2018-11-13T13:42:09-06:00 2017-12-31 592922169 SALTMARSH CLEAVELAND & GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2017-01-01 593060139 COVENANT HOSPICE FOUNDATION INC COVE 8504332155 5041 N 12TH AVENUE PENSACOLA FL 32504 ODIN BERG CFO 8504332155 2018-11-09 1 CHARLES F GUND JR CPA P00138367 8504358300 2018-11-09 70.169.168.131 2018-11-09 13:01:57 CS P 4208B98AE2DE865DA8220B5D7308967EBA4369BF 4208B98AE2DE865DA8220B5D7308967EBA4369BF 2017 2019-02-21 02:37:17Z JEFF MISLEVY 5041 N 12TH AVENUE PENSACOLA FL 32504 2564562 0 X WWW.CHOOSECOVENANT.ORG/HOSPICE X 1991 FL THE 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. 9 8 0 38 0 0 218134 1140430 0 0 134369 184872 -69760 16577 282743 1341879 486414 355 0 0 0 552391 0 0 425698 16094 242089 502508 794835 -219765 547044 4645955 5725693 124802 151185 4521153 5574508 THE ORGANIZATIONS MISSION IS TO PROVIDE FUNDING TO COVENANT HOSPICE, INC. IN ORDER TO SUPPLEMENT CHARITY AND INDIGENT CARE. 0 0 227053 355 THE 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. 227053 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARTIN FRANKLIN 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 TOM OWENS CHAIRMAN 4.00 12.00 X X 0 0 0 RODNEY GUTTMAN PHD 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 MISLEVY PRESIDENT/CEO 4.00 52.00 X X 0 607038 33197 BILL GREENHUT PAST CHAIRMAN 4.00 8.00 X 0 0 0 BOB PETERSON DIRECTOR 4.00 4.00 X 0 0 0 JOHN R FOGG DIRECTOR 4.00 X 0 0 0 SUE STRAUGHN DIRECTOR 4.00 4.00 X 0 0 0 ODIN BERG CFO 4.00 52.00 X 0 336622 16068 CHERYL HAMILTON COO 4.00 48.00 X 0 322912 12538 MICHAEL HAMAKER COO 4.00 48.00 X 0 116139 0 0 1382711 61803 0 0 1 0 0 69967 203521 866942 203521 1140430 94382 94382 1182753 1092263 90490 90490 90490 145312 203521 130420 14892 14892 OTHER INCOME 900099 1685 1685 1685 1341879 0 0 201449 355 355 472197 99161 66108 306928 -978 -205 -137 -636 48919 10273 6849 31797 32253 6773 4515 20965 20998 20998 15366 3027 2018 10321 SALARY ALLOCATION 86812 35593 20835 30384 OTHER EXPENSES 45641 11246 9227 25168 SERVICE CHARGE 7343 7343 65929 39832 25326 771 794835 227053 142084 425698 132001 401162 271480 5292468 3286 30828 216 1235 4238972 0 4645955 5725693 82361 124802 68824 124802 151185 X 4490814 5271335 30339 103173 200000 4521153 5574508 4645955 5725693 X 547044 508208 -1897 X X 0 1 X 1 0 X 611970 642137 692158 395281 1085742 3427288 611970 642137 692158 395281 1085742 3427288 3427288 43021 79663 96671 90569 94382 404306 96756 105611 99215 43800 90490 435872 4267466 0.80310 0.77620 X 0 DUE TO COVENANT HOSPICE, INC. 23582 GIFT ANNUITY OBLIGATION 14959 DUE TO CHCS 30283 68824 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. MASK PARADE 188920 128439 60481 17118 25669 4440 12533 LIFE'S A DANCE 88039 50536 37503 13097 49500 10755 2 54821 28695 26126 14801 5342 11249 331780 207670 124110 45016 25669 59282 34537 164504 -40394 1 X X X 0 0 0 0 0 0 0 0 0 JEFFREY MISLEVY PRESIDENT/CEO 0 416202 0 190458 0 378 0 0 0 33197 0 640235 0 0 ODIN BERG CFO 0 269123 0 48030 0 19469 0 3333 0 12735 0 352690 0 0 CHERYL HAMILTON COO 0 172704 0 0 0 150208 0 832 0 11706 0 335450 0 0 X ITEMS FOR EVENTS 333 203521 FAIR MARKET VALUE 0 0 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 FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH AND COMMUNITY SERVICES, INC. ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7B THE 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 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 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 19 GOVERNING 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. 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 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 352543765 HOME HEALTH CARE FL 501(C)(3) 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 COVENANT HEALTH AND COMMUNITY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 465132177 SEE SCHEDULE R, PART VII FL 501(C)(3) 10 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 FORM 990, SCHEDULE R, PART II PART 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.