2023-08-14T14:22:05-05:00 2022-09-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2021-10-01 591940256 COMMUNITY HOSPICE OF NORTHEAST FLORIDA COMM 9042685200 4266 SUNBEAM RD JACKSONVILLE FL 32257 SUSAN PONDER-STANSEL PRESIDENT & CEO ALIVIA CARE 9042685200 2023-08-14 1 SUSAN PONDER-STANSEL 999009999 AMY BIBBY P00445891 8282542254 2023-08-14 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z SEE SCH O DISCLOSURE SUSAN PONDER-STANSEL 4266 SUNBEAM RD JACKSONVILLE FL 32257 115309579 0 X WWW.COMMUNITYHOSPICE.COM X 1984 FL ADVANCING PHILANTHROPY TO ENABLE COMMUNITY HOSPICE OF NORTHEAST FLORIDA TO FULFILL ITS MISSION AND VISION OF CARE, RESEARCH AND EDUCATION. 25 25 1019 231 0 0 1938853 1186800 113711376 111923024 2360151 1550354 842995 649401 118853375 115309579 291 132 0 0 64582857 65723605 0 0 0 47316727 49909352 111899875 115633089 6953500 -323510 107746508 97103089 14923961 11163710 92822547 85939379 X ADVANCING PHILANTHROPY TO ENABLE COMMUNITY HOSPICE OF NORTHEAST FLORIDA TO FULFILL ITS MISSION AND VISION OF CARE, RESEARCH AND EDUCATION. 0 0 77572182 93909354 HOSPICE HOMECARE ESTABLISHED IN 1979, COMMUNITY HOSPICE & PALLIATIVE CARE IS AN INNOVATIVE NATIONAL LEADER IN PALLIATIVE AND HOSPICE CARE, PROVIDING PROGRAMS AND SERVICES TO MEET THE DIVERSE NEEDS OF THE COMMUNITIES IT SERVES. DURING ITS 44-YEAR HISTORY, THE JACKSONVILLE, FLORIDA-BASED NONPROFIT ORGANIZATION HAS SERVED APPROXIMATELY 144,423 ADULTS AND CHILDREN IN BAKER, CLAY, DUVAL, NASSAU AND ST. JOHNS COUNTIES, AS WELL AS 11 COUNTIES IN NORTH CENTRAL FLORIDA. DURING FISCAL YEAR 2022, THE ORGANIZATION HELPED 7349 PATIENTS AND THEIR FAMILIES LIVE BETTER WITH ADVANCED ILLNESS THROUGH HOSPICE CARE AND SUPPORT PROGRAMS. MOST OF THIS CARE IS PROVIDED IN THE HOME SETTING, INCLUDING PRIVATE RESIDENCES, NURSING HOMES AND ASSISTED LIVING COMMUNITIES. COMMUNITY HOSPICE & PALLIATIVE CARE ENSURES PATIENTS' COMFORT BY ADDRESSING THEIR PHYSICAL, EMOTIONAL, AND SPIRITUAL NEEDS THROUGH INTERDISCIPLINARY CLINICAL CARE TEAMS, WHOSE MEMBERS MAKE UP MORE THAN HALF OF THE ORGANIZATION'S 821 EMPLOYEES, ALONG WITH THE SERVICES OF APPROXIMATELY 812 VOLUNTEERS. THE ORGANIZATION ALSO ASSISTS FAMILY CAREGIVERS THROUGH EDUCATION, ACCESS TO COMMUNITY RESOURCES AND BEREAVEMENT SUPPORT FOR UP TO 13 MONTHS AFTER A LOSS.THE COMMUNITY HOSPICE & PALLIATIVE CARE MISSION IS TO IMPROVE THE QUALITY OF LIFE FOR PATIENTS AND THEIR FAMILIES AND TO BE THE COMPASSIONATE GUIDE FOR END-OF-LIFE CARE IN OUR COMMUNITY. OUR GOAL IS TO PROVIDE COMFORT AND ADDRESS SYMPTOMS FROM LIFE-LIMITING CONDITIONS, AS WELL AS PROVIDE SUPPORTIVE CARE TO FAMILY MEMBERS AND OTHER LOVED ONES. THE ORGANIZATION FOCUSES ON ENHANCING THE QUALITY OF LIFE WHILE RESPECTING PATIENTS' CULTURAL BELIEFS AND VALUES. NO ONE IS EVER DENIED CARE DUE TO AN INABILITY TO PAY.COMMUNITY HOSPICE & PALLIATIVE CARE SUPPORT INCLUDES: IN-HOME NURSING; PHYSICIAN SERVICES; PSYCHOSOCIAL