2020-12-08T15:29:20-06:00 2019-12-31 592922169 SALTMARSH CLEAVELAND AND GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2019-01-01 592208300 COVENANT HOSPICE INC COVE 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 MARTY FRANKLIN CFO 8504332155 2020-12-08 1 CHARLES F GUND JR CPA P00138367 8504358300 2020-12-08 2019 2022-09-23 18:48:47Z JEFF MISLEVY 5041 N 12TH AVE PENSACOLA FL 32504 65430069 0 X WWW.CHOOSECOVENANT.ORG/HOSPICE X 1981 FL COVENANT HOSPICE IS DEDICATED TO PROVIDING COMPREHENSIVE, COMPASSIONATE SERVICES (SEE SCHEDULE O) (CONTINUATION FROM PART I, LINE 1) TO PATIENTS AND THEIR LOVED ONES DURING TIMES OF LIFE-LIMITING ILLNESSES. 11 10 549 692 0 0 3057568 283756 54727869 53276197 2248915 1858337 51707 535306 60086059 55953596 0 0 0 0 25348102 24025597 0 0 0 31191691 29363768 56539793 53389365 3546266 2564231 58835656 66075307 23596459 26176316 35239197 39898991 X COVENANT HOSPICE IS DEDICATED TO PROVIDING COMPREHENSIVE, COMPASSIONATE SERVICES TO PATIENTS AND THEIR LOVED ONES DURING TIMES OF LIFE-LIMITING ILLNESSES. SINCE DYING IS A PART OF THE NORMAL PROCESS OF LIFE, THE FOCUS OF COVENANT HOSPICE (SEE SCHEDULE O) (CONTINUATION FROM PART III, LINE 1) IS TO ENABLE OUR PATIENTS TO LIVE AS FULLY AND COMFORTABLY AS POSSIBLE, TO PROVIDE DIGNIFIED PALLIATIVE CARE, TO ASSIST PATIENT'S LOVED ONES IN COPING WITH END-OF-LIFE ISSUES, AND TO IMPROVE CARE FOR ALL PATIENTS AT THE END OF THEIR LIVES BY EXAMPLE AND EDUCATION. FOR 2019, THE ORGANIZATION PROVIDED $704,064 OF CHARITY CARE TO PATIENTS. 0 0 40306368 53276197 DURING 2019, DIRECT CARE WAS PROVIDED TO 5,790 PATIENTS IN NORTHWEST FLORIDA AND SOUTH ALABAMA. COVENANT HOSPICE, INC. ALSO OFFERS A PREDIATRIC PALLIATIVE CARE PROGRAM. "PARTNERS IN CARE: TOGETHER FOR KIDS", TO CHILDREN FROM BIRTH TO AGE 21 WHO ARE COPING WITH POTENTIALLY LIFE-LIMITING CONDITIONS. 40306368 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 202 0 1 549 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARTY FRANKLIN 8504332155 5401 N 12TH AVE PENSACOLA FL 32504 TOM OWENS CHAIRMAN 4.00 12.00 X X 0 0 0 RODNEY GUTMAN VICE-CHAIRMAN 4.00 12.00 X X 0 0 0 CAREY KING SECRETARY 4.00 12.00 X X 0 0 0 XAN SMITH TREASURER 4.00 12.00 X X 0 0 0 JEFFREY M MISLEVY PRESIDENT/CEO 40.00 16.00 X X 0 671407 41844 MILLER CALDWELL DIRECTOR 4.00 4.00 X 0 0 0 JAMIE CAMPBELL DIRECTOR 4.00 4.00 X 0 0 0 DON HAFERKAMP DIRECTOR 4.00 4.00 X 0 0 0 BRETT PARA MD DIRECTOR 4.00 4.00 X 0 0 0 STEVE SARROS DIRECTOR 4.00 4.00 X 0 0 0 KENT SKOLROOD DIRECTOR 4.00 4.00 X 0 0 0 ODIN BERG CSO 40.00 16.00 X 0 332581 21738 MARTIN FRANKLIN CFO 40.00 12.00 X 0 211099 19041 TODD FISHER COO 40.00 12.00 X 0 312444 26871 JAMES SMITH PHYSICIAN 40.00 X 287889 0 26935 SAUL RODRIGUEZ PHYSICIAN 40.00 X 276892 0 2244 STEPHEN DILL PHYSICIAN 40.00 X 242836 0 7318 RICK HARRELSON PHYSICIAN 40.00 X 265438 0 10825 DIANE SPARKS PHYSICIAN 40.00 X 160336 0 9119 1233391 1527531 165935 16 0 1 0 ENCLARA PHARMECIA 1601 CHERRY STREET PHILADELPHIA PA 19102 PATIENT DRUGS 1468475 WESCON CORPORATION PO BOX 2095 PENSACOLA FL 32513 PATIENT DME 1064979 QUALIS MANAGEMENT PO BOX 7458 RIOCKY MOUNT NC 27804 DME 884570 MEDLINE INDUSTRIES DEPT CH 14400 PALATINE IL 60055 PATIENT MEDICAL SUPPLIES 688455 BEGGS & LANE 501 COMMENDENCIA STREET PENSACOLA FL 32502 LEGAL 553235 48 283756 283756 PATIENT SERVICES 621610 52856065 52856065 RENTAL FROM AFFILIATES 632299 420132 420132 53276197 425488 425488 177252 47135 130117 130117 130117 10862187 9410939 18399 1451248 -18399 1432849 1432849 BUSINESS INTERRUPTION INSURANCE 900099 335420 335420 PURCHASE CARD REBATE 900099 69769 69769 405189 55953596 53276197 0 