2019-11-15T08:29:34-06:00 2018-12-31 592922169 SALTMARSH CLEAVELAND & GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2018-01-01 465132177 COVENANT HEALTH AND COMMUNITY SERVICES INC COVE 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 MARTY FRANKLIN CFO 8504332155 2019-11-11 1 CHARLES F GUND JR CPA P00138367 8504358300 2019-10-25 170.249.129.82 2019-11-11 10:40:13 CS P 485E2A1375944CFBAB9FA0C6BA2180630D642600 485E2A1375944CFBAB9FA0C6BA2180630D642600 2018 2020-03-31 21:24:44Z COVENANT CARE JEFF MISLEVY 5041 N 12TH AVE PENSACOLA FL 32504 14054053 0 X WWW.CHOOSECOVENANT.ORG X 2014 FL COVENANT HEALTH AND COMMUNITY SERVICES, INC. WAS FORMED TO ACT AS THE PARENT (SEE SCHEDULE O) (CONTINUATION FROM PART I, LINE 1) CORPORATION OF COVENANT HOSPICE AND ITS AFFILIATES. 16 15 248 11 0 0 0 0 13370990 14042911 1541 3323 0 7819 13372531 14054053 0 0 0 0 11192247 14536101 0 0 0 1458041 -1928204 12650288 12607897 722243 1446156 13633290 14781036 14057973 13759563 -424683 1021473 X COVENANT HEALTH AND COMMUNITY SERVICES, INC. WAS FORMED TO ACT AS THE PARENT CORPORATION OF THE FOUR CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, COVENANT HOSPICE, INC., COVENANT HOSPICE FOUNDATION, INC., ALZHEIMERS FAMILY SERVICES, INC., (SEE SCHEDULE O) (CONTINUATION FROM PART III, LINE 1) AND COVENANT AT HOME, INC. AS WELL AS COVENANT PALLIATIVE CARE SERVICES, LLC AND COVENANT HOME HEALTH HOLDING, LLC. 0 0 COVENANT HEALTH AND COMMUNITY SERVICES, INC. WAS FORMED TO ACT AS THE PARENT CORPORATION OF THE FOUR CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE, COVENANT HOSPICE, INC., COVENANT HOSPICE FOUNDATION, INC., ALZHEIMERS FAMILY SERVICES, INC., AND COVENANT AT HOME, INC. AS WELL AS THE TWO DISREGARDED ENTITES COVENANT PALLIATIVE CARE SERVICES, LLC, AND COVENANT HOME HEALTH HOLDINGS, LLC. COVENANT HOME HEALTH HOLDINGS, LLC IS THE SINGLE MEMBER OF COVENANT HOME HEALTH CARE, LLC. 6912296 14037419 HOME HEALTH CARE SERVICES - COVENANT CARE IS MAKING A GREATER PROMISE, OFFERING ADDITIONAL SKILLED, HOME-BASED MEDICAL SERVICES AND THERAPIES FOR THOSE:I. RECOVERING FROM SURGERYII. RECOVERING FROM AN ACCIDENT OR INJURYIII. DEALING WITH A SERIOUS ILLNESS OR DISABILITY 43779 5492 PALLIATIVE CARE SERVICES - COVENANT CARE'S PALLIATIVE CARE SERVICES CAN ASSIST PATIENT WHO NEED RELIEF FROM PAIN AND ALLEVIATE DISTRESSING SYMPTOMS. PALLIATIVE CARE CAN BE OFFERED ANY TIME DURING DIAGNOSIS AND TREATMENT OF MANY LONG-TERM CONDITIONS. OUR FOCUS IS TO RELIEVE THE PHYSICAL, SOCIAL, EMOTIONAL AND SPIRITUAL SUFFERING THAT OFTEN ACCOMPANIES A CHRONIC OR COMPLEX ILLNESS. 6956075 1 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 11 0 1 248 1 0 0 0 0 0 0 0 0 0 0 X 16 15 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MARTY FRANKLIN 8504322155 5401 N 12TH AVE PENSACOLA FL 32504 TOM OWENS CHAIRMAN 4.00 12.00 X X 0 0 0 RODNEY GUTTMANN 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 BILL GREENHUT PAST CHAIRMAN 4.00 8.00 X 0 0 0 JEFF MISLEVY PRESIDENT/CEO 4.00 52.00 X X 774470 0 58427 SUSAN DAVIS DIRECTOR 4.00 4.00 X 0 0 0 TERESA DOS SANTOS DIRECTOR 4.00 4.00 X 0 0 0 DON HAFERKAMP DIRECTOR 4.00 4.00 X 0 0 0 WANDA KAYE HAMBRICK DIRECTOR 4.00 4.00 X 0 0 0 JANET KINNEY DIRECTOR 4.00 4.00 X 0 0 0 BRETT PARRA DIRECTOR 4.00 4.00 X 0 0 0 ROGER POISTRAS 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 PATRICE VILLEMURE DIRECTOR 4.00 4.00 X 140242 0 1435 ODIN BERG CSO 4.00 52.00 X 328853 0 20589 TODD FISHER CIO 4.00 48.00 X 279239 0 30248 AARON WEST VP FOUNDATION 4.00 48.00 X 201358 0 27708 MARTIN FRANKLIN CFO 4.00 48.00 X 179624 0 16832 PAMELA CAMPBELL ASSOCIATE VP OF HOME HEALTH 40.00 X 190818 0 19665 AMY BAJJALY VP ORGANIZATIONAL ENGAGEMENT AND DEVELOPMENT 40.00 X 145042 0 8446 KAREN YOUNG PAYROLL MANAGER 40.00 X 136215 0 9241 KARA BENEDICT SENIOR DIRECTOR, ORGANIZATIONAL INTEGRITY 40.00 X 123644 0 2851 2499505 0 195442 10 0 1 0 MEDLINE THREE LAKES DRIVE NORTHFIELD IL 60093 MEDICAL SUPPLIES 193262 HEALTHWYSE 5210 LEWIS ROAD AGOURA HILLS CA 91356 EMR SOFTWARE 117955 2 HOME