONFLICT. THE CORPORATE COMPLIANCE OFFICER (CCO) ALSO HAS ACCESS TO THE BOARD AT LEAST ANNUALLY. THE ORGANIZATION ALSO UTILIZES C-TRAC (CROWE TAX RISK ASSESSMENT AND CONTROL), A TOOL PROVIDED BY OUR TAX ADVISORS, TO SEND CONFLICT OF INTEREST SURVEYS TO ALL VOTING BOARD MEMBERS, EXECUTIVES, AND THE HIGHEST PAID STAFF. (2) ALL BOARD MEMBERS AND EMPLOYEES ARE REQUIRED TO SUBMIT A DISCLOSURE STATEMENT, IF THERE IS A CONFLICT OF INTEREST THAT MEETS THE STATED DEFINITION, AT THE BEGINNING OF EMPLOYMENT OR TERM. (3) IF A MATTER ARISES IN WHICH A MEMBER OF THE BOARD OR EMPLOYEE HAS A CONFLICT OF INTEREST, THE INDIVIDUAL SHALL PROMPTLY DISCLOSE IT TO THE CEO, OR THE CASE OF THE CEO, THE BOARD CHAIRPERSON. (4) AN INDIVIDUAL WITH A POTENTIAL CONFLICT OF INTEREST SHALL NOT PROCEED TO MAKE ANY DECISION OR TAKE ANY ACTION ON BEHALF OF THE ORGANIZATION WITHOUT APPROVAL OF THE BOARD OF TRUSTEES. (5) HOM EMPLOYEES ARE PRECLUDED FROM ENGAGING IN ACTIVITIES WITH ANY "VENDOR OR SUPPLIER BUSINESS" (AS THAT TERM IS DEFINED IN THE POLICY) THAT DOES OR SEEKS BUSINESS WITH HOM WHICH MAY RESULT IN A PERSONAL BENEFIT TO THE EMPLOYEE AT THE EXPENSE OF HOM OR MAY INFLUENCE THE EMPLOYEE'S DECISIONS ON MATTERS INVOLVING HOM AND A VENDOR OR SUPPLIER BUSINESS.
Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES MEETS ANNUALLY IN MARCH TO REVIEW AND APPROVE AS APPROPRIATE, FUNDS TO BE ALLOCATED FOR TOTAL COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO, INCLUDING BASE SALARY, BONUS, CAR ALLOWANCE, AND OTHER BENEFITS. THE EXECUTIVE COMMITTEE ALSO DETERMINES IF THE PRESIDENT/CEO'S CONTRACT NEEDS TO BE UPDATED OR RENEWED AT THIS TIME. MINUTES ARE TAKEN UP UNTIL THE POINT WHERE DISCUSSION OF COMPENSATION TAKES PLACE AND VOTE/DECISION IS MADE IN REGARDS TO COMPENSATION. THE CEO AND EXECUTIVE ASSISTANT ARE EXCUSED FROM THE MEETING AT THIS POINT WHILE DISCUSSION AND DECISION IS MADE. IN ADDITION, IN 2012 AN EXTERNAL COMPENSATION STUDY WAS PERFORMED TO ASSESS EXECUTIVE COMPENSATION; THIS EXTERNAL COMPENSATION STUDY IS PLANNED TO BE PERFORMED ANNUALLY. THE COMPENSATION STUDY AIMS TO PRICE POSITIONS AT MARKET BY USING LOCAL, NATIONAL, AND INDUSTRY SPECIFIC SURVEY DATA. AN OUTSIDE CONSULTANT IS ENGAGED THROUGH AN AFFILIATION WITH AMERICAN SOCIETY OF EMPLOYERS (ASE). MARKET DATA WAS GATHERED THROUGH CRAINS TOP NON-PROFIT SURVEY, ASE NATIONAL EXECUTIVE COMPENSATION SURVEY, NATIONALLY COMPARED 990'S OF THE 37 LARGEST HOSPICE'S, AS WELL AS THE TOP 32 HOSPITALS WITH REVENUE $150 MILLION OR LESS. TWO OPTIONS ARE PRESENTED TO THE EXECUTIVE COMMITTEE BASED ON THE MARKET DATA THAT WAS GATHERED.
PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES FORM 990, PART VI, LINE 15B THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES MEETS ANNUALLY IN MARCH TO REVIEW AND APPROVE AS APPROPRIATE, FUNDS TO BE ALLOCATED FOR TOTAL COMPENSATION FOR THE ORGANIZATION'S CHIEF ADMINISTRATIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, CHIEF MARKETING OFFICER AND CHIEF FUNDRAISING OFFICER, INCLUDING BASE SALARY, BONUS, CAR ALLOWANCE, AND OTHER BENEFITS. MINUTES ARE TAKEN UP UNTIL THE POINT WHERE DISCUSSION OF COMPENSATION TAKES PLACE AND VOTE/DECISION IS MADE IN REGARDS TO COMPENSATION. THE CEO AND EXECUTIVE ASSISTANT ARE EXCUSED FROM THE MEETING AT THIS POINT WHILE DISCUSSION AND DECISION IS MADE. IN ADDITION, IN 2012 AN EXTERNAL COMPENSATION STUDY WAS PERFORMED TO ASSESS EXECUTIVE COMPENSATION; THIS EXTERNAL COMPENSATION STUDY IS PLANNED TO BE PERFORMED ANNUALLY. THE COMPENSATION STUDY AIMS TO PRICE POSITIONS AT MARKET BY USING LOCAL, NATIONAL, AND INDUSTRY SPECIFIC SURVEY DATA. AN OUTSIDE CONSULTANT IS ENGAGED THROUGH AN AFFILIATION WITH AMERICAN SOCIETY OF EMPLOYERS (ASE). MARKET DATA WAS GATHERED THROUGH CRAINS TOP NON-PROFIT SURVEY, ASE NATIONAL EXECUTIVE COMPENSATION SURVEY, NATIONALLY COMPARED 990'S OF THE 37 LARGEST HOSPICE'S, AS WELL AS THE TOP 32 HOSPITALS WITH REVENUE $150 MILLION OR LESS. TWO OPTIONS ARE PRESENTED BY THE PRESIDENT/CEO TO THE EXECUTIVE COMMITTEE BASED ON THE MARKET DATA THAT WAS GATHERED.
Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 FINANCIAL STATEMENTS ARE PROVIDED ANNUALLY IN THE ANNUAL REPORT THAT IS LOCATED ON OUR EXTERNAL WEBSITE (WWW.HOM.ORG). OTHER SPECIFIC DOCUMENTS CAN BE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOSPICE OF MICHIGAN INC
 
Employer identification number

38-2255529
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) SUPPORTIVE CARE SERVICES OF MICHIGAN

400 MACK AVENUE

DETROIT,MI48201
 HOME HEALTH MI 501(C)(3) 9 HOSPICE OF MICHIGAN
 
Yes
 
(2) HOSPICE OF MICHIGAN FOUNDATION

400 MACK AVENUE

DETROIT,MI48201
 FUNDRAISING MI 501(C)(3) 11 - Type I HOSPICE OF MICHIGAN
 
Yes
 










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) SUPPORTIVE CARE SERVICES OF MICHIGAN INC

 Q 778,865 COST
(2) SUPPORTIVE CARE SERVICES OF MICHIGAN INC

 R 1,355,439 COST
(3) SUPPORTIVE CARE SERVICES OF MICHIGAN INC

 S 885,596 COST



Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID: 12000266
Software Version: v2012.1.0