2019-02-14T11:18:24-06:00 2018-09-30 941239084 ATHERTON & ASSOCIATES LLP PO BOX 4339 MODESTO CA 953524339 990 2017-10-01 770562224 COMMUNITY HOSPICE FOUNDATION COMM 2095786300 4368 SPYRES WAY MODESTO CA 95356 C DESHA MCLEOD CHIEF EXECUTIVE OFFICER 2095786300 2019-02-12 1 REBECCA TERPSTRA P00644129 2095774800 X 40.78.20.117 2019-02-12 10:54:39 PS P 54AE4CD357D5262618D17D9116C5C91855C11534 54AE4CD357D5262618D17D9116C5C91855C11534 2017 2019-02-21 02:37:17Z C DESHA MCLEOD 4368 SPYRES WAY MODESTO CA 95356 1622153 0 X WWW.HOSPICEHEART.ORG X 2002 CA SUPPORT OF COMMUNITY HOSPICE, INC. 20 20 6 92 0 0 1019491 804980 0 0 132165 161667 230475 346087 1382131 1312734 1676441 1572885 0 0 371225 359954 0 0 185091 262398 299737 2310064 2232576 -927933 -919842 7898367 7176784 912037 855431 6986330 6321353 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 1998825 1572885 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. 1998825 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 8 0 6 1 0 0 0 0 0 1 1 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 TAMI BENNETT 2095786300 4368 SPYRES WAY MODESTO CA 95356 JENNIFER SANGUINETTI CHAIRMAN 1.00 1.00 X X 0 0 0 JENNIFER GOMES VICE CHAIR 1.00 X X 0 0 0 KRISTI AH YOU DIRECTOR 1.00 X 0 0 0 JAMES A COGDILL TREASURER 1.00 X X 0 0 0 SUE CIPPONERI CPA PAST CHAIR 1.00 X X 0 0 0 EUGENE AWUAH DIRECTOR 1.00 X 0 0 0 PATRICK BLUM DIRECTOR 1.00 X 0 0 0 MELVIN BRADLEY DIRECTOR 1.00 X 0 0 0 JAMES RYAN COGDILL DIRECTOR 1.00 X 0 0 0 DON GAEKLE DIRECTOR 1.00 X 0 0 0 TERESA SCOTT SECRETARY 1.00 X X 0 0 0 SHANNON GILBERT-WEAVER DIRECTOR 1.00 X 0 0 0 CLAIRE HELBIG DIRECTOR 1.00 X 0 0 0 NANCY HOUGHTON CHF DIRECTOR & CAMP 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 CHUCK MITTEN DIRECTOR 1.00 X 0 0 0 MERYL SNIDER DIRECTOR 1.00 X 0 0 0 JUDY WETZEL DIRECTOR 1.00 X 0 0 0 MONICA OJCIUS CHF EXECUTIVE DIRECTOR 40.00 2.00 X 110049 0 5790 MELISSA VAN DIEPEN CHF EXECUTIVE DIRECTOR 40.00 2.00 X 64383 0 3219 CHARLOTTE D MCLEOD CHIEF EXECUTIVE OFFICER 1.00 41.00 X 0 272851 10283 TAMI BENNETT DIRECTOR OF FINANCE 1.00 41.00 X 0 122039 0 KAREN HALL DIRECTOR OF PALLIATIVE CARE 1.00 41.00 X 0 107826 2121 LAURA MILLER ACHH ADMINISTRATOR 1.00 41.00 X 0 132580 6944 MANINDERDEEP KAHLON NURSE PRACTITIONER 1.00 41.00 X 0 157197 4241 JOANN LINDBERG CLINICAL EDUCATOR 1.00 41.00 X 0 129142 2605 CHRISTINE STEWART PATIENT CARE MANAGER 1.00 41.00 X 0 145216 7292 174432 1066851 42495 1 0 1 0 0 87092 717888 87092 804980 152159 152159 9508 0 9508 9508 9508 602725 87092 309419 293306 293306 52781 0 52781 52781 1312734 0 0 507754 1572885 1572885 121567 60783 60784 211332 105666 105666 3596 1798 1798 23459 11730 11729 48660 48660 27138 27138 50 50 65980 65980 18000 18000 8314 8314 4413 4413 14 14 9429 8877 552 BANK, CREDIT CARD & PAY 60553 60553 COMPUTER MAINTENANCE 24810 24810 OTHER PROGRAM EXPENSES 13788 13788 STAFF RECRUITMENT, TRAI 8696 8696 9892 5330 4562 2232576 1998825 48660 185091 392845 185564 606865 150132 15902 24828 9066 9301 54292 42085 45570 45570 0 0 2528383 2276143 3273000 3446000 1018014 1042731 7898367 7176784 121201 79346 71966 30225 718870 745860 912037 855431 X 6071205 5363924 85223 124107 829902 833322 6986330 6321353 7898367 7176784 -919842 254865 0 X X 0 1 X 1 0 X X 1 COMMUNITY HOSPICE INC 942638213 10 1 1572885 0 1 1572885 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1037202 1638 19608 1058448 994697 2158 40347 1037202 514920 404500 75277 994697 552733 2752 -40565 514920 510920 3213 38600 552733 0.21270 0.78730 0.00000 0 0 17989 17989 0 27581 27581 0 0 LIMITED PARTNERSHIP 3446000 F 3446000 INVESTMENT PROPERTY 4000 ENDOWMENT INVESTMENTS 1038731 1042731 RELATED PARTY PAYABLE 745860 745860 X 1576061 254865 8462 263327 1312734 0 1312734 668153 8462 8462 659691 1572885 1572885 2232576 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, 2014 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: SUPPORT TRANSFERRED TO OTHER PARTIES NOT INCLUDED IN EXPENSES ON F/S PART XIII, LINE 2D AND 4B LINE 2D OTHER REVENUE - COST OF GOOD SOLD FOR FUNDRAISING EVENTS LINE 2D OTHER EXPENSES - COST OF GOODS SOLD FOR FUNDRAISING EVENTS LINE 4B OTHER EXPENSES - TRANSFERS MADE TO RELATED PARTIES GALA 299658 19645 280013 23123 39099 40315 GOLF FORE HOSPICE 110914 25258 85656 8360 20422 38433 7 279245 42189 237056 13584 20863 105220 689817 87092 602725 45067 80384 183968 309419 293306 52781 1 0.95000 52781 52781 CA 1 0 0 0 1.00000 TAMI BENNETT 4368 SPYRES WAY MODESTO CA 95356 0 MELISSA VAN DIEPEN 727 REGISTRATION AND OPERATION OF RAFFLES. X 0 1 COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 501(C)(3) 1572885 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 272851 0 0 0 0 0 8169 0 2114 0 283134 0 0 MANINDERDEEP KAHLON NURSE PRACTITIONER 0 157197 0 0 0 0 0 4241 0 0 0 161438 0 0 CHRISTINE STEWART PATIENT CARE MANAGER 0 145216 0 0 0 0 0 7292 0 0 0 152508 0 0 X PRIZES 174 87092 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