2020-02-13T12:23:25-06:00 2019-09-30 941239084 ATHERTON & ASSOCIATES LLP PO BOX 4339 MODESTO CA 953524339 990 2018-10-01 770562224 COMMUNITY HOSPICE FOUNDATION COMM 2095786300 4368 SPYRES WAY MODESTO CA 95356 C DESHA MCLEOD CHIEF EXECUTIVE OFFICER 2095786300 2020-01-29 1 JACQUELYN HOWELL P01327223 2095774800 40.78.20.117 2020-01-29 16:21:58 PS P AA4754A7C66D45AA15D6CE8B9DF6349192B50C3A 419D865F74232CCBCCAD33BAEF513083C78AEE62 2018 2020-11-19 02:30:22Z C DESHA MCLEOD 4368 SPYRES WAY MODESTO CA 95356 2040820 0 X WWW.HOSPICEHEART.ORG X 2002 CA SUPPORT OF COMMUNITY HOSPICE, INC. 20 20 7 89 0 0 804980 1441614 0 0 161667 168075 346087 23463 1312734 1633152 1572885 388837 0 0 359954 357542 0 0 181654 299737 273204 2232576 1019583 -919842 613569 7176784 7426353 855431 565537 6321353 6860816 THE FOUNDATION EXISTS TO RAISE FUNDS AND AWARENESS OF THE COMMUNITY HOSPICE MISSION. COMMUNITY HOSPICE PROVIDES COMPASSIONATE END-OF-LIFE CARE AND BEREAVEMENT SUPPORT TO PATIENTS AND THEIR FAMILIES REGARDLESS OF ABILITY TO PAY. 0 0 792452 388837 0 TO RAISE FUNDS TO SUPPORT THE OPERATIONS OF COMMUNITY HOSPICE, INC., A RELATED NOT-FOR-PROFIT CORPORATION. COMMUNITY HOSPICE, INC. USES THESE FUNDS TO PROVIDE SERVICES AND SUPPORT TO THE TERMINALLY ILL AND THEIR FAMILIES. 792452 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 6 0 7 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 20 20 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X CHARISE REEVES 2095786300 4368 SPYRES WAY MODESTO CA 95356 JENNIFER GOMES CHAIRMAN 1.00 1.00 X X 0 0 0 JAMES A COGDILL VICE CHAIR 1.00 X X 0 0 0 MELVIN BRADLEY DIRECTOR 1.00 X 0 0 0 TERESA SCOTT TREASURER 1.00 X X 0 0 0 JENNIFER SANGUINETTI PAST CHAIR 1.00 X X 0 0 0 NANCY HOUGHTON DIRECTOR 1.00 X 0 0 0 TRACEY KERR DIRECTOR 1.00 X 0 0 0 CLAUDIA KRAUSNICK DIRECTOR 1.00 X 0 0 0 ROBERT LOPEZ DIRECTOR 1.00 X 0 0 0 JUDY WETZEL DIRECTOR 1.00 X 0 0 0 CHUCK MITTEN SECRETARY 1.00 X X 0 0 0 CLAIRE HELBIG MD DIRECTOR 1.00 X 0 0 0 SHANNON GILBERT-WEAVER DIRECTOR 1.00 X 0 0 0 PATRICK BLUM DIRECTOR 1.00 X 0 0 0 EUGENE AWUAH DIRECTOR 1.00 X 0 0 0 DON GAEKLE DIRECTOR 1.00 X 0 0 0 KRISTI AH YOU DIRECTOR 1.00 X 0 0 0 JAMES RYAN COGDILL DIRECTOR 1.00 X 0 0 0 MERYL SNIDER DIRECTOR 1.00 X 0 0 0 CATHY MENDOZA DIRECTOR 1.00 X 0 0 0 MELISSA VAN DIEPEN CHF EXECUTIVE DIRECTOR 40.00 2.00 X 78284 0 3914 CHARLOTTE D MCLEOD CHIEF EXECUTIVE OFFICER 1.00 41.00 X 0 279630 11231 TAMI BENNETT DIRECTOR OF FINANCE 1.00 41.00 X 0 115439 0 KAREN HALL PAIN AND PALLIATIVE CARE RESOURCE NURSE 1.00 41.00 X 0 138816 7021 JOHN RENNER DIRECTOR OF RETAIL OPERATIONS 1.00 41.00 X 0 131134 6764 MANINDERDEEP KAHLON NURSE PRACTITIONER 1.00 41.00 X 0 162105 8105 CHRISTINE STEWART DIRECTOR OF PALLIATIVE CARE 1.00 41.00 X 0 149331 7500 