2018-02-15T10:12:37-06:00 2017-09-30 941239084 ATHERTON & ASSOCIATES LLP PO BOX 4339 MODESTO CA 953524339 990 2016-10-01 770562224 COMMUNITY HOSPICE FOUNDATION COMM 2095786300 4368 SPYRES WAY MODESTO CA 95356 TAMI BENNETT DIRECTOR OF FINANCE 2095786300 2018-02-13 1 RONALD EHRKE P00141781 2095774800 X 208.89.120.251 2018-02-13 16:26:25 PS P DB658A82FAC4299F552324F6A1372227CBFFAB5C F85F28CF2729C8206500BEDA5BD42276EADA2E0D 2016 2021-01-29 14:40:06Z C DESHA MCLEOD 4368 SPYRES WAY MODESTO CA 95356 1779379 0 X WWW.HOSPICEHEART.ORG X 2002 CA SUPPORT OF COMMUNITY HOSPICE, INC. 22 22 6 92 0 0 1279384 1019491 0 0 187104 132165 243419 230475 1709907 1382131 272783 1676441 0 0 320700 371225 0 0 188059 241257 262398 834740 2310064 875167 -927933 7613513 7898367 177703 912037 7435810 6986330 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 2068204 1676441 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. 2068204 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 4 0 6 1 0 0 0 0 0 1 1 0 0 0 0 X 22 22 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 SUE CIPPONERI CPA CHAIRMAN 1.00 X X 0 0 0 JENNIFER SANGUINETTI VICE CHAIR 1.00 X X 0 0 0 KRISTI AH YOU DIRECTOR 1.00 X 0 0 0 JENNIFER GOMES TREASURER 1.00 X X 0 0 0 JON TREMAYNE PAST CHAIR 1.00 X X 0 0 0 JAMES RYAN COGDILL ESQ DIRECTOR 1.00 X 0 0 0 MELVIN BRADLEY DIRECTOR 1.00 X 0 0 0 DON GAEKLE DIRECTOR 1.00 X 0 0 0 SUZANNE CANDINI DIRECTOR 1.00 X 0 0 0 DEANNA HANSEN DIRECTOR 1.00 X 0 0 0 JAMES A COGDILL SECRETARY 1.00 X X 0 0 0 CLAIRE HELBIG MD DIRECTOR 1.00 X 0 0 0 TRACEY KERR DIRECTOR 1.00 X 0 0 0 CHUCK MITTEN DIRECTOR 1.00 X 0 0 0 MICHAEL KRAUSNICK ESQ DIRECTOR 1.00 X 0 0 0 JUDITH LANNING SPHR DIRECTOR 1.00 X 0 0 0 TERESA SCOTT DIRECTOR 1.00 X 0 0 0 JYOTHI PRABHU SEETHARAM DIRECTOR 1.00 X 0 0 0 ROBERT LOPEZ DIRECTOR 1.00 X 0 0 0 MERYL SNIDER DIRECTOR 1.00 X 0 0 0 JANICE LUCERO DIRECTOR 1.00 X 0 0 0 JUDY WETZEL DIRECTOR 1.00 X 0 0 0 MONICA OJCIUS EXECUTIVE DIRECTOR 40.00 X 97063 0 4270 CHARLOTTE D MCLEOD CHIEF EXECUTIVE OFFICER 1.00 41.00 X 0 263776 7973 SHAILESH KANTILAL VP CIO 1.00 40.00 X 0 157614 7959 CHERYL KIRK RN CASE MANAGER 1.00 41.00 X 0 139610 7442 LAURA MILLER VP CHIEF CLINICAL OFFICER 1.00 41.00 X 0 141164 7494 TERESA ANNE HARRINGTON DIRECTOR OF INTEGRATED QUALITY SERVICES 1.00 41.00 X 0 137475 7008 JOANN LINDBERG CLINICAL EDUCATOR 1.00 41.00 X 0 118795 2400 CHRISTINE STEWART PATIENT CARE MANAGER 1.00 41.00 X 0 132211 6883 97063 1090645 51429 0 0 1 0 0 176231 843260 176231 1019491 126619 126619 5546 0 5546 5546 5546 583113 176231 397248 185865 185865 44610 0 44610 44610 1382131 0 0 362640 1676441 1676441 121270 60635 60635 220752 110376 110376 5296 2648 2648 23907 11954 11953 53801 53801 29904 29904 288 288 40526 40526 18000 18000 7719 7719 6534 6534 105 105 9385 8818 567 BANK, CREDIT CARD & PAY 57897 57897 COMPUTER MAINTENANCE 18688 18688 STAFF RECRUITMENT, TRAI 8597 8597 OTHER PROGRAM EXPENSES 5948 5948 5006 3126 1880 2310064 2068204 53801 188059 665167 392845 603280 606865 6206 15902 0 9066 38966 54292 53685 53685 105 0 2318638 2528383 3007000 3273000 974151 1018014 7613513 7898367 81992 121201 70910 71966 24801 718870 177703 912037 X 6532039 6071205 76027 85223 827744 829902 7435810 6986330 7613513 7898367 -927933 478453 0 X X 0 1 X 1 0 X X 1 COMMUNITY HOSPICE INC 942638213 10 1 1676441 0 1 1676441 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 994697 2158 40347 1037202 514920 404500 75277 994697 552733 2752 -40565 514920 510920 3213 38600 552733 470320 8577 32023 510920 0.19990 0.80010 0.00000 0 0 26104 26104 0 27581 27581 0 0 LIMITED PARTNERSHIP 3273000 F 3273000 INVESTMENT PROPERTY 4000 ENDOWMENT INVESTMENTS 1014014 1018014 RELATED PARTY PAYABLE 718870 718870 X 1872123 478453 11539 489992 1382131 0 1382131 645162 11539 11539 633623 1676441 1676441 2310064 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, 2013 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 301081 76375 224706 29854 57849 74194 GOLF FORE HOSPICE 116157 29184 86973 15669 13152 35060 7 342106 70672 271434 14540 27497 129433 759344 176231 583113 60063 98498 238687 397248 185865 44610 1 0.95000 44610 44610 CA 1 0 0 0 1.00000 TAMI BENNETT 4368 SPYRES WAY MODESTO CA 95356 0 MONICA OJCIUS 1156 REGISTRATION AND OPERATION OF RAFFLES. X 0 1 COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 501(C)(3) 1676441 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 263776 0 0 0 0 0 7973 0 0 0 271749 0 0 SHAILESH KANTILAL VP CIO 0 157614 0 0 0 0 0 7959 0 0 0 165573 0 0 X PRIZES 221 176231 DONOR REPRESENTATION 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 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