SERVICES; SPIRITUAL SUPPORT; CERTIFIED NURSING ASSISTANT (CNA); MEDICAL EQUIPMENT (SUCH AS WHEELCHAIRS, BEDS AND WALKERS); MEDICAL SUPPLIES (SUCH AS BANDAGES AND CATHETERS); DRUGS FOR SYMPTOM MANAGEMENT AND/OR PAIN RELIEF; BEREAVEMENT COUNSELING AND SUPPORT; PHYSICAL AND OCCUPATIONAL THERAPY; SPEECH, MUSIC, MASSAGE AND/OR PET THERAPY; AND DIETARY COUNSELING. THE ORGANIZATION ALSO OFFERS INPATIENT CARE, SHORT-TERM RESPITE CARE, VETERAN- AND CAREGIVER-FOCUSED SERVICES, AND SPECIALIZED CARE FOR THOSE OF THE JEWISH FAITH, CHILDREN'S PROGRAMS AND ADVANCE CARE PLANNING.A DEDICATED, INTERDISCIPLINARY TEAM OF PROFESSIONALS WORKS WITH PATIENTS TO HELP MANAGE THE PAIN AND SYMPTOMS ASSOCIATED WITH A LIFE-LIMITING ILLNESS, AND PROVIDES PERSONAL, RESPECTFUL CARE AND ASSISTANCE. THE ORGANIZATION HELPS EDUCATE PATIENTS AND THEIR CAREGIVERS ABOUT THE ILLNESS THEY HAVE AND WHAT TO EXPECT AS THE ILLNESS PROGRESSES, AND ABOUT MEDICINES AND THERAPIES TO HELP MANAGE PATIENT COMFORT. ON-CALL SERVICES ARE AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK. IN FISCAL YEAR 2022, OUR HOMECARE TEAMS PROVIDED 443,178 ROUTINE DAYS OF CARE. 16692748 18200797 HOSPICE INPATIENT CARE INPATIENT CARE, IF NEEDED, IS AVAILABLE IN ONE OF OUR TEN INPATIENT CENTERS, CALLED CENTERS FOR CARING. THESE FACILITIES ARE AVAILABLE FOR PATIENTS WHO NEED PAIN AND SYMPTOM MANAGEMENT AT AN ACUTE LEVEL UNAVAILABLE IN A HOMECARE SETTING. THE PATIENT STAYS UNTIL HIS/HER CONDITION AND SYMPTOMS ARE STABILIZED, TYPICALLY THREE TO FIVE DAYS OR LESS. OUR FACILITIES OFFER HOMELIKE SURROUNDINGS WITH GARDENS AND SERENE SETTINGS. IN FISCAL YEAR 2022, OUR STAFF PROVIDED 18,766 DAYS OF GENERAL INPATIENT CARE (GIP). 3436742 132 PALLIATIVE CARE ESTABLISHED IN 2010, COMMUNITY PALLIATIVE CONSULTANTS PROVIDES PALLIATIVE CONSULTATIVE SERVICES THROUGH TWELVE LOCAL HOSPITALS OR WHEREVER THE PATIENT CALLS HOME. AT THE REQUEST OF THE PATIENT'S ATTENDING PHYSICIAN, SPECIALLY TRAINED PHYSICIANS, AND ADVANCED PRACTICE REGISTERED NURSES (APRNS) TAKE THE TIME TO UNDERSTAND EACH INDIVIDUAL SITUATION AND THEN RECOMMEND OPTIONS TO MEET THE PATIENT'S PERSONAL GOALS OF CARE. COMMUNITY PALLIATIVE CONSULTANTS ALSO PROVIDES EDUCATION AND TRAINING OF HOSPITAL/FACILITY STAFF. PALLIATIVE CARE PROVIDES AN EXTRA LAYER OF SUPPORT FOR PATIENTS AND THEIR FAMILIES THROUGH A MULTIDISCIPLINARY TEAM FOCUSED ON PROVIDING RELIEF FROM THE SYMPTOMS, PAIN, AND STRESS ASSOCIATED WITH A SERIOUS ILLNESS OR COMPLEX CHRONIC CONDITION. IN FISCAL YEAR 2022, OUR PALLIATIVE CARE TEAM SAW 12,060 PATIENTS. 