2023-02-14T09:52:24-06:00 2021-12-31 592922169 SALTMARSH CLEAVELAND AND GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2021-01-01 465132177 COVENANT HEALTH AND COMMUNITY SERVICES INC COVE 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 ROLAND CLENEAY CFO 8504332155 2023-02-10 1 ROLAND CLENEAY 999009999 ALLISON JONES CPA P02434475 8504358300 2023-02-10 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z COVENANT CARE JEFF MISLEVY 5041 N 12TH AVE PENSACOLA FL 32504 23118935 0 X WWW.CHOOSECOVENANT.ORG X 2014 FL COVENANT HEALTH AND COMMUNITY SERVICES, INC. WAS FORMED TO ACT AS THE PARENT (SEE SCHEDULE O) (CONTINUATION FROM PART I, LINE 1) CORPORATION OF COVENANT HOSPICE AND ITS AFFILIATES. 11 9 685 0 0 0 2474678 281509 17831033 22677525 175 0 46183 159901 20352069 23118935 0 0 0 0 23047865 29274859 0 0 0 -1133695 298744 21914170 29573603 -1562101 -6454668 22995823 26538010 25728669 35725524 -2732846 -9187514 X COVENANT HEALTH AND COMMUNITY SERVICES, INC. WAS FORMED TO ACT AS THE PARENT CORPORATION OF THE FOUR CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, COVENANT HOSPICE, INC., COVENANT HOSPICE FOUNDATION, INC., ALZHEIMERS FAMILY SERVICES, INC., (SEE SCHEDULE O) (CONTINUATION FROM PART III, LINE 1) AND COVENANT AT HOME, INC. AS WELL AS COVENANT PALLIATIVE CARE SERVICES, LLC AND COVENANT HOME HEALTH HOLDING, LLC. 0 0 12868356 21567941 HOME HEALTH CARE SERVICES - COVENANT CARE IS MAKING A GREATER PROMISE, OFFERING ADDITIONAL SKILLED, HOME-BASED MEDICAL SERVICES AND THERAPIES FOR THOSE:I.RECOVERING FROM SURGERYII.RECOVERING FROM AN ACCIDENT OR INJURYIII.DEALING WITH A SERIOUS ILLNESS OR DISABILITY 1548241 1109584 PALLIATIVE CARE SERVICES - COVENANT CARE'S PALLIATIVE CARE SERVICES CAN ASSIST PATIENT WHO NEED RELIEF FROM PAIN AND ALLEVIATE DISTRESSING SYMPTOMS. PALLIATIVE CARE CAN BE OFFERED ANY TIME DURING DIAGNOSIS AND TREATMENT OF MANY LONG-TERM CONDITIONS. OUR FOCUS IS TO RELIEVE THE PHYSICAL, SOCIAL, EMOTIONAL AND SPIRITUAL SUFFERING THAT OFTEN ACCOMPANIES A CHRONIC OR COMPLEX ILLNESS. 0 0 COVENANT HEALTH AND COMMUNITY SERVICES, INC. WAS FORMED TO ACT AS THE PARENT CORPORATION OF THE FOUR CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, COVENANT HOSPICE, INC., COVENANT HOSPICE FOUNDATION, INC., ALZHEIMERS FAMILY SERVICES, INC., AND COVENANT AT HOME, INC. AS WELL AS THE TWO DISREGARDED ENTITES COVENANT PALLIATIVE CARE SERVICES, LLC, AND COVENANT HOME HEALTH HOLDINGS, LLC. COVENANT HOME HEALTH HOLDINGS, LLC IS THE SINGLE MEMBER OF COVENANT HOME HEALTH CARE, LLC, COVENANT HOME HEALTH CARE 3, LLC, COVENANT HOME HEALTH CARE 4, LLC, COVENANT HOME HEALTH CARE 5, LLC, COVENANT HOME HEALTH CARE 6, LLC, COVENANT HOME HEALTH CARE 7, LLC, COVENANT HOME HEALTH CARE 8, LLC, COVENANT HOME HEALTH CARE 9, LLC, COVENANT HOME HEALTH CARE 10, LLC AND COVENANT HOME HEALTH CARE 11, LLC. 14416597 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 21 0 685 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X ROLAND CLENEAY 