COVENANT HOSPICE FOUNDATION INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
COVENANT HOSPICE FOUNDATION INC (EIN 59-3060139)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-13
IRS object ID
201823179349304972
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-13T13:42:09-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN592922169PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SALTMARSH CLEAVELAND & GUNDBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1900 NORTH 12TH AVENUEAddressLine1Txt
CityPENSACOLACityNm
State AbbreviationFLStateAbbreviationCd
ZIP32501ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN593060139EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COVENANT HOSPICE FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOVEBusinessNameControlTxt
Phone8504332155PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15041 N 12TH AVENUEAddressLine1Txt
CityPENSACOLACityNm
State AbbreviationFLStateAbbreviationCd
ZIP32504ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonODIN BERGPersonNm
Person TitleCFOPersonTitleTxt
Phone8504332155PhoneNum
Signature2018-11-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHARLES F GUND JR CPAPreparerPersonNm
PTINP00138367PTIN
Phone8504358300PhoneNum
Preparation2018-11-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address70.169.168.131IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-09IPDt
IP Tm13:01:57IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id4208B98AE2DE865DA8220B5D7308967EBA4369BFAtSubmissionCreationDeviceId
At Submission Filing Device Id4208B98AE2DE865DA8220B5D7308967EBA4369BFAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJEFF MISLEVYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line15041 N 12TH AVENUEAddressLine1Txt
CityPENSACOLACityNm
State AbbreviationFLStateAbbreviationCd
ZIP32504ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,564,562GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CHOOSECOVENANT.ORG/HOSPICEWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1991FormationYr
Legal Domicile StateFLLegalDomicileStateCd
Activity Or MissionTHE ORGANIZATION'S MISSION IS TO PROVIDE FUNDING TO COVENANT HOSPICE, INC. IN ORDER (SEE SCHEDULE O) (CONTINUATION FROM PART I, LINE 1) TO SUPPLEMENT CHARITY AND INDIGENT CARE.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers38TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$218,134PYContributionsGrantsAmt
CY Contributions Grants$1,140,430CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$134,369PYInvestmentIncomeAmt
CY Investment Income$184,872CYInvestmentIncomeAmt
PY Other Revenue-$69,760PYOtherRevenueAmt
CY Other Revenue$16,577CYOtherRevenueAmt
PY Total Revenue$282,743PYTotalRevenueAmt
CY Total Revenue$1,341,879CYTotalRevenueAmt
PY Grants And Similar Paid$486,414PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$355CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$552,391CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$425,698CYTotalFundraisingExpenseAmt
PY Other Expenses$16,094PYOtherExpensesAmt
CY Other Expenses$242,089CYOtherExpensesAmt
PY Total Expenses$502,508PYTotalExpensesAmt
CY Total Expenses$794,835CYTotalExpensesAmt
PY Revenues Less Expenses-$219,765PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$547,044CYRevenuesLessExpensesAmt
Total Assets BOY$4,645,955TotalAssetsBOYAmt
Total Assets EOY$5,725,693TotalAssetsEOYAmt
Total Liabilities BOY$124,802TotalLiabilitiesBOYAmt
Total Liabilities EOY$151,185TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,521,153NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,574,508NetAssetsOrFundBalancesEOYAmt
MissionTHE ORGANIZATIONS MISSION IS TO PROVIDE FUNDING TO COVENANT HOSPICE, INC. IN ORDER TO SUPPLEMENT CHARITY AND INDIGENT CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$227,053ExpenseAmt
Grant$355GrantAmt
DescTHE PURPOSE OF COVENANT HOSPICE FOUNDATION, INC. IS TO RECEIVE AND MAINTAIN A FUND OR FUNDS OF REAL OR PERSONAL PROPERTY, TO USE PRIMARILY FOR THE FINANCIAL SUPPORT AND ENCOURAGEMENT OF THE HEALTH CARE AND COMMUNITY SUPPORT PROGRAMS OF COVENANT HOSPICE, INC. IN 2017, THE AMOUNT TRANSFERRED HELPED SUPPORT THE COSTS OF UNFUNDED PROGRAMS OF COVENANT HOSPICE, INC. THESE UNFUNDED PROGRAMS INCLUDE SERVICES FROM THE FOLLOWING DEPARTMENTS: CHAPLAINS, BEREAVEMENT, CHILDREN, AND VOLUNTEERS. PALLIATIVE CARE SERVICES ARE ALSO OFFERED TO PATIENTS AFTER LIFE-LIMITING DIAGNOSES, BUT BEFORE THEY ARE READY FOR HOSPICE.Desc
Total Program Service Expenses$227,053TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document7IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARTIN FRANKLINBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8504332155PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15041 N 12TH AVEAddressLine1Txt