JOANN LINDBERG CLINICAL EDUCATOR 1.00 41.00 X 0 129281 2603 LAURA MILLER FORMER ACHH ADMINISTRATOR 1.00 41.00 X 0 135932 6122 78284 1241668 53260 0 1 1 0 0 453570 988044 138584 1441614 139506 139506 28569 0 28569 28569 28569 375721 453570 407668 -31947 -31947 55410 0 55410 55410 1633152 0 0 191538 388837 388837 97361 48680 48681 232100 116050 116050 3611 1806 1805 24470 12235 12235 45477 45477 26360 26360 36667 36667 19226 19226 5640 5640 5606 5606 10073 9390 683 BANK, CREDIT CARD & PAY 64044 64044 COMPUTER MAINTENANCE 28961 28961 OTHER PROGRAM EXPENSES 20365 20365 STAFF RECRUITMENT, TRAI 6423 6423 4362 2162 2200 1019583 792452 45477 181654 185564 331898 150132 136411 24828 31641 9301 10514 42085 31988 45570 45570 0 0 2276143 2294013 3446000 3468000 1042731 1121888 7176784 7426353 79346 86202 30225 32378 745860 446957 855431 565537 X 5363924 5800564 124107 111353 833322 948899 6321353 6860816 7176784 7426353 613569 -74106 0 X X 0 1 X 1 0 X X 1 COMMUNITY HOSPICE INC 942638213 10 1 388837 0 1 388837 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1058448 114384 -30508 1142324 1037202 1638 19608 1058448 994697 2158 40347 1037202 514920 404500 75277 994697 552733 2752 -40565 514920 0.16930 0.83070 0.00000 0 0 17989 17989 0 27581 27581 0 0 LIMITED PARTNERSHIP 3468000 F 3468000 INVESTMENT PROPERTY 4000 ENDOWMENT INVESTMENTS 1117888 1121888 RELATED PARTY PAYABLE 446957 446957 X 1559180 -74106 134 -73972 1633152 0 1633152 630880 134 134 630746 388837 388837 1019583 PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS ARE TO FUND FUTURE OPERATING EXPENSES OF COMMUNITY HOSPICE, INC. PART X, LINE 2: MANAGEMENT HAS EVALUATED THE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT THE FOUNDATION 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. THE FOUNDATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR TAX YEARS ENDING SEPTEMBER 30, 2015 AND PRIOR. PART XI, LINE 2D - OTHER ADJUSTMENTS: EVENT EXPENSES INCLUDED IN PART VIII LINE 8B PART XII, LINE 2D - OTHER ADJUSTMENTS: EVENT EXPENSES INCLUDED IN PART VIII LINE 8B PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION TO COMMUNITY HOSPICE NOT INCLUDED AS FINANCIAL STATEMENT EXP. GALA 391128 270261 120867 59419 58900 99192 GOLF FORE HOSPICE 114818 74746 40072 9620 22048 34524 8 323345 108563 214782 17212 15849 90904 829291 453570 375721 86251 96797 224620 407668 -31947 55410 1 0.95000 55410 55410 CA 1 0 0 0 1.00000 CHARISE REEVES 4368 SPYRES WAY MODESTO CA 95356 0 MELISSA VAN DIEPEN 927 REGISTRATION AND OPERATION OF RAFFLES. X 0 1 COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 501(C)(3) 388837 FUNDS RAISED AND REIMBURSED EXPENSES FOR COMMUNITY HOSPICE INC 1 PART I, LINE 2: ALL FUNDS ARE DISTRIBUTED TO COMMUNITY HOSPICE, INC. WHICH IS A