2018-11-13T13:38:37-06:00 2017-12-31 592922169 SALTMARSH CLEAVELAND & GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2017-01-01 465132177 COVENANT HEALTH AND COMMUNITY SERVICES INC COVE 8504332155 5041 N 12TH AVE 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 10:03:58 CS P 4208B98AE2DE865DA8220B5D7308967EBA4369BF 4208B98AE2DE865DA8220B5D7308967EBA4369BF 2017 2019-02-21 02:37:17Z COVENANT CARE JEFF MISLEVY 5041 N 12TH AVE PENSACOLA FL 32504 13372531 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. 18 17 12 38 0 0 0 0 8549082 13370990 253 1541 0 0 8549335 13372531 0 0 0 0 5989111 11192247 0 0 0 3474628 1458041 9463739 12650288 -914404 722243 12300797 13633290 13447723 14057973 -1146926 -424683 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. 6434649 13339567 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 109134 31423 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. 6543783 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 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 0 0 12 1 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARTIN 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 607038 0 33197 SUSAN DAVIS DIRECTOR 4.00 4.00 X 0 0 0 JAMES S CAMPBELL 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 0 0 0 JARL T YOUNG DIRECTOR 4.00 4.00 X 0 0 0 ODIN BERG CFO 4.00 52.00 X 336622 0 16068 CHERYL HAMILTON COO 4.00 48.00 X 322912 0 12538 TODD FISHER CIO 4.00 48.00 X 171500 0 18647 AARON WEST VP FOUNDATION 40.00 0.00 X 274549 0 20669 JAMES SMITH PHYSICIAN 40.00 0.00 X 274549 0 20669 JEAN MURPHY PHYSICIAN 40.00 0.00 X 200095 0 2030 STEPHEN DILL PHYSICIAN 40.00 0.00 X 165118 0 25 2352383 0 123843 4 0 1 0 0 HOME HEALTH CARE SERVICES 621610 13339567 13339567 PALLATIVE CARE SERVICES 623990 31423 31423 13370990 1541 1541 13372531 13370990 0 1541 9585737 4836455 4749282 63528 31107 32421 767084 433352 333732 775898 481606 294292 307412 307412 8317 8317 553639 553639 121340 121340 480204 480204 136323 136323 192908 192908 341434 335531 5903 212916 212916 19296 19296 14488 14488 MEDICAL SUPPLIES 316408 316408 SALARY ALLOCATION -1402552 109134 -1511686 155908 190 155718 12650288 6543783 6106505 0 48681 128449 1278009 1782961 1427859 1549072 10614 6832 335969 301249 23002 34720 9084225 9079725 428407 1051531 12300797 13633290 784330 1437240 9600000 8250000 3063393 4370733 13447723 14057973 X -1146926 -424683 -1146926 -424683 12300797 13633290 722243 0 X X 0 1 X 1 0 X 8549082 13370990 21920072 8549082 13370990 21920072 0 0 0 21920072 253 1541 1794 253 1541 1794 8549335 13372531 21921866 X 29537 29537 0 306432 271712 34720 34720 DUE FROM COVENANT AT HOME, INC. 86660 DUE FROM COVENANT HOSPICE, INC. 702340 DUE FROM COVENANT HOSPICE FOUNDATION, INC. 30283 DUE FROM MEMORY CARE CLINIC 142194 DUE FROM COVENANT ALZHEIMER'S SERVICES 90054 1051531 DUE TO COVENANT HOSPICE, INC. 4370733 4370733 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. 1 0 0 0 0 0 0 0 0 JEFF MISLEVY PRESIDENT/CEO 416202 0 190458 0 378 0 0 0 33197 0 640235 0 0 0 ODIN BERG CFO 269123 0 48030 0 19469 0 3333 0 12735 0 352690 0 0 0 CHERYL HAMILTON COO 172704 0 0 0 150208 0 832 0 11706 0 335450 0 0 0 TODD FISHER CIO 130873 0 32406 0 8221 0 0 0 18647 0 190147 0 0 0 AARON WEST VP FOUNDATION 271158 0 3391 0 0 0 2022 0 18647 0 295218 0 0 0 JAMES SMITH PHYSICIAN 248363 0 19779 0 6407 0 2022 0 18647 0 295218 0 0 0 JEAN MURPHY PHYSICIAN 200064 0 31 0 0 0 1974 0 56 0 202125 0 0 0 STEPHEN DILL PHYSICIAN 164817 0 301 0 0 0 0 0 25 0 165143 0 0 0 PART I, LINE 4A CHERYL HAMILTON, COO, RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $143,542. 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 2017. 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 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 0 13557717 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT PALLIATIVE CARE SERVICES LLC 5401 N 12TH AVE PENSACOLA FL 32504 464822066 PALLIATIVE SERVICES FL 31423 5320 COVENANT HEALTH AND COMMUNITY SERVICES INC COVENANT HOME HEALTH CARE LLC 5401 N 12TH AVE PENSACOLA FL 32504 262335536 HOME HEALTH CARE SERVICE FL 13340708 5028525 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 8250000 FAIR VALUE DUE TO COVENANT HOSPICE INC E 4370733 FAIR VALUE DUE FROM FOUNDATION D 30283 FAIR VALUE DUE FROM PRIVATE DUTY D 86660 FAIR VALUE DUE FROM COVENANT HOSPICE INC D 702340 FAIR VALUE DUE FROM COVENANT ALZHEIMER'S SERVICES D 90054 FAIR VALUE DUE FROM MEMORY CARE CLINIC D 142194 FAIR VALUE