8504322155 5401 N 12TH AVE PENSACOLA FL 32504 JEFF MISLEVY PRESIDENT/CEO 4.00 52.00 X X 833778 0 39643 ODIN BERG TREASURER, CSO 4.00 52.00 X X 290860 0 26014 RODNEY GUTTMANN CHAIRMAN 4.00 4.00 X X 0 0 0 TOM OWENS PAST CHAIR 4.00 4.00 X X 0 0 0 BRETT PARRA SECRETARY 4.00 4.00 X X 0 0 0 JAMES JAMIE CAMPBELL DIRECTOR 4.00 4.00 X 0 0 0 KENT SKOLROOD DIRECTOR 4.00 4.00 X 0 0 0 MILLER CALDWELL BOARD MEMBER 4.00 4.00 X 0 0 0 DON HAFERKAMP BOARD MEMBER 4.00 4.00 X 0 0 0 PETER JENNINGS BOARD MEMBER 4.00 4.00 X 0 0 0 STEVEN SATTOS BOARD MEMBER 4.00 4.00 X 0 0 0 TODD FISHER COO 4.00 52.00 X 369369 0 37011 ROLAND CLENEAY CFO 4.00 52.00 X 144361 0 17738 AARON WEST VP ADVANCEMENT 40.00 X 303977 0 33439 CHRISTIAN DEJESUS ASSOCIATE VP OF REV. 40.00 X 254523 0 27377 CHRISTINE PERRY ASSOCIATE VP OF HOME HEALTH 40.00 X 306680 0 26160 ADAM REED VP ORGANIZATIONAL ENG. 40.00 X 261843 0 27908 MICHAEL VALERIO VP ADVANCEMENT 40.00 X 235313 0 6106 3000704 0 241396 30 0 1 0 SMART HEALTHCARE COMPLIANCE RESOURCES 3013 WORSHAM SPRINGS RD SPRINGFIELD TN 37172 CLINICAL ASSESSMENTS 711040 MEDLINE INDUSTRIES THREE LAKES DRIVE NORTHFIELD IL 60093 MEDICAL SUPPLIES 553876 CMG CIT ACQUISITION LLC 655 SOUTH WILLOW ST SUITE 128 MANCHESTER NH 03103 CONTRACT LABOR 136726 3 193501 88008 281509 HOME HEALTH CARE SERVICES 621610 21567941 21567941 PALLATIVE CARE SERVICES 623990 1109584 1109584 22677525 MSA REVENUE - CV BUILD OUT 990009 159901 159901 159901 23118935 22677525 0 159901 1638368 701733 936635 23431546 10036017 13395529 38833 25780 13053 2389458 1028570 1360888 1776654 807279 969375 801369 801369 87300 87300 1858499 1858499 1054600 1054600 1474952 1474952 1187473 1187473 893848 893848 1189943 657929 532014 9075 128 8947 137230 137230 216851 216851 78844 78844 MEDICAL SUPPLIES 652331 652331 CONTRACT CARE 334932 334932 CONTRACT LABOR 232257 171898 60359 RECRUITMENT/RETENTION 99818 99818 -10010578 -10010578 29573603 14416597 15157006 0 3870945 320164 6504 5005 8010493 14778476 317904 775121 1042268 518728 576140 523540 9448350 10098350 765487 37354 22995823 26538010 5974326 4712282 7550000 7618407 12204343 23394835 25728669 35725524 X -2732846 -9187514 -2732846 -9187514 22995823 26538010 -6454668 0 X 0 1 X 1 0 X 2474678 281509 2756187 13370990 14042911 14082578 17831033 22677525 82005037 13370990 14042911 14082578 20305711 22959034 84761224 0 0 0 84761224 1541 3323 4480 175 0 9519 1541 3323 4480 175 9519 46183 159901 206084 13372531 14046234 14087058 20352069 23118935 84976827 0.99750 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 356240 177298 178942 686028 341430 344598 523540 DUE TO COVENANT HOSPICE, INC. 24376133 DUE TO CHAH -114032 DUE TO FOUNDATION 17467 DUE TO COVENANT ALZHEIMER'S SERVICE -54426 DUE TO MEMORY CARE CLINIC -830307 23394835 X 89356294 70783420 70783420 18572874 4546061 4546061 23118935 86378939 56805336 56805336 29573603 0 29573603 PART X, LINE 2: CHCS, HOSPICE, THE FOUNDATION, AFS, CAH AND CPCS ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PART XI, LINE 2D - OTHER ADJUSTMENTS: INCOME REPORTED BY COVENANT HOSPICE, INC. EIN 59-2208300 63,052,639. INCOME REPORTED BY ALZHEIMER'S FAMILY SERVICES, INC. EIN 59-3394242 1,801,200. INCOME REPORTED BY COVENANT AT HOME, INC. EIN 35-2543765 INCOME REPORTED BY COVENANT HOSPICE FOUNDATION, INC. EIN 59-3060139 1,803,652. ELIMINATION 4,125,929. PART XI, LINE 4B - OTHER ADJUSTMENTS: EQUITY LOSS IN SUBSIDIARIES 4,546,061. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES REPORTED BY COVENANT HOSPICE FOUNDATION, INC. EIN 59-3060139 1,252,597. EXPENSES REPORTED BY COVENANT HOSPICE EIN 59-2208300 53,876,079. EXPENSES REPORTED BY COVENANT AT HOME, INC. EIN 35-2543765 EXPENSES REPORTED BY ALZHEIMER'S FAMILY SERVICES, INC. EIN 59-3394242 2,096,792. ELIMINATION -420,132. X 0 1 X X X 0 0 0 0 0 0 0 0 0 JEFF MISLEVY PRESIDENT/CEO 416242 0 390889 0 26647 0 19500 0 20143 0 873421 0 0 0 TODD FISHER COO 274942 0 78851 0 15576 0 18702 0 18309 0 406380 0 0 0 AARON WEST VP ADVANCEMENT 244262 0 59715 0 0 0 15166 0 18273 0 337416 0 0 0 CHRISTINE PERRY ASSOCIATE VP OF HOME HEALTH 213187 0 93493 0 0 0 14674 0 11486 0 332840 0 0 0 ODIN BERG TREASURER, CSO 210838 0 58388 0 21634 0 13951 0 12063 0 316874 0 0 0 ADAM REED VP ORGANIZATIONAL ENG. 200443 0 49862 0 11538 0 13062 0 14846 0 289751 0 0 0 CHRISTIAN DEJESUS ASSOCIATE VP OF REV. 204701 0 49822 0 0 0 12368 0 15009 0 281900 0 0 0 MICHAEL VALERIO VP ADVANCEMENT 235313 0 0 0 0 0 0 0 6106 0 241419 0 0 0 ROLAND CLENEAY CFO 93537 0 50824 0 0 0 14000 0 3738 0 162099 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY STAFF WITH THE ASSISTANCE OF AND REVIEW BY AN INDEPENDENT ACCOUNTING FIRM BEFORE IT IS SIGNED AND SUBMITTED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SENT ANNUALLY TO MEMBERS OF THE BOARD OF DIRECTORS, AND ALL KEY STAFF MEMBERS REPORTABLE ON THE FORM 990. THE FORMS ARE REVIEWED FOR RESPONSES INDICATING A POSSIBLE CONFLICT OF INTEREST. IN ADDITION, THE DIRECTOR OF ACCOUNTING REVIEWS TRANSACTIONS WITH VENDORS WITH WHICH THE BOARD MAY BE AFFILIATED TO DETERMINE THAT ALL TRANSACTIONS ARE MADE AT ARM'S LENGTH. IF A POSSIBLE CONFLICT IS IDENTIFIED, THE PERSON WITH A CONFLICT IS PROHIBITED FROM PARTICIPATING IN THE BOARD OF DIRECTORS DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 TO DETERMINE THE CEO'S, OTHER OFFICERS', AND OTHER EMPLOYEES' COMPENSATION, COVENANT HEALTH AND COMMUNITY SERVICES, INC. PROCURES SALARY COMPARABILITY DATA AND HIRES AN INDEPENDENT FIRM TO DO A SALARY COMPARISON FOR ALL SENIOR ADMINISTRATIVE STAFF. THE SALARY COMPARISON WITH THE INDEPENDENT FIRM IS UNDERTAKEN ANNUALLY. THE CEO'S COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD WITH INSIGHT GIVEN FROM THE SALARY COMPARISON OF THE INDEPENDENT FIRM. THIS PROCESS IS DONE ANNUALLY AND IS DOCUMENTED. THE PROCESS WAS LAST PERFORMED IN 2018. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE ON WRITTEN REQUEST. COVENANT HOME HEALTH HOLDINGS LLC 5401 N 12TH AVE PENSACOLA FL 32504 811010716 SINGLE MEMBER OF COVENANT HOME HEALTH CARE, LLC FL 159901 13258795 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT PALLIATIVE CARE SERVICES LLC 5401 N 12TH AVE PENSACOLA FL 32504 464822066 PALLIATIVE SERVICES FL 1303085 1232186 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE LLC 5401 N 12TH AVE PENSACOLA FL 32504 262335536 HOME HEALTH CARE SERVICE FL 18292224 11352538 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 3 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841850981 HOME HEALTH CARE SERVICE FL 656212 581510 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 4 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841866523 HOME HEALTH CARE SERVICE FL 376335 336550 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 5 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841803949 HOME HEALTH CARE SERVICE FL 701696 658396 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 6 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841790239 HOME HEALTH CARE SERVICE FL 388744 558867 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 7 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841811553 HOME HEALTH CARE SERVICE FL 544193 469543 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 8 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841838540 HOME HEALTH CARE SERVICE FL 222543 239498 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 9 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841875410 HOME HEALTH CARE SERVICE FL 147621 154319 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 10 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841895925 HOME HEALTH CARE SERVICE FL 291599 269981 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE 11 LLC 5401 N 12TH AVE PENSACOLA FL 32504 841916945 HOME HEALTH CARE SERVICE FL 34782 78286 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOSPICE INC 5041 N 12TH AVE PENSACOLA FL 32504 592208300 PROVIDES CARE TO TERMINALLY ILL PATIENTS FL 501(C)(3) LINE 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 COVENANT HOSPICE FOUNDATION INC 5041 N 12TH AVE PENSACOLA FL 32504 593060139 FUNDRAISING FL 501(C)(3) LINE 12A, I COVENANT HEALTH AND COMMUNITY SERVICES INC 1 ALZHEIMERS FAMILY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 593394242 SUPPORT TO ALZHEIMERS PATIENTS AND FAMILIES FL 501(C)(3) LINE 7 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 COVENANT AT HOME INC 5041 N 12TH AVE PENSACOLA FL 32504 322543765 HOME HEALTH CARE FL 501(C)(3) LINE 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 0 0 1 1 1 0 0 0 0 0 1 0 1 1 1 0 0 0 0 COVENANT ALZHEIMER'S SERVICES E 18755 FMV COVENANT ALZHEIMER'S SERVICES D 903488 FMV COVENANT ALZHEIMER'S SERVICES O 297803 FMV COVENANT AT HOME INC D 114032 FMV COVENANT HOSPICE FOUNDATION INC C 193501 FMV COVENANT HOSPICE FOUNDATION INC O 349104 FMV COVENANT HOSPICE FOUNDATION INC E 17467 FMV COVENANT HOSPICE INC O 9368916 FMV COVENANT HOSPICE INC K 150024 FMV COVENANT HOSPICE INC E 24376133 FMV