RELATED ENTITY. X X X X X 0 0 0 0 0 0 0 0 0 CHARLOTTE D MCLEOD CHIEF EXECUTIVE OFFICER 0 279630 0 0 0 0 0 8318 0 2913 0 290861 0 0 MANINDERDEEP KAHLON NURSE PRACTITIONER 0 162105 0 0 0 0 0 8105 0 0 0 170210 0 0 CHRISTINE STEWART DIRECTOR OF PALLIATIVE CARE 0 149331 0 0 0 0 0 7500 0 0 0 156831 0 0 LAURA MILLER FORMER ACHH ADMINISTRATOR 0 135932 0 0 0 0 0 6122 0 0 0 142054 0 0 X CONSUMABLE GOODS 36 73059 DONOR REPRESENTATION X PRIZES 277 65525 DONOR REPRESENTATION 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES ARE PERFORMED BY CHI MANAGEMENT, INC. WHICH IS A RELATED PARTY EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY HOSPICE INC. IS THE MEMBER OF COMMUNITY HOSPICE FOUNDATION AND IS A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS ONE MEMBER WITH THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY. THE MEMBER IS COMMUNITY HOSPICE, INC., A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS BY THE ORGANIZATION MAY BE SUBJECT TO APPROVAL BY COMMUNITY HOSPICE, INC. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS REVIEWS THE FORM 990 AND IS PROVIDED WITH AN OPPORTUNITY TO COMMENT ON THE TAX RETURN PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES, VOLUNTEERS, AND MEMBERS OF THE BOARD OF DIRECTORS AND ADVISORY COMMITTEES WILL SIGN A CONFLICT OF INTEREST DOCUMENT UPON EMPLOYMENT, APPOINTMENT, OR REAPPOINTMENT AT LEAST ANNUALLY AND MONITORED BY THE CORPORATE COMPLIANCE OFFICER, INDICATING THAT THEY HAVE READ AND UNDERSTOOD THE RELEVANT POLICIES AND THAT THEY WILL OBSERVE THEM. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS APPROVED BY THE INDEPENDENT BOARD OF DIRECTORS WHERE THE VOTE OF EACH MEMBER IS COUNTED. COMPENSATION ANALYSIS OF SIMILARLY SITUATED ORGANIZATIONS (TAXABLE AND TAX-EXEMPT) WITH RESPECT TO SIZE AND RESPONSIBILITIES OF EACH POSITION ARE COMPARED. THIS ANALYSIS IS PREPARED ANNUALLY. THE PROCESS OF ARRIVING AT EACH INDIVIDUAL'S COMPENSATION ARRANGEMENT IS DOCUMENTED IN BOARD MINUTES, PERSONAL ACTION FORMS, AND THE EMPLOYEE'S PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ANNUAL REPORT TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: MEMBERS OF THE BOARD OF DIRECTORS FROM COMMUNITY HOSPICE, INC., CHI MANAGEMENT, INC. AND COMMUNITY HOSPICE FOUNDATION MAKE UP THE AUDIT COMMITTEE CHARGED WITH THE RESPONSIBILITY OF OVERSIGHT IN CONNECTION TO THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT AUDITORS. COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 HOSPICE CARE FOR THE TERMINALLY ILL CA 501(C)(3) 509(A)(2) N/A 0 CHI MANAGEMENT INC 4368 SPYRES WAY MODESTO CA 95356 200178425 PROVIDE PROFESSIONAL SERVICES FOR CHI INC., CHI FOUNDATION AND HOPE CHEST CA 501(C)(3) 509(A)(2) N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0