2023-05-15T13:49:11-05:00 2022-06-30 941239084 ATHERTON & ASSOCIATES LLP PO BOX 4339 MODESTO CA 953524339 990 2021-07-01 942497618 HOSPICE OF SANTA CRUZ COUNTY HOSP 8314303000 940 DISC DRIVE SCOTTS VALLEY CA 95066 ADAM SHORE CFO 8314303000 2023-05-12 1 ADAM SHORE 999009999 JACQUELYN HOWELL P01327223 2095774800 X 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z ADAM SHORE 940 DISC DRIVE SCOTTS VALLEY CA 95066 19290539 0 X HOSPICESANTACRUZ.ORG X 1978 CA HOSPICE SERVICE AND SUPPORT FOR TERMINAL PATIENTS AND THEIR FAMILIES. 12 12 167 80 0 0 2825299 1268698 17943603 17950638 245920 10621 52666 60582 21067488 19290539 0 0 0 0 14446300 14699094 0 0 482662 5758196 7664671 20204496 22363765 862992 -3073226 16612272 12203092 5395377 4311272 11216895 7891820 HOSPICE SERVICE AND SUPPORT FOR TERMINAL PATIENTS AND THEIR FAMILIES. 0 0 13784098 0 17950638 992 PATIENTS AND FAMILIES RECEIVED 57,913 DAYS OF EXPERT END-OF-LIFE CARE FROM HOSPICE TEAMS OF MEDICAL DIRECTORS, NURSES, SOCIAL WORKERS, CHAPLAINS, HOSPICE AIDES, AND VOLUNTEERS. ADDITIONALLY, 2,210 INDIVIDUAL GRIEF SUPPORT SESSIONS AND 94 GROUP GRIEF SUPPORT SESSIONS WERE PROVIDED TO HOSPICE FAMILIES AND GRIEVING COMMUNITY MEMBERS OF ALL AGES. 13784098 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 86 0 167 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X ADAM SHORE 8314303000 940 DISC DRIVE SCOTTS VALLEY CA 95066 RICHARD CLARK PRESIDENT 5.00 X X 0 0 0 JULIA COWELL RN PHD VICE PRESIDENT 5.00 X X 0 0 0 CARA DESIMONE SECRETARY 1.00 X X 0 0 0 TIMOTHY ULEN TREASURER 1.00 X X 0 0 0 BETH HANSMAN DIRECTOR 1.00 X 0 0 0 DALE BISHOP MD DIRECTOR 1.00 X 0 0 0 DAVID KLUGER DIRECTOR 1.00 X 0 0 0 SHARON TAPPER MD DIRECTOR 1.00 X 0 0 0 MICHAEL ALLARD DIRECTOR 1.00 X 0 0 0 DAISY NUNEZ DIRECTOR 1.00 X 0 0 0 KATHERINE GABRIEL-COX MD DIRECTOR 1.00 X 0 0 0 SIGOLENE A ORTEGA DIRECTOR 1.00 X 0 0 0 CATHY CONWAY CHIEF EXECUTIVE OFFICER 40.00 X 271419 0 9941 ADAM SHORE CHIEF FINANCIAL OFFICER 40.00 X 230103 0 9641 KARL SEGNITZ CHIEF MEDICAL OFFICER 40.00 X 285836 0 10292 JUDITH HUMBLE CHIEF COMPLIANCE OFFICER 40.00 X 211929 0 10062 GLORIA REED CHIEF CLINICAL OFFICER 40.00 X 203236 0 12409 DIANE SYRCLE CHIEF MISSION OFFICER 40.00 X 175956 0 11983 ANGELA BROUSE ADMISSIONS NURSE 40.00 X 172082 0 7344 1550561 0 71672 39 0 1 0 ALLEN BUENO DEL BOSQUE 311 33RD AVE SANTA CRUZ CA 95062 PHYSICIAN 294194 BONNY MASTERS 634 SAN JUAN AVENUE SANTA CRUZ CA 95065 PHYSICIAN 115390 2 52925 1215773 7130 1268698 HOSPICE SERVICES 621610 17950638 17950638 17950638 6576 6576 4045 0 4045 4045 4045 0 52925 0 0 OTHER INCOME 900099 60582 60582 60582 19290539 17950638 0 71203 567668 567668 11782537 8058085 3428126 296326 1205532 784659 381851 39022 1143357 750461 363662 29234 31920 31920 184912 184912 28370 28370 1942520 1227355 698757 16408 97501 2231 94649 621 181728 3178 158125 20425 249582 249582 212277 191732 20427 118 66875 12970 27302 26603 39018 12577 26441 310558 310558 128665 128665 PATIENT RELATED 1501111 1500521 590 OTHER EXPENSE 1123483 1123483 COMPUTER & SUPPORT EXPE 620172 6973 587583 25616 BAD DEBT EXPENSE 358506 358506 587473 122450 463765 1258 22363765 13784098 8097005 482662 3261887 462169 1742989 3037138 30000 113764 2269174 1984266 61056 0 274248 303749 4698197 2328540 2815874 2369657 4724930 3287197 0 159990 1432114 485162 16612272 12203092 1962972 1181499 223569 194503 3208836 2935270 5395377 4311272 X 10495872 7170797 721023 721023 11216895 7891820 16612272 12203092 -3073226 -172324 -79525 0 X 0 1 X 1 0 X 1405711 1808791 1106587 2825299 1268698 8415086 1405711 1808791 1106587 2825299 1268698 8415086 950203 7464883 62977 97561 52065 45248 6576 264427 31122 47477 