490964 SPECIALIZED CARE FOR CHILDREN SINCE 2000, COMMUNITY HOSPICE & PALLIATIVE CARE HAS PROVIDED PALLIATIVE AND HOSPICE CARE AND SUPPORT FOR CHILDREN LIVING WITH LIFE-LIMITING AND LIFE-THREATENING CONDITIONS THROUGH COMMUNITY PEDSCARE, AN AWARD-WINNING PEDIATRIC CARE PROGRAM IN COLLABORATION WITH WOLFSON CHILDREN'S HOSPITAL, NEMOURS CHILDREN'S SPECIALTY CARE AND THE UNIVERSITY OF FLORIDA-JACKSONVILLE. THE PROGRAM, ONE OF ONLY A FEW COMMUNITY PEDIATRIC PROGRAMS IN THE UNITED STATES OFFERING BOTH PALLIATIVE AND HOSPICE CARE, PROVIDES CLINICAL, SOCIAL SERVICE, SPIRITUAL, CHILD LIFE, MEDICAL AND VOLUNTEER SUPPORT TO IMPROVE QUALITY OF LIFE FOR CHILDREN FROM PRENATAL TO AGE 21. TO DATE, THE PROGRAM HAS SERVED NEARLY 2,000 PATIENTS WITH AN AVERAGE DAILY CENSUS IN FISCAL YEAR 2022 OF 353 PATIENTS.ADVANCE CARE PLANNING HONORING CHOICES FLORIDA IS A COMMUNITY COLLABORATIVE ADVANCE CARE PLANNING INITIATIVE OF COMMUNITY HOSPICE & PALLIATIVE CARE. THE PROGRAM LAUNCHED IN 2014 AND IS BASED ON A MODEL FROM RESPECTING CHOICES, A PIONEERING ACP PROGRAM IMPLEMENTING THROUGHOUT THE UNITED STATES, CANADA AND MANY COUNTRIES IN EUROPE AND ASIA. HONORING CHOICES FLORIDA IS DESIGNED TO SUSTAIN AN INTEGRATED, COMMUNITY-WIDE SYSTEM TO ENSURE PATIENTS' FUTURE HEALTH CARE PREFERENCES ARE DISCUSSED, DOCUMENTED, AND HONORED. THE PROGRAM ENGAGES INDIVIDUALS THROUGH HEALTH CARE FACILITIES AND COMMUNITY-BASED VENUES THROUGH A SPECIALIZED ADVANCE CARE PLANNING DOCUMENT AND OFFERS TRAINED FACILITATORSMORE THAN 590 TO DATETO GUIDE INDIVIDUALS AND FAMILIES THROUGH THE PROCESS OF DISCUSSING AND DOCUMENTING THEIR HEALTH CARE WISHES. IN FISCAL YEAR 2022, FACILITATORS GUIDED OVER 7,074 CONVERSATIONS AND HELPED 6,111 INDIVIDUALS DOCUMENT THEIR WISHES. PROGRAM STAFF PRESENTED ON ADVANCE CARE PLANNING IN 135 VENUES REACHING OVER 2,471 INDIVIDUALS AND RESPONDED TO ANOTHER 850 INDIVIDUAL INQUIRIES THROUGH THE WEBSITE AND DESIGNATED PHONE LINE.BEREAVEMENT SERVICES AND COMMUNITY GRIEF SUPPORT COMMUNITY HOSPICE & PALLIATIVE CARE OFFERS A VARIETY OF GRIEF AND LOSS SUPPORT SERVICES FOR THOSE WHO HAVE EXPERIENCED THE DEATH OF A LOVED ONE. THESE SERVICES PROVIDE SUPPORT OR GUIDANCE FOR DEALING WITH THE LOSS AND SORROW. SERVICES ARE AVAILABLE NOT ONLY TO SURVIVORS OF PATIENTS IN OUR HOSPICE CARE PROGRAM BUT TO ANYONE IN THE COMMUNITY WHO REQUESTS THEM. SERVICES INCLUDE BEREAVEMENT SUPPORT GROUPS HELD AT MANY LOCATIONS, UNDERSTANDING GRIEF (A PROGRAM FOR THE NEWLY BEREAVED), AN ANNUAL CANDLELIGHT SERVICE OF REMEMBRANCE, GRIEF CAMP FOR KIDS (CAMP HEALING POWERS) AND A PROGRAM TO COPE WITH GRIEF DURING THE HOLIDAY SEASON (NOVEMBER AND DECEMBER). HOSPICE PATIENTS' FAMILY MEMBERS MAY ALSO RECEIVE INDIVIDUAL AND FAMILY COUNSELING (INCLUDING CHILDREN AND TEENS). WE SEND LETTERS TO THE BEREAVED DURING THE YEAR AFTER THE DEATH, THESE INCLUDE HELPFUL HINTS AND INVITATIONS TO OUR SUPPORT ACTIVITIES. IN FISCAL YEAR 2022, 10,078 FOUND HOPE AND HEALING THROUGH BEREAVEMENT SERVICES WITH AN ADDITIONAL 2,317 COMMUNITY GRIEF SESSIONS SERVING AREA RESIDENTS.OUTREACH TO FAMILY CAREGIVERS AND MILITARY/VETERAN COMMUNITIES THE COMMUNITY HOSPICE VETERANS PARTNERSHIP (CHVP) RAISES AWARENESS AS WELL AS FUNDS FOR PINS AND FLAGS TO HONOR VETERANS IN THE CARE OF