2022-11-16T20:03:45-06:00 2021-06-30 946214841 ARMANINO LLP 50 W SAN FERNANDO ST STE 500 SAN JOSE CA 95113 990 2020-07-01 942497618 HOSPICE OF SANTA CRUZ COUNTY HOSP 8314303000 940 DISC DRIVE SCOTTS VALLEY CA 95066 CATHERINE CONWAY CHIEF EXECUTIVE OFFICER 8314303000 2022-11-15 1 CATHERINE CONWAY 999009999 MATTHEW PETROSKI P00853132 4082006400 2022-11-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CATHERINE CONWAY 940 DISC DRIVE SCOTTS VALLEY CA 95066 21336470 0 X HOSPICESANTACRUZ.ORG X 1978 CA HOSPICE SERVICE AND SUPPORT FOR TERMINAL PATIENTS AND THEIR FAMILIES. 15 15 176 80 0 0 1106587 2825299 20945187 17943603 10565 245920 61954 52666 22124293 21067488 0 0 0 0 16143935 14446300 0 0 466578 7220241 5758196 23364176 20204496 -1239883 862992 13958586 16612272 4099504 5395377 9859082 11216895 HOSPICE OF SANTA CRUZ COUNTY HONORS THE CHOICES OF INDIVIDUALS AND FAMILIES BY PROVIDING EXEMPLARY END-OF-LIFE CARE AND GRIEF SUPPORT TO OUR COMMUNITY. 0 0 14864074 17943603 1,049 PATIENTS AND FAMILIES RECEIVED 63,250 DAYS OF EXPERT END-OF-LIFE CARE FROM HOSPICE TEAMS OF MEDICAL DIRECTORS, NURSES, SOCIAL WORKERS, CHAPLAINS, HOSPICE AIDES, AND VOLUNTEERS. ADDITIONALLY, 2,141 INDIVIDUAL GRIEF SUPPORT SESSIONS AND 92 GROUP GRIEF SUPPORT SESSIONS WERE PROVIDED TO HOSPICE FAMILIES AND GRIEVING COMMUNITY MEMBERS OF ALL AGES. 14864074 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 74 0 1 176 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 15 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X THE ORGANIZATION 8314303000 940 DISC DRIVE SCOTTS VALLEY CA 95066 BOB KASWEN PRESIDENT (THRU 12/20), DIRECTOR 5.00 X X 0 0 0 DICK CLARK PRESIDENT (AS OF 01/21)) 5.00 X X 0 0 0 DAVID KLUGER VICE PRESIDENT (THRU 12/20), DIRECTOR 2.00 X X 0 0 0 JULIA COWELL VICE PRESIDENT (AS OF 01/21) 5.00 X X 0 0 0 CARA DISIMONE SECRETARY (AS OF 01/21) 1.00 X X 0 0 0 MARGARET GORDON SECRETARY (THRU 12/20) 1.00 X X 0 0 0 TIMOTHY TIM ULEN TREASURER (AS OF 01/21) 1.00 X X 0 0 0 ALICIA FLORES DIRECTOR (THRU 12/20) 1.00 X 0 0 0 DALE BISHOP MD DIRECTOR 1.00 X 0 0 0 ED NEWMAN DIRECTOR (THRU 02/21) 1.00 X 0 0 0 ED SACKS MD DIRECTOR (THRU 01/21) 1.00 X 0 0 0 HOLLY ALEXANDER DIRECTOR 1.00 X 0 0 0 KUNTAL THAKER MD DIRECTOR (THRU 01/21) 1.00 X 0 0 0 SHARON TAPPER MD DIRECTOR 1.00 X 0 0 0 BETH HANSMAN DIRECTOR 1.00 X 0 0 0 MICHAEL ALLARD DIRECTOR (AS OF 01/21) 1.00 X 0 0 0 GARRY CRUMMER MD DIRECTOR (AS OF 01/21) 1.00 X 0 0 0 DAISY NUNEZ DIRECTOR (AS OF 01/21) 1.00 X 0 0 0 KATHERINE KATIE GABRIEL-COX MD DIRECTOR (AS OF 03/21) 1.00 X 0 0 0 SIGOLENE A ORTEGA DIRECTOR (AS OF 03/21) 1.00 X 0 0 0 RACHEL WEDEEN DIRECTOR (THRU 12/20) 1.00 X 0 0 0 CATHERINE G CONWAY CHIEF EXECUTIVE OFFICER CURRENT 40.00 X 229493 0 33294 ADAM SIMON SHORE CHIEF FINANCIAL OFFICER 40.00 X 236935 0 14102 MICHAEL MILWARD CEO FORMER 40.00 X 189167 0 19821 LISA M FLORES SENIOR IT DIRECTOR 40.00 X 152989 0 11378 KARL JOSEPH SEGNITZ CHIEF MEDICAL OFFICER 40.00 X 261743 0 15458 JUDITH HUMBLE CHIEF COMPLIANCE OFFICER 40.00 X 204488 0 14798 GLORIA REED CHIEF CLINICAL OFFICER 40.00 X 189515 0 11096 KAREN TANASESCU DIRECTOR OF OPERATIONS 40.00 X 158450 0 12886 ANGELA MAE BROUSE NURSE TEAM LEAD 