2022-02-09T07:30:30-06:00 2021-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2020-10-01 591940256 COMMUNITY HOSPICE OF NORTHEAST FLORIDA COMM 9042685200 4266 SUNBEAM RD JACKSONVILLE FL 32257 ANDREA FRITZ SR VP FINANCE 9042685200 2022-02-09 1 ANDREA FRITZ 999009999 AMY BIBBY P00445891 8282542254 2022-02-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SEE SCH O DISCLOSURE ANDREA FRITZ 4266 SUNBEAM RD JACKSONVILLE FL 32257 119573840 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. 28 28 1097 673 0 0 1456171 1938853 114295208 113711376 870503 2360151 1981085 842995 118602967 118853375 2370 291 0 0 65741803 64582857 0 0 0 49581486 47316727 115325659 111899875 3277308 6953500 100782418 107746508 16606759 14923961 84175659 92822547 X ADVANCING PHILANTHROPY TO ENABLE COMMUNITY HOSPICE OF NORTHEAST FLORIDA TO FULFILL ITS MISSION AND VISION OF CARE, RESEARCH AND EDUCATION. 0 0 74614795 95777167 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 40-YEAR HISTORY, THE JACKSONVILLE, FLORIDA-BASED NONPROFIT ORGANIZATION HAS SERVED APPROXIMATELY 135,832 ADULTS AND CHILDREN IN BAKER, CLAY, DUVAL, NASSAU AND ST. JOHNS COUNTIES, AS WELL AS 11 COUNTIES IN NORTH CENTRAL FLORIDA. DURING FISCAL YEAR 2021, THE ORGANIZATION HELPED 24,104 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 815 EMPLOYEES, ALONG WITH THE SERVICES OF APPROXIMATELY 1,000 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 2021, OUR HOMECARE TEAMS PROVIDED 418,930 ROUTINE DAYS OF CARE. 16056348 18121404 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 2021, OUR STAFF PROVIDED 21,299 DAYS OF GENERAL INPATIENT CARE (GIP). 3305719 291 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 2021, OUR PALLIATIVE CARE TEAM SAW 8,066 PATIENTS. 472246 MEDICARE CARE CHOICES MODEL IN 2015, COMMUNITY HOSPICE & PALLIATIVE CARE JOINED A SELECT GROUP OF PALLIATIVE AND HOSPICE PROVIDERS NATIONWIDE AS PARTICIPANTS IN THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) RESEARCH EFFORT WHICH HAS NOW BEEN EXTENDED TO 12/31/21: THE MEDICARE CARE CHOICES MODEL (MCCM). LAUNCHED IN JANUARY 2016, COMMUNITY CARE CHOICES IS BASED ON THE MCCM MODEL TO HELP PEOPLE WITH ADVANCED ILLNESS FIND GREATER ACCESS TO COMFORT CARE AND SUPPORT. THE MODEL PROVIDES SELECT HOSPICE SUPPORTIVE SERVICES, INCLUDING CASE MANAGEMENT AND CARE COORDINATION, IN A HOMECARE SETTING TO PATIENTS WHO MEET ELIGIBILITY CRITERIA FOR HOSPICE CARE AND ADDITIONAL CMS CRITERIA. IN FISCAL YEAR 2021, THE PROGRAM DID NOT ADMIT AFTER 6/30/2021 DUE TO PROGRAM RESEARCH CLOSURE FOR ADMISSION. CARE IS BEING PROVIDED TO PATIENTS UNTIL 12/31/2021 (THE MODEL END DATE). THE ENROLLMENT FOR FISCAL YEAR 2021 WAS 47 PATIENTS. 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 2021 OF 220 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 2021, 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 2021, 3,033 INDIVIDUALS WERE HELPED THROUGH A COMBINATION OF IN-PERSON, VIRTUAL, AND TELEPHONIC COUNSELING. 