COMMUNITY HOSPICE & PALLIATIVE CARE, A WE HONOR VETERANS LEVEL III PROVIDER. IN FISCAL YEAR 2022, COMMUNITY HOSPICE & PALLIATIVE CARE PROVIDED HOSPICE SERVICES TO 1,442 VETERANS FROM ALL BRANCHES OF SERVICES THROUGHOUT THE ORGANIZATION'S 16-COUNTY REGION.VOLUNTEERSTHE NEARLY 812 COMMUNITY HOSPICE & PALLIATIVE CARE VOLUNTEERS ARE VITAL MEMBERS OF OUR TEAM. WHETHER OFFERING COMPANIONSHIP AND A LISTENING EAR TO PATIENTS AND FAMILY MEMBERS, HELPING WITH CLERICAL WORK AT ONE OF OUR OFFICE LOCATIONS, ASSISTING AT FUNDRAISING EVENTS OR GREETING GUESTS AT ONE OF OUR FRONT DESK LOCATIONS, THERE'S A VOLUNTEER OPPORTUNITY FOR EVERYONE. FOUNDATION THE COMMUNITY HOSPICE & PALLIATIVE CARE FOUNDATION IS DEDICATED TO ENABLING COMMUNITY HOSPICE & PALLIATIVE CARE TO FULFILL ITS MISSION AND VISION. FUNDS RAISED THROUGH THE FOUNDATION ENHANCE THE QUALITY OF LIFE FOR PATIENTS AND FAMILIES AND SUPPORT UNFUNDED AND UNDER-FUNDED PATIENT CARE, OUTREACH PROGRAMS, AND SERVICES FOR THOSE FACING ADVANCED ILLNESS AND GRIEF. DONOR SUPPORT PROVIDES COMMUNITY PROGRAMS AND COMPASSIONATE CARE TO ALL WHO NEED IT, REGARDLESS OF ABILITY TO PAY. 490964 98192636 1 1 0 1 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 0 0 0 1 177 0 1 1019 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 25 25 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 FL X X ANDREA FRITZ 9042685200 4266 SUNBEAM ROAD JACKSONVILLE FL 32257 SUSAN PONDER-STANSEL PRES. & CEO ALIVIA CARE, INC. 37.00 3.00 X X 0 738407 43988 KEVIN ROBBINS CHAIR 2.00 X X 0 0 0 ANN HARWOOD-NUSS MD VICE CHAIR 2.00 X X 0 0 0 TRACY ARTHUR SECRETARY 2.00 X X 0 0 0 CHRISTOPHER EMANS TREASURER 2.00 X X 0 0 0 JASON W OSBORNE EX-OFFICIO 2.00 X 0 0 0 KATHERINE BATENHORST BOARD MEMBER 1.00 X 0 0 0 JANE BOLES BOARD MEMBER 1.00 X 0 0 0 GERARDO COLON-OTERO MD BOARD MEMBER 1.00 X 0 0 0 JON COOPER BOARD MEMBER 1.00 X 0 0 0 NANCY L DAWSON MD BOARD MEMBER 1.00 X 0 0 0 CARLTON DEVOOGHT BOARD MEMBER 1.00 X 0 0 0 LT COLONEL BILL DUDLEY RET BOARD MEMBER 1.00 X 0 0 0 SENATOR AUDREY GIBSON BOARD MEMBER 1.00 X 0 0 0 MARIE GNAGE PHD BOARD MEMBER 1.00 X 0 0 0 RICHARD W RICK HAWTHORNE BOARD MEMBER 1.00 X 0 0 0 PATRICE JONES DNP RN NE-BC BOARD MEMBER 1.00 X 0 0 0 T FITCH KING III BOARD MEMBER 1.00 X 0 0 0 SUE LEGER-KRALL ARNP PHD BOARD MEMBER 1.00 X 0 0 0 JOHN D LOGUE CFP BOARD MEMBER 1.00 X 0 0 0 MICHAEL A MAYO DHA BOARD MEMBER 1.00 X 0 0 0 GREG MILLER MBA BOARD MEMBER 1.00 X 0 0 0 JOSEPH M MITRICK FACHE BOARD MEMBER 1.00 X 0 0 0 DR JUDY SAYRE BOARD MEMBER 1.00 X 0 0 0 GREGORY DIXON CFO ALIVIA CARE (THROUGH 4/22/22) 40.00 X 0 411030 26301 PHILLIP WARD PRES. & CEO COMMUNITY HOSPICE OF NORTHEAST FLO 38.00 2.00 X 0 471986 35901 MARY MCELROY SR. VP OF HOSPICE SERVICES 40.00 X 269238 0 23610 ANA SANCHEZ CHIEF MEDICAL DIRECTOR 40.00 X 399271 0 31014 JENNIFER CONTIN SR MEDICAL DIRECTOR 40.00 X 278237 0 22678 JAMES BOMHARD SR MEDICAL DIRECTOR 40.00 X 267981 