40.00 X 150483 0 11929 1773263 0 144762 55 0 1 0 COVENANT CARE CAPITOLA LLC 1935 WHARF ROAD CAPITOLA CA 950102606 NURSING HOME R/B 531122 ALLEN BUENO DEL BOSQUE 311 33RD AVE SANTA CRUZ CA 95062 CONTRACT MEDICAL DIRECTOR 294194 SANTA CRUZIDENCEOPCO LLC 1115 CAPITOLA RD SANTA CRUZ CA 95062 NURSING HOME R/B 208279 BONNY MASTERS 634 SAN JUAN AVENUE SANTA CRUZ CA 95065 CONTRACT MEDICAL DIRECTOR 115390 DRIFTWOOD S C OPERATING CO LLC 675 24TH AVE SANTA CRUZ CA 95062 NURSING HOME R/B 107660 5 8924 1227051 1589324 578587 2825299 HOSPICE SERVICES 621610 17943603 17943603 17943603 1353 1353 43895 43895 513549 268982 244567 244567 244567 OTHER REVENUE 900099 8771 8771 8771 21067488 17943603 0 298586 779958 43909 736049 11216863 9909875 972884 334104 131196 107968 19578 3650 1381485 1089097 256242 36146 936798 785652 125388 25758 12590 3283 9307 58697 58697 96 96 19316 19316 1305744 958895 341358 5491 62286 805 57491 3990 493894 126103 344964 22827 724369 11347 695981 17041 285580 285580 150814 149108 1687 19 40241 14912 24493 836 29026 16879 12147 341143 341143 174680 75592 99088 PATIENT SERVICE, SUPPLY 1536230 1531813 4417 MEMBERSHIPS AND SUBSCRI 342740 43670 298920 150 BAD DEBT 168703 168703 MEDICAL ROOM & BOARD 11825 11823 2 222 222 20204496 14864074 4873844 466578 4029477 3261887 1045918 1742989 369689 30000 1742354 2269174 0 61056 356757 274248 5221173 2405299 2965277 2815874 2788469 4724930 660645 1432114 13958586 16612272 1997422 1962972 248658 223569 1853424 3208836 4099504 5395377 X 9247624 10495872 611458 721023 9859082 11216895 13958586 16612272 862992 354757 140064 0 X X 0 0 0 X 958027 1405711 1808791 1106587 2825299 8104415 958027 1405711 1808791 1106587 2825299 8104415 938562 7165853 54691 62977 97561 52065 45248 312542 55517 31122 47477 26862 8771 169749 8586706 101381035 0.83450 0.87180 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GROSS INCOME SPECIAL EVENTS GROSS INCOME SPECIAL EVENTS GAMING OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 96 96 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION, WHICH PERFORMS LIMITED LOBBYING ACTIVITIES. BASED ON THAT ORGANIZATIONS TAX RETURN THE AMOUNT OF ALLOCATED LOBBYING EXPENSES IS DE MINIMIS ($96) 511407 133480 9706 635181 535980 -17237 7336 511407 530022 15146 9188 535980 517009 13013 530022 470969 100 45940 517009 0.00000 1.00000 0.00000 0 0 558850 558850 2658158 1135152 1523006 541874 284696 257178 932186 647774 284412 530105 337677 192428 2815874 ENDOWED AGENCY FUND HELD AT COMMUNITY FOUNDATION OF SCC 511307 F NON ENDOWED AGENCY FUND HELD AT COMMUNITY FOUNDATION OF SCC 4213623 F 4724930 DEPOSITS 799294 DEFERRED COMPENSATION ASSETS 287413 SELF-INSURANCE RESERVE 244243 DUE FROM CHN 101164 1432114 DEFERRED COMPENSATION LIABILITIES 287413 SELF-INSURANCE LIABILITY 244243 PPP LOAN 2677180 3208836 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS CONSISTS OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES TO SUPPORT THE ORGANIZATIONS PROGRAMS. THE ORGANIZATION HAS A POLICY OF CLASSIFYING INVESTMENT INCOME ON ENDOWMENT FUNDS AS TEMPORARILY RESTRICTED UNTIL SUCH TIME AS SPECIFICALLY BUDGETED FOR SPENDING AND APPROVED BY THE BOARD. X X X