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 2021, COMMUNITY HOSPICE & PALLIATIVE CARE PROVIDED HOSPICE SERVICES TO 1,632 VETERANS FROM ALL BRANCHES OF SERVICES THROUGHOUT THE ORGANIZATION'S 16-COUNTY REGION.VOLUNTEERSTHE NEARLY 1,000 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. THRIFT SHOPS SINCE 2000, SHOPPERS, DONORS, AND VOLUNTEERS HAVE GENERATED NEARLY $4.9 MILLION FOR UNFUNDED AND UNDERFUNDED PROGRAMS FOR ADULTS AND CHILDREN IN OUR SERVICE AREA. NEW AND GENTLY USED CLOTHING, FURNITURE, HOUSEHOLD ITEMS, JEWELRY, COLLECTIBLES AND MORE FILL OUR LARGE CENTERS, WHICH ARE LOCATED AT 11173 BEACH BLVD. IN JACKSONVILLE, FL AND 845 BLANDING BLVD. IN ORANGE PARK, FL AND 1355 U.S HIGHWAY 1 SOUTH, ST. AUGUSTINE, FL.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. ALIVIA CARE ALIVIA CARE IS A NURSE-LED, HOME-BASED CARE COORDINATION SERVICE FOR PATIENTS WITH AN ADVANCED ILLNESS, PROVIDING COMPLEX CARE MANAGEMENT AND A SUPPORT SYSTEM TO ENHANCE THE QUALITY OF LIFE OF A PATIENT AND THEIR CAREGIVERS WHEREVER THEY CALL HOME. ALIVIA CARE, A DIVISION OF COMMUNITY HOSPICE & PALLIATIVE CARE, HAS PARTNERED WITH SEVERAL MEDICAL PROVIDERS TO PROVIDE ADVANCED ILLNESS MANAGEMENT SERVICES TO THEIR PATIENTS. IN FISCAL YEAR 2021, WE PROVIDED CARE TO 104 PATIENTS. 472246 94449108 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 1 0 0 0 0 0 0 1 0 0 0 1 164 0 1 1097 1 0 0 0 0 0 0 0 0 0 1 0 0 0 X 28 28 0 0 1 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 CEO ALIVIA CARE, INC. 10.00 3.00 X X 351876 213939 41833 GREGG DIXON CFO ALIVIA CARE, INC. 4.00 X X 24120 64082 2113 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 BARRETT BOARD MEMBER 1.00 X 0 0 0 KATHERINE BATENHORST BOARD MEMBER 1.00 X 0 0 0 JANE BOLES BOARD MEMBER 1.00 X 0 0 0 GERADO COLON-OTERO MD BOARD MEMBER 1.00 X 0 0 0 NANCY DAWSON MD BOARD MEMBER 1.00 X 0 0 0 COLONEL BILL DUDLEY RET BOARD MEMBER 1.00 X 0 0 0 AUDREY GIBSON BOARD MEMBER 1.00 X 0 0 0 MARIE GNAGE PHD BOARD MEMBER 1.00 X 0 0 0 RICHARD HAWTHORNE BOARD MEMBER 1.00 X 0 0 0 PATRICE JONES DNP RN 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 MAYO BOARD MEMBER 1.00 X 0 0 0 MARILYN MCAFEE BOARD MEMBER 1.00 X 0 0 0 DAVID MEYER BOARD MEMBER 1.00 X 0 0 0 GREG MILLER BOARD MEMBER 1.00 X 0 0 0 JOSEPH M MITRICK BOARD MEMBER 1.00 X 0 0 0 LARRY D WAGONER PHD BOARD MEMBER 1.00 X 0 0 0 PHILLIP WARD CEO 35.00 2.00 X 245090 126250 34410 ANDREA FRITZ SR. VICE PRESIDENT OF FINANCE 30.00 X 187480 41288 39000 MARY MCELROY SR. VICE PRESIDENT OF HOSPICE SERVICES 40.00 X 257582 0 21745 KENNY STEVENSON SR. VICE PRESIDENT OF OPERATIONAL EXCELLENCE 35.00 X 189821 43573 22184 BRANDON CULP VICE PRESIDENT OF BUSINESS DEVELOPMENT 20.00 X 127185 27591 25707 ANA SANCHEZ CMO 40.00 X 413285 0 22357 JAMES BOMHARD PHYSICIAN 40.00 X 258538 0 12192 MARIA TIOMICO PHYSICIAN 40.00 X 250064 0 16766 ANNA