26862 8771 60582 174814 8854327 99347639 0.84310 0.83450 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 635181 62889 698070 511407 133480 9706 635181 535980 -17237 7336 511407 530022 15146 9188 535980 517009 13013 0 530022 0.00000 1.00000 0.00000 0 0 565980 565980 2658159 1233728 1424431 541874 321715 220159 370584 299904 70680 561600 473193 88407 2369657 ENDOWED AGENCY FUND HELD AT COMMUNITY FOUNDATION OF SCC 698070 F NON ENDOWED AGENCY FUND HELD AT COMMUNITY FOUNDATION OF SCC 2589127 F 3287197 SELF-INSURANCE LIABILITY 258090 PPP LOAN 2677180 2935270 X 19118215 -172324 -172324 19290539 0 19290539 22363765 0 22363765 0 22363765 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS CONSIST OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES TO SUPPORT THE ORGANIZATION'S PROGRAMS. THE ORGANIZATION HAS A POLICY OF CLASSIFYING INVESTMENT INCOME ON THE ENDOWMENT FUNDS AS TEMPORARILY RESTRICTED UNTIL SUCH TIME AS SPECIFICALLY BUDGETED FOR SPENDING AND APPROVED BY THE BOARD. PART X, LINE 2: MANAGEMENT HAS EVALUATED HOSPICE'S TAX POSITIONS AND CONCLUDED THAT HOSPICE HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. HOSPICE IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR TAX YEARS ENDING JUNE 30, 2018 AND PRIOR. FAIRWAYS FOR KIDS GOLF TOURNAMENT 52925 52925 0 52925 52925 X X X X X X 0 0 0 0 0 0 0 0 0 KARL SEGNITZ CHIEF MEDICAL OFFICER 285836 0 0 0 0 0 3350 0 6942 0 296128 0 0 0 CATHY CONWAY CHIEF EXECUTIVE OFFICER 271419 0 0 0 0 0 0 0 9941 0 281360 0 0 0 ADAM SHORE CHIEF FINANCIAL OFFICER 230103 0 0 0 0 0 2699 0 6942 0 239744 0 0 0 JUDITH HUMBLE CHIEF COMPLIANCE OFFICER 211929 0 0 0 0 0 3120 0 6942 0 221991 0 0 0 GLORIA REED CHIEF CLINICAL OFFICER 203236 0 0 0 0 0 2325 0 10084 0 215645 0 0 0 DIANE SYRCLE CHIEF MISSION OFFICER 175956 0 0 0 0 0 3742 0 8241 0 187939 0 0 0 ANGELA BROUSE ADMISSIONS NURSE 172082 0 0 0 0 0 1008 0 6336 0 179426 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS CALIFORNIA HOSPICE NETWORK, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S SOLE MEMBER IS CALIFORNIA HOSPICE NETWORK. THE ORGANIZATION ELECTS DIRECTORS, WHO ARE APPROVED BY THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S BYLAWS INCLUDE CERTAIN POWERS RESERVED BY MEMBER, WHICH INCLUDE APPOINTMENT OF THE ORGANIZATION'S DIRECTORS AND CEO, APPROVAL OF THE ANNUAL OPERATING BUDGET, AND ANY ACTION TO MERGE, DISSOLVE OR SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE CFO AND CEO REVIEW THE FORM 990 WHEN COMPLETED BY THE CPA FIRM. A COPY OF THE FORM 990 IS FURNISHED TO THE FINANCE COMMITTEE AND TO THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT HSCC'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE ORGANIZATION. OFFICERS AND DIRECTORS REVIEW AND SIGN AN ANNUAL STATEMENT INDICATING UNDERSTANDING AND ADHERENCE TO THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 MARKET DATA ON SALARIES FOR CEO AND CFO POSITIONS IN THE HEALTHCARE AND HOSPICE FIELD IS COMPILED AND REVIEWED ANNUALLY BY THE HR DIRECTOR. A REPORT CONSIDERING MARKET AND GEOGRAPHIC FACTORS WAS PRESENTED TO THE ORGANIZATION'S COMPENSATION COMMITTEE, WHICH REVIEWS AND RECOMMENDS ANY SALARY ADJUSTMENT TO THE FULL BOARD OF DIRECTORS. THE BOARD OF DIRECTORS REVIEW AND VOTE ON PROPOSED SALARY CHANGES. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, AND ANNUAL FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL RESULTS ARE PUBLISHED IN THE ORGANIZATION'S ANNUAL REPORT. CALIFORNIA HOSPICE NETWORK 66 BOVET RD SUITE 100 SAN MATEO CA 94402 834716484 TO PROVIDE HOSPICE SUPPORT, ADMIN, PROGRAMMATIC AND OTHER SUPPORT CA 501(C)(3) 509(A)(3) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0