X X X 0 0 0 0 0 0 0 1 0 KARL JOSEPH SEGNITZ CHIEF MEDICAL OFFICER 261743 0 0 0 0 0 3900 0 11558 0 277201 0 0 0 CATHERINE G CONWAY CHIEF EXECUTIVE OFFICER CURRENT 229493 0 0 0 0 0 23413 0 9881 0 262787 0 0 0 ADAM SIMON SHORE CHIEF FINANCIAL OFFICER 236935 0 0 0 0 0 2803 0 11299 0 251037 0 0 0 JUDITH HUMBLE CHIEF COMPLIANCE OFFICER 204488 0 0 0 0 0 3240 0 11558 0 219286 0 0 0 MICHAEL MILWARD CEO FORMER 189167 0 0 0 0 0 15150 0 4671 0 208988 0 0 0 GLORIA REED CHIEF CLINICAL OFFICER 189515 0 0 0 0 0 1215 0 9881 0 200611 0 0 0 KAREN TANASESCU DIRECTOR OF OPERATIONS 155121 0 3329 0 0 0 1543 0 11343 0 171336 0 0 0 LISA M FLORES SENIOR IT DIRECTOR 147046 0 5943 0 0 0 0 0 11378 0 164367 0 0 0 ANGELA MAE BROUSE NURSE TEAM LEAD 148138 0 2345 0 0 0 688 0 11241 0 162412 0 0 0 PART I, LINE 7 INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED NONFIXED PAYMENTS IN THE FORM OF A BONUS, AMOUNTS WERE INCLUDED IN COLUMN B(II) AND IN THE EMPLOYEE W-2. BONUS AMOUNTS ARE BASED ON PERFORMANCE MEASURED AGAINST METRICS WHICH ARE REVIEWED AND APPROVED ANNUALLY BY THE COMPENSATION COMMITTEE. KATHERYNE ROBINSON DAUGHTER OF BOARD MEMBER 81312 EMPLOYMENT 0 X 3 578587 MARKET QUOTATIONS 0 0 1 1 PART I, COLUMN (B): THIS NUMBER REFLECTS THE NUMBER OF CONTRIBUTIONS, NOT THE NUMBER OF ITEMS CONTRIBUTED. PART I, LINE 32B: ALL SECURITIES ARE TO BE SOLD IMMEDIATELY UPON RECEIPT. FORM 990, PART VI, SECTION A, LINE 4 THE CHANGES IN THE AMENDED BYLAWS INCLUDE A REDUCTION IN CHN RESERVED POWERS, A CHN POSITION OF OVERSIGHT VS. CONTROL, CHN'S REMAINING LEGALLY REQUIRED CONTROL HAS LESS INVOLVEMENT IN THE PROCESS, CHN'S CONTROL OF THE AFFILIATES' CEOS HAS BEEN REMOVED, AND THE REQUIREMENT FOR CONSOLIDATED FINANCIAL REPORTS AND A JUNE THROUGH JULY FISCAL YEAR HAVE BEEN REMOVED. 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 ORGANIZATION'S SOLE MEMBER IS CALIFORNIA HOSPICE NETWORK. ORGANIZATION ELECTS DIRECTORS, WHOM ARE APPROVED BY MEMBER. FORM 990, PART VI, SECTION A, LINE 7B ORGANIZATION'S RESTATED BYLAWS INCLUDE CERTAIN POWERS RESERVED BY MEMBER, WHICH INCLUDE APPOINTMENT OF ORGANIZATION'S DIRECTORS AND CEO, APPROVAL OF ANNUAL OPERATING BUDGET, AND ANY ACTION TO MERGE OR DISSOLVE OR SELL SUBSTANTIALLY ALL THE ASSETS OF ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B CFO AND CEO REVIEW 990 WHEN COMPLETED BY CPA FIRM. A COPY OF THE 990 IS FURNISHED TO THE FINANCE COMMITTEE AND TO THE BOARD MEMBERS BEFORE THE 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C 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 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 FULL BOARD OF DIRECTORS. BOARD OF DIRECTORS REVIEW AND VOTE ON PROPOSED SALARY CHANGES. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, AND ANNUAL 990 INFORMATION RETURNS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ANNUAL FINANCIAL RESULTS ARE PUBLISHED IN THE ORGANIZATION'S ANNUAL REPORT. FORM 990, PART XI, LINE 2C: THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CALIFORNIA HOSPICE NETWORK 66 BOVET RD SUITE 100 SAN MATEO CA 94402 834716484 HOSPICE SUPPORT. ADMIN, PROGRAMMATIC AND OTHER SUPPORT CA 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0