CityPENSACOLACityNm
State AbbreviationFLStateAbbreviationCd
ZIP32504ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
TOM OWENS
CHAIRMAN4.0012.00Yes (X)Yes (X)$0$0$0
RODNEY GUTTMAN PHD
VICE CHAIRMAN4.0012.00Yes (X)Yes (X)$0$0$0
CAREY KING
SECRETARY4.0012.00Yes (X)Yes (X)$0$0$0
XAN SMITH
TREASURER4.0012.00Yes (X)Yes (X)$0$0$0
JEFFREY MISLEVY
PRESIDENT/CEO4.0052.00Yes (X)Yes (X)$0$607,038$33,197
BILL GREENHUT
PAST CHAIRMAN4.008.00Yes (X)$0$0$0
BOB PETERSON
DIRECTOR4.004.00Yes (X)$0$0$0
JOHN R FOGG
DIRECTOR4.00Yes (X)$0$0$0
SUE STRAUGHN
DIRECTOR4.004.00Yes (X)$0$0$0
ODIN BERG
CFO4.0052.00Yes (X)$0$336,622$16,068
CHERYL HAMILTON
COO4.0048.00Yes (X)$0$322,912$12,538
MICHAEL HAMAKER
COO4.0048.00Yes (X)$0$116,139$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,382,711TotReportableCompRltdOrgAmt
Total Other Compensation$61,803TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$69,967FederatedCampaignsAmt
Fundraising$203,521FundraisingAmt
All Other Contributions$866,942AllOtherContributionsAmt
Noncash Contributions$203,521NoncashContributionsAmt
Total Contributions$1,140,430TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$94,382TotalRevenueColumnAmt
Exclusion$94,382ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,182,753SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,092,263SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$90,490SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$90,490TotalRevenueColumnAmt
Exclusion$90,490ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$145,312FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$203,521ContriRptFundraisingEventAmt
Fundraising Direct Expenses$130,420FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,892TotalRevenueColumnAmt
Exclusion$14,892ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$1,685TotalRevenueColumnAmt
Exclusion$1,685ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,685OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,341,879TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$201,449ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$355TotalAmt
Program Services$355ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$472,197TotalAmt
Program Services$99,161ProgramServicesAmt
Management And General$66,108ManagementAndGeneralAmt
Fundraising$306,928FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total-$978TotalAmt
Program Services-$205ProgramServicesAmt
Management And General-$137ManagementAndGeneralAmt
Fundraising-$636FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$48,919TotalAmt
Program Services$10,273ProgramServicesAmt
Management And General$6,849ManagementAndGeneralAmt
Fundraising$31,797FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$32,253TotalAmt
Program Services$6,773ProgramServicesAmt
Management And General$4,515ManagementAndGeneralAmt
Fundraising$20,965FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$20,998TotalAmt
Program Services$20,998ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$15,366TotalAmt
Program Services$3,027ProgramServicesAmt
Management And General$2,018ManagementAndGeneralAmt
Fundraising$10,321FundraisingAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
SALARY ALLOCATION$86,812$35,593$20,835$30,384
OTHER EXPENSES$45,641$11,246$9,227$25,168
SERVICE CHARGE$7,343$7,343

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$65,929TotalAmt
Program Services$39,832ProgramServicesAmt
Management And General$25,326ManagementAndGeneralAmt
Fundraising$771FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$794,835TotalAmt
Program Services$227,053ProgramServicesAmt
Management And General$142,084ManagementAndGeneralAmt
Fundraising$425,698FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$132,001BOYAmt
EOY$401,162EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$271,480BOYAmt
EOY$5,292,468EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,286BOYAmt
EOY$30,828EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$216BOYAmt
EOY$1,235EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$4,238,972BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$4,645,955BOYAmt
EOY$5,725,693EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
EOY$82,361EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$124,802BOYAmt
EOY$68,824EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$124,802BOYAmt
EOY$151,185EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,490,814BOYAmt
EOY$5,271,335EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$30,339BOYAmt
EOY$103,173EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
EOY$200,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,521,153BOYAmt