2393643 19644082 15991983 3652099 109577 84625 24952 2362663 1850638 512025 1909275 1630052 279223 336355 336355 63000 63000 26655 26655 82614 82614 334143 334143 2617926 1963445 654481 2058984 1544238 514746 1331896 986023 345873 29384 29384 414701 414701 1586266 1189700 396566 375873 375873 ROOM & BOARD 9420884 9420884 SALARY ALLOCATION 4242045 4242045 MEDICATION AND MEDICAL 3910038 3910038 LAB SERVICES AND TREATM 1181336 1181336 1351668 553406 798262 53389365 40306368 13082997 0 2594 12938 3500696 4457225 2082461 3020687 12171777 11839040 102683 83558 1413121 903666 31245772 15412297 15703578 15833475 15047600 18214516 390779 346389 8420367 11363813 58835656 66075307 13002338 12417612 25322 5134569 3852297 3878625 6031275 1580927 3849810 23596459 26176316 X 33163657 36879045 2075540 3019946 35239197 39898991 58835656 66075307 X 2564231 1148748 946815 X X 0 1 X 1 0 X 1579900 1270186 0 1667 283756 3135509 1579900 1270186 1667 283756 3135509 3135509 583030 422365 387513 396583 425488 2214979 116624 253751 760468 51707 69769 1252319 6602807 52856065 0.47490 0.57160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 0 0 PART II-B, LINE 1: LINE 1G DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: THE ORGANIZATION PAYS CONSULTANTS TO LOBBY FOR LEGISLATION THAT PROMOTES HOSPICES. LINE 1L OTHER ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION ALONG WITH STATE HOSPICE ORGANIZATIONS. A PORTION OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. 1936722 1936722 14771307 4996582 9774725 5443671 2690238 2753433 9094072 7725477 1368595 15833475 CASH VALUE OF LIFE INSURANCE 1401549 DUE FROM ALZHEIMER'S FAMILY SERVICE 546797 DUE FROM COVENANT HEALTH AND COMMUNITY SERVICES 6587422 DUE FROM COVENANT HOME HEALTH HOLDING 1414969 DUE FROM MEMORY CARE CENTER 917561 DUE FROM COVENANT AT HOME 251305 DUE FROM COVENANT PALLIATIVE CARE 244210 11363813 DUE TO COVENANT HOME HEALTH CARE 3809825 DUE TO COVENANT HOSPICE FOUNDATION 39985 3849810 X PART X, LINE 2: CHCS, HOSPICE, THE FOUNDATION, AFS AND CPCS ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. X 0 1 X X X 0 0 0 0 0 0 0 0 0 JEFFREY M MISLEVY PRESIDENT/CEO 0 440884 0 230523 0 0 0 505 0 41339 0 713251 0 0 ODIN BERG CSO 0 255102 0 68706 0 8773 0 825 0 20913 0 354319 0 0 MARTIN FRANKLIN CFO 0 184566 0 26533 0 0 0 105 0 18936 0 230140 0 0 TODD FISHER COO 0 239251 0 59058 0 14135 0 177 0 26694 0 339315 0 0 JAMES SMITH PHYSICIAN 271554 0 11584 0 4751 0 401 0 26534 0 314824 0 0 0 SAUL RODRIGUEZ PHYSICIAN 276892 0 0 0 0 0 0 0 2244 0 279136 0 0 0 STEPHEN DILL PHYSICIAN 242836 0 0 0 0 0 781 0 6537 0 250154 0 0 0 RICK HARRELSON PHYSICIAN 245728 0 0 0 19710 0 705 0 10120 0 276263 0 0 0 DIANE SPARKS PHYSICIAN 91382 0 12078 0 56876 0 191 0 8928 0 169455 0 0 0 A ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY 521378815 2005-08-23 900000 RENOVATE INPATIENT FACILITY 0 0 0 B ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY 521378815 2005-08-23 8600000 BUILDING ACQUISITION 0 0 0 A 900000 17900 882100 2008 0 0 1 1 B 8600000 117139 8482861 2007 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/10/2010 ISSUER NAME: ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/10/2010 CAREY KING BOARD MEMBER 72772 CAREY KING IS STUDER GROUP'S DIRECTOR OF OPERATIONS AND COVENANT PAYS STUDER GROUP FOR CONSULTING SERVCIES. 0 XAN SMITH BOARD MEMBER 78947 XAN SMITH IS THE CFO OF BAPTIST HEALTH AND COVENANT PAYS BAPTISTS HEALTH FOR PATIENT EXPENSES. 0 DON HAFERKAMP BOARD MEMBER 80676 DON HAFERKAMP IS THE CEO CROWN HEALTH CARE LAUNDRY SERVICES. COVENANT HOSPICE PAYS CROWN HEALTH CARE LAUNDRY SERVICES FOR PATIENT RELATED EXPENSES. 