0 12353 MARIA TIOMICO MEDICAL DIRECTOR 40.00 X 262866 0 17353 REUBEN SMITH SR MEDICAL DIRECTOR 40.00 X 262619 0 21515 CARLOS BOSQUE FORMER CHIEF FINANCIAL OFFICER 0.00 X 174814 0 0 1915026 1621423 234713 47 1 1 0 LIFE CARE CTR -ORANGE PARK 2145 KINGSLEY AVENUE ORANGE PARK FL 32073 NURSING HOME 1186351 TAYLOR CARE CENTER 6535 CHESTER AVENUE JACKSONVILLE FL 33217 NURSING HOME 1043368 CATHEDRAL GERONTOLOGY CENTER 333 EAST ASHLEY STREET JACKSONVILLE FL 32202 NURSING HOME 877677 AT&T MOBILITY POBOX 6463 CAROL STREAM IL 601976463 CELLULAR 597852 MOULTRIE CREEK NURSING 200 MARINER HEALTH WAY ST AUGUSTINE FL 32086 NURSING HOME 595432 56 1186800 1186800 PATIENT SERVICE REV 623000 92509841 92509841 NURSING HOME SUPPORT 623000 18200797 18200797 COVID STIMULUS REVENUE 900099 1212386 1212386 111923024 820272 820272 187127 0 187127 187127 187127 679269 50813 0 0 679269 50813 730082 730082 MISCELLANOUS REVENUE 623000 419234 419234 CAFE REVENUE 722514 43040 43040 462274 115309579 112110151 0 2012628 132 132 295514 147757 147757 54730756 40668455 14062301 1306544 1149177 157367 5980994 5303065 677929 3409797 3049738 360059 194902 194902 59703 59703 77825 77825 37373 37373 1453997 1201541 252456 417864 172408 245456 4734111 3955931 778180 1402407 1402407 3360753 3360753 1655494 1559222 96272 105575 44897 60678 344084 344084 3262157 3262157 232195 232195 ROOM AND BOARD 19344702 19344702 MEDICAL SUPPLIES EXPENS 7911233 7911233 BAD DEBT EXPENSE 3044071 3044071 CHARITY CARE EXPENSES 1513681 1513681 757225 757225 115633089 98192636 17440453 0 1653 1650 18971224 20640037 13596930 9546869 467358 567285 2906678 3469130 70870694 35409495 37266903 35461199 33308862 26664689 1044922 577374 181978 174856 107746508 97103089 9717606 6355867 34748 26168 5171607 4781675 14923961 11163710 X 92822547 85939379 92822547 85939379 107746508 97103089 -323510 -6559658 0 X X 0 1 X 1 0 X 1726451 1808647 1456171 1938853 1186799 8116921 105581580 110302269 117107727 113711376 112110151 558813103 107308031 112110916 118563898 115650229 113296950 566930024 0 0 0 566930024 1037251 791899 1121937 1360365 1007399 5318851 1037251 791899 1121937 1360365 1007399 5318851 1548363 1411888 1003514 655800 462275 5081840 109893645 114314703 120689349 117666394 114766624 577330715 0.98200 0.98060 0.00920 0.00920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3559 3559 0 PART II-B, LINE 1: THE ORGANIZATION'S INCURRED LOBBYING EXPENSES ARE RELATED TO THAT PORTION OF THE ANNUAL DUES PAID TO THE FLORIDA HOSPICE AND PALLIATIVE CARE ASSOCIATION TO SUPPORT MEMBER ADVOCACY EFFORTS. 