HEALTH CARE SERVICES 621610 14037419 14037419 PALLATIVE CARE SERVICES 623990 5492 5492 14042911 3323 3323 MISC. REVENUE 900099 7819 7819 7819 14054053 14042911 0 11142 12210666 5063747 7146919 108476 46412 62064 1358368 549369 808999 858591 368386 490205 301565 301565 10800 10800 212972 212972 58548 58548 225681 225681 137071 137071 239226 239226 356791 335644 21147 248194 248194 82050 82050 84 84 MEDICAL SUPPLIES 353291 353291 BAD DEBT EXPENSE 149870 149870 SALARY ALLOCATION -4389497 -4389497 85150 85150 12607897 6956075 5651822 0 128449 37428 1782961 1201436 1549072 2260780 6832 17606 650567 378799 34720 271768 9079725 9075225 1051531 1916793 13633290 14781036 1437240 1555799 8250000 6700000 4370733 5503764 14057973 13759563 X -424683 1021473 -424683 1021473 13633290 14781036 1446156 0 X X 0 1 X 1 0 X 8549082 13370990 14042911 35962983 8549082 13370990 14042911 35962983 0 0 0 35962983 253 1541 3323 5117 253 1541 3323 5117 8549335 13372531 14046234 35968100 X 308742 49190 259552 341825 329609 12216 271768 DUE FROM COVENANT AT HOME, INC. 102267 DUE FROM COVENANT HOSPICE, INC. 1586266 DUE FROM COVENANT HOSPICE FOUNDATION, INC. 22854 DUE FROM MEMORY CARE CLINIC 176832 DUE FROM COVENANT ALZHEIMER'S SERVICES 28574 1916793 DUE TO COVENANT HOSPICE, INC. 5501890 DUE TO COVENANT AT HOME, INC. 1874 5503764 X PART X, LINE 2: CHCS, HOSPICE, THE FOUNDATION, AFS, CAH 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 JEFF MISLEVY PRESIDENT/CEO 393283 0 345613 0 35574 0 2700 0 55727 0 832897 0 0 0 ODIN BERG CSO 254285 0 64542 0 10026 0 2700 0 17889 0 349442 0 0 0 TODD FISHER CIO 213758 0 56827 0 8654 0 1663 0 28585 0 309487 0 0 0 AARON WEST VP FOUNDATION 175812 0 25546 0 0 0 0 0 27708 0 229066 0 0 0 MARTIN FRANKLIN CFO 157327 0 22297 0 0 0 0 0 16832 0 196456 0 0 0 PAMELA CAMPBELL ASSOCIATE VP OF HOME HEALTH 161319 0 22787 0 6712 0 2708 0 16957 0 210483 0 0 0 AMY BAJJALY VP ORGANIZATIONAL ENGAGEMENT AND DEV 130352 0 14690 0 0 0 1082 0 7364 0 153488 0 0 0 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 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 2018. 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 XII, LINE 2C: THE EXECUTIVE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCEDURE HAS NOT CHANGED DURING THE YEAR. COVENANT HOME HEALTH HOLDINGS LLC 5401 N 12TH AVE PENSACOLA FL 32504 811010716 SINGLE MEMBER OF COVENANT HOME HEALTH CARE, LLC FL 7819 15636507 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT PALLIATIVE CARE SERVICES LLC 5401 N 12TH AVE PENSACOLA FL 32504 464822066 PALLIATIVE SERVICES FL 5492 1217 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE LLC 5401 N 12TH AVE PENSACOLA FL 32504 262335536 HOME HEALTH CARE SERVICE FL 14030568 6905974 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOSPICE INC 5041 N 12TH AVE PENSACOLA FL 32504 592208300 PROVIDES CARE TO TERMINALLY ILL PATIENTS FL 501(C)(3) 7 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 COVENANT HOSPICE FOUNDATION INC 5041 N 12TH AVE PENSACOLA FL 32504 593060139 FUNDRAISING FL 501(C)(3) 7 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 ALZHEIMERS FAMILY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 593394242 SUPPORT TO ALZHEIMERS PATIENTS AND FAMILIES FL 501(C)(3) 7 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 COVENANT AT HOME INC 5041 N 12TH AVE PENSACOLA FL 32504 322543765 HOME HEALTH CARE FL 501(C)(3) 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 COVENANT HOSPICE INC E 6450000 FAIR VALUE DUE TO COVENANT HOSPICE INC E 5501890 FAIR VALUE DUE FROM COVENANT HOSPICE FOUNDATION INC D 22854 FAIR VALUE DUE FROM COVENANT AT HOME INC D 114032 FAIR VALUE DUE FROM COVENANT HOSPICE INC D 1586266 FAIR VALUE DUE FROM COVENANT ALZHEIMER'S SERVICES D 28574 FAIR VALUE DUE FROM MEMORY CARE CLINIC D 176832 FAIR VALUE COVENANT HOSPICE INC O 4186950 FAIR VALUE COVENANT ALZHEIMER'S SERVICES O 48984 FAIR VALUE COVENANT HOSPICE FOUNDATION INC O 91548 FAIR VALUE COVENANT AT HOME INC O 27372 FAIR VALUE MEMORY CARE CLINIC O 34638 FAIR VALUE