0 MILLER CALDWELL BOARD MEMBER 37197 MILLER CALDWELL IS A PARTNER WITH CALDWELL ASSOCIATES ARCHITECTS AND COVENANT PAID CALDWELL ASSOCIATES ARCHITECTS FOR ARCHITECTUAL SERVICES 0 STEVE SARROS BOARD MEMBER 78947 STEVE SARROS IS THE CIO OF BAPTIST HEALTH AND COVENANT PAYS BAPTISTS HEALTH FOR PATIENT EXPENSES. 0 KENT SKOLROOD BOARD MEMBER 78947 KENT SKOLROOD IS THE PRESIDENT OF BAPTIST HEALTH AND COVENANT PAYS BAPTISTS HEALTH FOR PATIENT EXPENSES. 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER IS COVENANT HEALTH AND COMMUNITY SERVICES, INC. (CHCS). CHCS ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE, INC. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH AND COMMUNITY SERVICES, INC. ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE APPROVAL FROM COVENANT HEALTH AND COMMUNITY SERVICES, INC.: - THE APPOINTMENT OR REMOVAL OF A MEMBER OF THE BOARD OF DIRECTORS; - THE INCURRENCE OF ANY SINGLE INDEBTNESS OR OTHER OBLIGATIONS IN EXCESS OF $500,000 OR IN THE AGGREGATE DURING ANY 12 MONTHS OF INDEBTNESS OR OBLIGATIONS IN EXCESS OF $1,000,000; - THE TRANSFER OF ASSETS OF THE CORPORATION IN ONE OR MORE TRANSACTIONS WITH A VALUE IN EXCESS OF $1,000,000 OR ANY TRANSFER IF THE AGGREGATE TRANSFER IN THE PRECEDING 12 MONTHS EXCEEDS A VALUE IS EXCESS OF $2,000,000; - ANY SINGLE CAPITAL EXPENDITURE IN EXCESS OF $500,000 OR ANY CAPITAL EXPENDITURES IF, IN THE AGGREGATE, THERE WILL BE CAPITAL EXPENDITURES IN EXCESS OF $1,000,000 FOR THE PRIOR 12 MONTHS; - DISSOLUTION OF THE CORPORATION; - A MERGER OF THE CORPORATION INTO ANOTHER ENTITY WHERE THE CORPORATION IS NOT THE SURVIVING ENTITY; AND - AN AMENDMENT TO THE ARTICLES OF INCORPORATION OR THE BYLAWS. 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 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE PAID BY COVENANT HEALTH AND COMMUNITY SERVICES, INC. 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 2019. BECAUSE THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE NOT COMPENSATED BY THE FILING ORGANIZATION, THIS QUESTION WAS MARKED "NO" IN ACCORDANCE WITH FORM 990 INSTRUCTIONS. FORM 990, PART VI, SECTION C, LINE 18 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE ON WRITTEN REQUEST. 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. FORM 990, PART XI, LINE 9: CHANGE IN CASH SURRENDER VALUE 2,149. CHANGE IN VALUE OF TRUST RECEIVABLE 944,666. FORM 990, PART XII, LINE 2C THE EXECUTIVE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED DURING THE YEAR. 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 0 ALZHEIMER'S 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 0 COVENANT AT HOME INC 5041 N 12TH AVE PENSACOLA FL 32504 352543765 HOME HEALTH CARE FL 501(C)(3) LINE 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 0 COVENANT HEALTH AND COMMUNITY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 465132177 SEE SCHEDULE R, PART VII FL 501(C)(3) LINE 10 N/A 0 CHARITABLE REMAINDER TRUST 5041 N 12TH AVE PENSACOLA FL 32504 TRUST FL COVENANT HOSPICE INC T 1 0 0 1 1 1 0 0 0 0 1 0 0 1 1 1 0 1 0 0 COVENANT HOSPICE FOUNDATION INC C 283756 FMV COVENANT MEMORY CARE CENTER J 267108 FMV COVENANT ALZHEIMER'S FAMILY SERVICES J 3000 FMV COVENANT HOME HEALTH CARE J 128424 FMV COVENANT HEALTH AND COMMUNITY SERVICES O 4242045 FMV COVENANT ALZHEIMER'S FAMILY SERVICES D 546797 FMV COVENANT HEALTH AND COMMUNITY SERVICES D 6587422 FMV COVENANT HOME HEALTH HOLDING D 1414969 FMV COVENANT MEMORY CARE CENTER D 917561 FMV COVENANT AT HOME D 251305 FMV COVENANT PALLIATIVE CARE SERVICES D 244210 FMV COVENANT HOME HEALTH CARE E 3809825 FMV COVENANT HOSPICE FOUNDATION INC E 39985 FMV