1967544 1967544 38318352 17537088 20781264 12117718 4291340 7826378 17886796 13581067 4305729 580284 580284 35461199 DEFERRED COMPENSATION 3109042 DUE TO AFFILIATES 1672633 4781675 X 103848085 -6559658 -344022 -6903680 110751765 4557814 4557814 115309579 110731253 0 110731253 4901836 4901836 115633089 PART X, LINE 2: COMMUNITY HOSPICE OF NORTHEAST FLORIDA AND ITS AFFILIATES ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPICE FOLLOWS THE FINANCIAL ACCOUNTING STANDARDS BOARD'S AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE CONSOLIDATED FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE HOSPICE'S CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPICE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTEREST EXPENSES -344,022. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE INCLUDED IN REVENUES 1,513,681. BAD DEBT EXPENSES 3,044,133. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE INCLUDED IN REVENUES 1,513,681. BAD DEBT EXPENSES 3,044,133. INTEREST EXPENSES 344,022. 1 1 0 0 0 0 0 0 0 SUSAN PONDER-STANSEL PRES. & CEO ALIVIA CARE, INC. 0 487692 0 206215 0 44500 0 15660 0 28328 0 782395 0 0 PHILLIP WARD PRES. & CEO COMMUNITY HOSPICE OF NOR 0 330173 0 122313 0 19500 0 15660 0 20241 0 507887 0 0 GREGORY DIXON CFO ALIVIA CARE (THROUGH 4/22/22) 0 310000 0 62030 0 39000 0 1546 0 24755 0 437331 0 0 ANA SANCHEZ CHIEF MEDICAL DIRECTOR 393633 0 75 0 5563 0 8700 0 22314 0 430285 0 0 0 JENNIFER CONTIN SR MEDICAL DIRECTOR 264932 0 10275 0 3030 0 8256 0 14422 0 300915 0 0 0 MARY MCELROY SR. VP OF HOSPICE SERVICES 205133 0 46387 0 17718 0 13582 0 10028 0 292848 0 0 0 REUBEN SMITH SR MEDICAL DIRECTOR 266723 0 0 0 -4104 0 8002 0 13513 0 284134 0 0 0 JAMES BOMHARD SR MEDICAL DIRECTOR 261580 0 150 0 6251 0 7852 0 4501 0 280334 0 0 0 MARIA TIOMICO MEDICAL DIRECTOR 255866 0 375 0 6625 0 7687 0 9666 0 280219 0 0 0 CARLOS BOSQUE FORMER CHIEF FINANCIAL OFFICER 143529 0 31285 0 0 0 0 0 0 0 174814 0 0 0 PART I, LINE 3 THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO WAS UNDERTAKEN BY A RELATED ORGANIZATION. THIS PROCESS INCLUDED THE USE OF A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, FORM 990S OF OTHER ORGANIZATIONS, COMPENSATION STUDIES/SURVEY, AND THE APPROVAL BY THE BOARD/COMMITTEE. PART I, LINES 4A-B CARLOS BOSQUE RECEIVED A SEVERANCE PAYMENT DURING THE FISCAL YEAR OF $143,529. NONQUALIFIED DEFERRED COMPENSATION - CERTAIN EMPLOYEES PARTICIPATE IN A 457(F) NON-QUALIFIED DEFERRED COMPENSATION PLAN SPONSORED BY THE ORGANIZATION. THE FOLLOWING AMOUNTS REPRESENT THE INCREASE IN VALUE RECEIVED UNDER THE TERMS OF THE PLAN. JAMES BOMHARD $7,852 ANA SANCHEZ $8,700 REUBEN SMITH $8,002 JENNIFER CONTIN $8,256 MARIA TIOMICO $7,687 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS AND THE IMMEDIATE PAST CHAIR, IF HE OR SHE CONTINUES TO SERVE ON THE BOARD, AND THE CHAIRS OF THE STRATEGIC PLANNING COMMITTEE, THE COMPLIANCE/QUALITY OVERSIGHT COMMITTEE AND THE NOMINATING AND BOARD DEVELOPMENT COMMITTEE. THE CHAIR OF THE COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION FOR CARING, INC. SHALL BE AN EX-OFFICIO MEMBER OF THE EXECUTIVE COMMITTEE WITHOUT VOTE. THE EXECUTIVE COMMITTEE SHALL MEET AT THE CALL OF THE CHAIR, OR, IN THE ABSENCE OF THE