EOY$5,574,508EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,645,955BOYAmt
EOY$5,725,693EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$547,044ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$508,208NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$1,897OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$611,970CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$642,137CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$692,158CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$395,281CurrentTaxYearMinus1YearAmt
Current Tax Year$1,085,742CurrentTaxYearAmt
Total$3,427,288TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$611,970CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$642,137CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$692,158CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$395,281CurrentTaxYearMinus1YearAmt
Current Tax Year$1,085,742CurrentTaxYearAmt
Total$3,427,288TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$3,427,288PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$43,021CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$79,663CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$96,671CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$90,569CurrentTaxYearMinus1YearAmt
Current Tax Year$94,382CurrentTaxYearAmt
Total$404,306TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$96,756CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$105,611CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$99,215CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$43,800CurrentTaxYearMinus1YearAmt
Current Tax Year$90,490CurrentTaxYearAmt
Total$435,872TotalAmt
FieldValueIRS element (for citing)
Total Support$4,267,466TotalSupportAmt
Public Support CY1700.80310PublicSupportCY170Pct
Public Support PY1700.77620PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO COVENANT HOSPICE, INC.$23,582
GIFT ANNUITY OBLIGATION$14,959
DUE TO CHCS$30,283
FieldValueIRS element (for citing)
Total Liability$68,824TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationCHCS, HOSPICE, THE FOUNDATION, AFS AND CPCS ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1MASK PARADEEvent1Nm
Gross Receipts Event1$188,920GrossReceiptsEvent1Amt
Charitable Contri Event1$128,439CharitableContriEvent1Amt
Gross Revenue Event1$60,481GrossRevenueEvent1Amt
Rent Facility Costs Event1$17,118RentFacilityCostsEvent1Amt
Food And Beverage Event1$25,669FoodAndBeverageEvent1Amt
Entertainment Event1$4,440EntertainmentEvent1Amt
Other Direct Expenses Event1$12,533OtherDirectExpensesEvent1Amt
Event2LIFE'S A DANCEEvent2Nm
Gross Receipts Event2$88,039GrossReceiptsEvent2Amt
Charitable Contri Event2$50,536CharitableContriEvent2Amt
Gross Revenue Event2$37,503GrossRevenueEvent2Amt
Rent Facility Costs Event2$13,097RentFacilityCostsEvent2Amt
Entertainment Event2$49,500EntertainmentEvent2Amt
Other Direct Expenses Event2$10,755OtherDirectExpensesEvent2Amt
Other Events Total2OtherEventsTotalCnt
Gross Receipts Other Events$54,821GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$28,695CharitableContriOtherEventsAmt
Gross Revenue Other Events$26,126GrossRevenueOtherEventsAmt
Rent Fclty Costs Other Events$14,801RentFcltyCostsOtherEventsAmt
Entertainment Other Events$5,342EntertainmentOtherEventsAmt
Oth Direct Expnss Other Events$11,249OthDirectExpnssOtherEventsAmt
Gross Receipts Total$331,780GrossReceiptsTotalAmt
Charitable Contributions Tot$207,670CharitableContributionsTotAmt
Gross Revenue Total Events$124,110GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$45,016RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$25,669FoodAndBeverageTotalEventsAmt
Entertainment Total Events$59,282EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$34,537OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$164,504DirectExpenseSummaryEventsAmt
Net Income Summary-$40,394NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JEFFREY MISLEVY
PRESIDENT/CEO$0$416,202$0$190,458$0$378$0$0$0$33,197$0$640,235$0$0
ODIN BERG
CFO$0$269,123$0$48,030$0$19,469$0$3,333$0$12,735$0$352,690$0$0
CHERYL HAMILTON
COO$0$172,704$0$0$0$150,208$0$832$0$11,706$0$335,450$0$0

Schedule M IRS990ScheduleM

Other Non Cash Contri Table OtherNonCashContriTableGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
DescITEMS FOR EVENTSDesc
Contribution333ContributionCnt
Noncash Contributions Rpt F990$203,521NoncashContributionsRptF990Amt
Method Of Determining RevenuesFAIR MARKET VALUEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION'S SOLE MEMBER IS COVENANT HEALTH AND COMMUNITY SERVICES, INC. (CHCS). CHCS ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE FOUNDATION, INC.