WRIGHT PHYSICIAN 40.00 X 248283 0 15010 REUBEN SMITH PHYSICIAN 40.00 X 245112 0 19841 CARLOS BOSQUE FORMER CFO 28.00 2.00 X 246945 0 18844 3045381 516723 292002 50 1 1 0 LIFE CARE CTR -ORANGE PK 2145 KINGSLEY AVENUE ORANGE PARK FL 32073 MEDICAL/NURSING HOME 1119654 CATHEDRAL GERONTOLOGY CENTER 333 EAST ASHLEY STREET JACKSONVILLE FL 32202 MEDICAL/NURSING HOME 1071677 TAYLOR CARE CENTER 6535 CHESTER AVENUE JACKSONVILLE FL 33217 MEDICAL/NURSING HOME 882313 CARLTON FIELDS PO BOX 3239 TAMPA FL 33601 LEGAL SERVICES 814736 MOOSEHAVEN 1701 PARK AVENUE ORANGE PARK FL 32073 MEDICAL/NURSING HOME 769130 58 1938853 1938853 PATIENT SERVICE REV 623000 92777446 92777446 NURSING HOME SUPPORT 623000 18121404 18121404 COVID STIMULUS REVENUE 900099 2812526 2812526 113711376 1173170 1173170 187195 0 187195 187195 187195 1907446 0 720465 1907446 -720465 1186981 1186981 MISCELLANOUS REVENUE 623000 624964 624964 CAFE REVENUE 722210 30373 30373 MEDICAL RECORDS REVENU 900099 463 463 655800 118853375 113898571 0 3015951 291 291 1317728 658864 658864 69894 69894 52765271 39433176 13332095 1300939 1077770 223169 5848153 5250505 597648 3280872 2901921 378951 207588 207588 85020 85020 41860 41860 42466 42466 1325519 870574 454945 413450 175149 238301 4811758 4073890 737868 1288948 1288948 2678459 2678459 1316860 1250350 66510 106974 49697 57277 298 298 3391290 3391290 328205 328205 ROOM AND BOARD 19261033 19261033 MEDICAL SUPPLIES EXPENS 8427705 8427705 BAD DEBT EXPENSE 1879667 1879667 CHARITY CARE EXPENSES 956947 956947 752680 752680 111899875 94449108 17450767 0 4420 1653 13563609 18971224 9391971 13596930 387806 467358 3169401 2906678 69862736 32595833 42947200 37266903 29417872 33308862 1210734 1044922 689405 181978 100782418 107746508 10721472 9717606 2909297 34748 2975990 5171607 16606759 14923961 X 84175659 92822547 84175659 92822547 100782418 107746508 X 6953500 1521086 11358 160944 X X 0 1 X 1 0 X 1904774 1726451 1808647 1456171 1938853 8834896 107483304 105581580 110302269 117107727 113711376 554186256 1164851 1179152 1037794 1021145 4402942 110552929 108487183 113148710 119585043 115650229 567424094 0 0 0 567424094 1019812 1037251 791899 1121937 1360365 5331264 1019812 1037251 791899 1121937 1360365 5331264 1270655 1548363 1411888 1003514 655800 5890220 112843396 111072797 115352497 121710494 117666394 578645578 0.98060 0.98000 0.00920 0.00850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 15514 0 1 4274 19788 0 PART II-B, LINE 1: THE ORGANIZATION INCURRED EXPENSES BY LOBBYING PRIMARILY FOR FUNDING NEW SLOTS FOR PACE AND HEADING OFF ANY EFFORTS TO DELETE CON FOR HOSPICE. ALSO, THE ORGANIZATION INCURRED EXPENSES BY LOBBYING TO ADDRESS THE "GLITCH CREATED BY THE PELVIC EXAM LAW. 1967544 1967544 38296879 16377431 21919448 11782881 3623719 8159162 17101680 12594683 4506997 713752 713752 37266903 DEFERRED COMPENSATION 3628196 DUE TO ALIVIA CARE 1543411 5171607 X 117537847 1521086 1521086 116016761 2836614 2836614 118853375 109063261 0 109063261 2836614 2836614 111899875 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, 2021. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE INCLUDED IN REVENUES 956,947. BAD DEBT EXPENSES 1,879,667. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHARITY CARE INCLUDED IN REVENUES 956,947. BAD DEBT EXPENSES 1,879,667. X X X X X 1 1 0 0 0 0 0 0 0 SUSAN PONDER-STANSEL CEO ALIVIA CARE, INC. 340308 88462 0 93840 11568 31637 15390 0 22036 4407 389302 218346 0 0 ANA SANCHEZ CMO 405326 0 5375 0 2584 0 8550 0 13807 0 435642 0 2584 0 PHILLIP WARD CEO 227096 60577 0 53550 17994 12123 12263 3127 15850 3170 273203 132547 0 0 MARY MCELROY SR. VICE PRESIDENT OF HOSPICE SERVIC 200808 0 27310 0 29464 0 12318 0 9427 0 279327 0 13208 0 JAMES BOMHARD PHYSICIAN 256928 0 300 0 1310 0 7799 0 4393 0 270730 0 1310 0 ANDREA FRITZ SR. VICE PRESIDENT OF FINANCE 155238 37665 26637 0 5605 3623 8383 3472 22621 4524 218484 49284 0 0 MARIA TIOMICO PHYSICIAN 247928 0 225 0 1911 0 7532 0 9234 0 266830 0 1911 0 CARLOS BOSQUE FORMER CFO 200285 0 31285 0 15375 0 10605 0 8239 0 265789 0 0 0 REUBEN SMITH PHYSICIAN 242897 0 75 0 2140 0 7679 0 12162 0 264953 0 2140 0 ANNA WRIGHT PHYSICIAN 246837 0 300 0 1146 0 7534 0 7476 0 263293 0 1146 0 KENNY STEVENSON SR. VICE PRESIDENT OF OPERATIONAL EX 145923 38462 27200 0 16698 5111 7880 3546 8965 1793 206666 48912 5138 0 BRANDON CULP VICE PRESIDENT OF BUSINESS DEVELOPME 116106 27591 11016 0 63 0 1161 0 20083 4463 148429 32054 0 0 PART I, LINES 4A-B CARLOS BOSQUE RECEIVED A SEVERANCE PAYMENT DURING THE FISCAL YEAR. 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 $7823 ANA SANCHEZ $8,288 ANNA WRIGHT $7,639 REUBEN SMITH $7,965 RUTH TIOMICO $7644 BRANDON WARD FAMILY MEMBER OF PHILLIP WARD 66995 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1 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 4 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 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 XI, LINE 9: NET ASSET TRANSFER TO PARENT 160,944. 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 ROAD JACKSONVILLE FL 32257 593583920 FUNDRAISING FOR COMMUNITY HOSPICE OF NORTHEAST FLORIDA FL 501(C)(3) 13, TYPE I COMMUNITY HOSPICE OF NORTHEAST FLORIDA 1 PACE PARTNERS OF NORTHEAST FLORIDA INC 4266 SUNBEAM ROAD JACKSONVILLE FL 32257 364861283 PROGRAM FOR NURSING HOME PATIENTS FL 501(C)(3) LINE 12A, I COMMUNITY HOSPICE OF NORTHEAST FLORIDA 1 ALIVIA CARE INC 4266 SUNBEAM ROAD JACKSONVILLE FL 32257 844695341 HOSPICE LEADERSHIP FL 501(C)(3) LINE 10 0 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 141122 FMV COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION C 1938852 FMV COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION O 1378544 FMV COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION M 6873769 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.