CHAIR, AT THE CALL OF THE FIRST VICE-CHAIR. THE EXECUTIVE COMMITTEE SHALL HAVE SUCH POWERS AS MAY BE DELEGATED BY THE BOARD OF DIRECTORS FROM TIME TO TIME. THE EXECUTIVE COMMITTEE SHALL ACT UPON INTERIM BUSINESS ARISING BETWEEN REGULAR MEETINGS OF THE BOARD OF DIRECTORS AND SHALL REPORT ITS ACTION AT THE NEXT MEETING OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL PERIODICALLY REVIEW THE PERFORMANCE OF THE PRESIDENT/CEO, AND SHALL REVIEW, FROM TIME TO TIME, PERSONNEL POLICIES, INCLUDING CONDITIONS OF EMPLOYMENT, AND SHALL MEET PERIODICALLY WITH THE PRESIDENT/CEO TO ASSESS PERSONNEL POLICIES AND WORKING CONDITIONS. THE COMMITTEE WILL REVIEW THE SALARY PLAN AND RECOMMEND CHANGES WHEN INDICATED. THE COMMITTEE SHALL OVERSEE THE ADMINISTRATION OF ANY AFFIRMATIVE ACTION PLAN. ACTIONS OF THE EXECUTIVE COMMITTEE PURSUANT TO THIS PARAGRAPH SHALL HAVE THE SAME EFFECT AS ACTIONS OF THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ALICARE CARE, INC A FLORIDA NOT-FOR-PROFIT TAX EXEMPT ENTITY AS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S BYLAWS WERE AMENDED TO STATE THAT ALICARE CARE, INC A FLORIDA NOT-FOR-PROFIT TAX EXEMPT ENTITY AS THE SOLE MEMBER. AS THE SOLE MEMBER ALIVIA CARE, INC HAS THE RIGHT TO: (A) EMPLOY THE PRESIDENT OF THE CORPORATION (THE "HOSPICE PRESIDENT"); (B) APPROVE THE AMENDMENT, MODIFICATION, OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION, IN WHOLE OR IN PART; (C) APPROVE THE ANNUAL CAPITAL AND OPERATING BUDGET OF THE CORPORATION; (D) APPROVE THE ANNUAL AND LONG-TERM STRATEGIC PLANS OF THE CORPORATION; (E) INCUR ANY LONG-TERM DEBT OR FINANCING TO BE USED IN FURTHERANCE OF THE CORPORATION'S PURPOSES; (F) APPROVE AND AUTHORIZE THE EXPANSION OF THE CORPORATION INTO ANY NEW SERVICE LINES WHICH ARE NOT SET FORTH IN ARTICLE I OF THESE BYLAWS; (G) APPROVE AND AUTHORIZE THE GEOGRAPHIC EXPANSION OF THE CORPORATION INTO ANY SERVICE AREA BEYOND THE CORPORATION'S LICENSED HOSPICE SERVICE AREA; (H) APPROVE AND AUTHORIZE THE ESTABLISHMENT OR DISSOLUTION OF ORGANIZATIONAL RELATIONSHIPS BY THE CORPORATION INCLUDING SUBSIDIARIES, CONSOLIDATION, PARTNERSHIPS, JOINT VENTURES, MERGERS, OR ANY OTHER FUNDAMENTAL REORGANIZATION OF THE CORPORATION; FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED IN ITS ENTIRETY BY THE BUDGET FINANCE COMMITTEE OF THE BOARD, FOLLOWED BY A PRESENTATION TO THE FULL BOARD FOR APPROVAL. FOLLOWING APPROVAL, THE RETURN WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED ANNUALLY TO COMPLETE AND SIGN A CONFLICT OF INTEREST POLICY IDENTIFYING RELATIONSHIPS THAT MAY GIVE RISE TO CONFLICT. OFFICERS AND KEY MANAGEMENT PERSONNEL ALSO COMPLETE A SURVEY REGARDING POTENTIAL BUSINESS RELATIONSHIPS WITH OTHER OFFICERS, DIRECTORS, AND KEY PERSONNEL.ANY PERSON DETERMINED TO HAVE A CONFLICT OF INTEREST IS REQUIRED TO RECUSE THEMSELVES FROM ANY VOTE RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMMITTEE OF THE BOARD REVIEWS AND MAKES DECISIONS ANNUALLY REGARDING COMPENSATION FOR EXECUTIVE STAFF. THE EXECUTIVE COMMITTEE RETAINED AN INDEPENDENT CONSULTANT TO CONDUCT A COMPREHENSIVE REVIEW OF THE COMPETITIVENESS AND REASONABLENESS OF THE COMPENSATION AND BENEFITS PROVIDED TO THE FOLLOWING POSITIONS: CEO, COO, CFO, SVP OF PALLIATIVE CARE, SVP HOSPICE SERVICES, VP DEPUTY CHIEF FINANCIAL OFFICER, VP COMPLIANCE AND QUALITY, AND VICE PRESIDENT EDUCATION & COMMUNITY ENGAGEMENT. A REVIEW OF COMPETITIVENESS AND REASONABLENESS FOR LIKE ORGANIZATIONS TO INCLUDE NOT-FOR-PROFIT POST ACUTE CARE PROVIDERS AND HOSPITALS OF COMPARABLE SIZE, REGARDLESS OF GEOGRAPHY WAS CONDUCTED. TARGET MARKET AT MEDIAN. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE ANY GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS UPON REQUEST. THIS CAN BE DONE IN PERSON, BY PHONE, VIA OUR WEBSITE OR ON WWW.GUIDESTAR.COM. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION FOR CARING 4266 SUNBEAM RD JACKSONVILLE FL 32257 593583920 FUNDRAISING FOR COMMUNITY HOSPICE OF NORTHEAST FLORIDA FL 501(C)(3) LINE 12B, II COMMUNITY HOSPICE OF NORTHEAST FLORIDA 1 HOSPICE OF GOLDEN ISLES INC 1692 GLYNCO PKWY BRUNSWICK GA 31525 581428562 HOSPICE & PALLIATIVE CARE GA 501(C)(3) LINE 7 ALIVIA CARE OF GEORGIA INC 0 HOSPICE SATILLA 808 EVERGREEN WAY WAYCROSS GA 31501 581741612 HOSPICE & PALLIATIVE CARE GA 501(C)(3) LINE 3 ALIVIA CARE OF GEORGIA INC 0 ALIVIA CARE INC 4266 SUNBEAM RD JACKSONVILLE FL 32257 844695341 LEADERSHIP SUPPORT FOR HOSPICE & PALLIATIVE CARE FL 501(C)(3) LINE 10 N/A 0 ALIVIA CARE OF GEORGIA INC 4266 SUNBEAM RD JACKSONVILLE FL 32257 850842222 LEADERSHIP SUPPORT FOR HOSPICE & PALLIATIVE CARE FL 501(C)(3) LINE 10 ALIVIA CARE INC 0 ALIVIA CARE SOLUTIONS INC 4266 SUNBEAM RD JACKSONVILLE FL 32257 852777461 HOSPICE & PALLIATIVE CARE FL 501(C)(3) LINE 10 ALIVIA CARE INC 0 PACE PARNTERS FOR NORTHEAST FLORIDA INC 4266 SUNBEAM RD JACKSONVILLE FL 32257 364861283 PROGRAM FOR NURSING HOME PATIENTS FL 501(C)(3) LINE 12A, I COMMUNITY HOSPICE OF NORTHEAST FLORIDA 1 0 0 1 1 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION A 144959 FMV COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION C 1050000 FMV COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION O 893917 FMV COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION M 3507251 FMV SCHEDULE R, PART VII THE COMMUNITY MANAGEMENT COMPANY OF NORTHEAST FLORIDA, INC. WAS ESTABLISHED IN DECEMBER 2012 AND IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE AND EDUCATIONAL PURPOSES, INCLUDING THE PROVISION OF PALLIATIVE CARE SERVICES AND OTHER HEALTH SERVICES TO IMPROVE THE HEALTH SERVICES OF THE PEOPLE IN THE COMMUNITY IT SERVES. AS OF SEPTEMBER 30, 2020, COMMUNITY MANAGEMENT COMPANY OF NORTHEAST FLORIDA, INC. HAD NOT ENGAGED IN ANY FINANCIAL TRANSACTIONS AND THEIR APPLICATION FOR EXEMPTION WAS STILL IN THE PROCESS.