FORM 990, PART VI, SECTION A, LINE 7ACOVENANT HEALTH AND COMMUNITY SERVICES, INC. ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE FOUNDATION, INC.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING ACTIONS REQUIRE WRITTEN APPROVAL FROM COVENANT HEALTH AND COMMUNITY SERVICES, INC: -THE APPOINTMENT OR THE REMOVAL OF A MEMBER OF THE BOARD OF DIRECTORS. -THE INCURRENCE OF ANY SINGLE INDEBTEDNESS OR OTHER OBLIGATIONS IN EXCESS OF $500,000 OR IN THE AGGREGATE DURING ANY 12 MONTHS OF INDEBTEDNESS 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 TRANSFERS IN THE PRECEDING 12 MONTHS EXCEEDS A VALUE OF $2,000,000. -ANY SINGLE CAPITAL EXPENDITURE IN EXCESS OF $500,000 OR ANY CAPITAL EXPENDITURE 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. -AN AMENDMENT TO THE ARTICLES OF INCORPORATION OR THE BYLAWS
FORM 990, PART VI, SECTION B, LINE 11BTHE 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 12CCONFLICT 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 15THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS ARE PAID BY COVENANT HOSPICE, INC. TO DETERMINE THE CEO'S, OTHER OFFICERS', AND OTHER EMPLOYEES' COMPENSATION, THE COVENANT HOSPICE, 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 2016. 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 19GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE ORGANIZATIONS CONFLICT OF INTEREST POLICY ARE AVAILABLE ON WRITTEN REQUEST.
FORM 990, PART XI, LINE 9:CHANGE IN SPLIT INTEREST TRANSFER OF COVENANT PALLIATIVE CARE SERVICES, LLC NET ASSETS EXPENSES PAID BY COVENANT HOSPICE, INC. ON BEHALF OF THE FOUNDATION CHANGE IN SPLIT INTEREST -1,897.
FORM 990, PART XII, LINE 2C:THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
COVENANT HOSPICE INC
5041 N 12TH AVEPENSACOLAFL32504592208300PROVIDES CARE TO TERMINALLY ILL PATIENTSFL501(C)(3)7COVENANT HEALTH AND COMMUNITY SERVICES INCYes (1)
ALZHEIMERS FAMILY SERVICES INC
5041 N 12TH AVEPENSACOLAFL32504593394242SUPPORT TO ALZHEIMERS PATIENTS AND FAMILIESFL501(C)(3)7COVENANT HEALTH AND COMMUNITY SERVICES INCYes (1)
COVENANT AT HOME INC
5041 N 12TH AVEPENSACOLAFL32504352543765HOME HEALTH CAREFL501(C)(3)10COVENANT HEALTH AND COMMUNITY SERVICES INCYes (1)
COVENANT HEALTH AND COMMUNITY SERVICES INC
5041 N 12TH AVEPENSACOLAFL32504465132177SEE SCHEDULE R, PART VIIFL501(C)(3)10Yes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990, SCHEDULE R, PART IIFormAndLineReferenceDesc
ExplanationPART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS NAME OF RELATED ORGANIZATION: COVENANT HEALTH AND COMMUNITY SERVICES, INC. PRIMARY ACTIVITY: PARENT CORPORATION OF COVENANT HOSPICE, INC., COVENANT HOSPICE FOUNDATION, INC., ALZHEIMER'S FAMILY SERVICES, INC., AND COVENANT HOME HEALTH HOLDINGS, LLC.ExplanationTxt

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