2016-02-12T17:27:47-06:00 2015-09-30 941239084 ATHERTON & ASSOCIATES LLP PO BOX 4339 MODESTO CA 953524339 990 2014-10-01 770562224 COMMUNITY HOSPICE FOUNDATION COMM 2095786300 4368 SPYRES WAY MODESTO CA 95356 RICK DAHLSEID CPA VP/CFO 2095786300 2016-02-11 1 RONALD EHRKE P00141781 2095774800 X 2014 2016-08-17 19:52:53Z C DESHA MCLEOD 4368 SPYRES WAY MODESTO CA 95356 1642138 0 X WWW.HOSPICEHEART.ORG X 2002 CA SUPPORT OF COMMUNITY HOSPICE, INC. 18 18 4 61 0 0 797965 901132 0 0 245839 315156 263131 237326 1306935 1453614 410698 248418 0 0 246511 205109 0 0 113381 217064 225824 874273 679351 432662 774263 6239108 6392558 82444 108440 6156664 6284118 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 508947 248418 121814 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. 508947 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 6 0 1 4 1 0 0 0 0 0 1 1 0 0 0 0 0 X 18 18 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X RICK DAHLSEID CPA 2095786300 4368 SPYRES WAY MODESTO CA 95356 JON TREMAYNE CHAIRMAN 1.00 X X 0 0 0 SUZANNE CANDINI VICE CHAIR 1.00 X X 0 0 0 SALLY COFER-LINDBERG DIRECTOR 1.00 X 0 0 0 SUE CIPPONERI TREASURER 1.00 X X 0 0 0 JANICE LUCERO PAST CHAIR 1.00 X X 0 0 0 ASHLEY BARBOZA DIRECTOR 1.00 X 0 0 0 JAMES RYAN COGDILL DIRECTOR 1.00 X 0 0 0 PATTY DUVAL DIRECTOR 1.00 X 0 0 0 RONI EDGMON DIRECTOR 1.00 X 0 0 0 DEANNA HANSEN DIRECTOR 1.00 X 0 0 0 LESLIE KALIM MCHUGH DIRECTOR 1.00 X 0 0 0 MICHAEL KRAUSNICK DIRECTOR 1.00 X 0 0 0 JYOTHI PRABHU SEETHARAM DIRECTOR 1.00 X 0 0 0 TICIA SODHI DIRECTOR 1.00 X 0 0 0 GINA MACHADO DIRECTOR 1.00 X 0 0 0 KRISTI AH YOU SECRETARY 1.00 X X 0 0 0 GLENN RICHARDSON DIRECTOR 1.00 X 0 0 0 JENNIFER SANGUINETTI DIRECTOR 1.00 X 0 0 0 LYNIS CHAFFEY EXECUTIVE DIRECTOR 40.00 X 89905 0 3266 RICK DAHLSEID CPA VICE PRESIDENT, CFO 40.00 X 0 132764 7136 CHARLOTTE D MCLEOD CHIEF EXECUTIVE OFFICER 40.00 X 0 219690 4492 MONICA OJCIUS EXECUTIVE DIRECTOR 40.00 X 0 0 0 SHAILESH KANTILAL VP CHIEF INFORMATION OFFICER 40.00 X 0 151849 7230 CHERYL KIRK RN CASE MANAGER 40.00 X 0 153172 7931 JOHN RENNER DIRECTOR OF RETAIL OPS 40.00 X 0 116087 5152 LAURA MILLER VP CHIEF CLINICAL OFFICER 40.00 X 0 134439 6800 TERESA ANNE HARRINGTON DIRECTOR OF INTEGRATED QUALITY AND HEALTH INFORMAT 40.00 X 0 117424 6097 89905 1025425 48104 0 0 1 0 0 43752 857380 43752 901132 193342 193342 121814 0 121814 121814 121814 402359 43752 188524 213835 213835 23491 0 23491 23491 1453614 121814 0 430668 248418 248418 75675 37838 37837 108734 54367 54367 6024 3012 3012 14676 7338 7338 35327 35327 25 25 26938 26938 18000 18000 3999 3999 7986 7986 MANAGEMENT SERVICE FEES 57023 57023 BANK, CREDIT CARD & PAY 26815 26815 COMPUTER MAINTENANCE 12974 12974 POSTAGE 9323 9323 27414 20586 6828 679351 508947 57023 113381 175800 827102 2700 0 20425 11150 16627 10830 53685 52838 8833 847 5386101 5029884 628622 512745 6239108 6392558 80200 71624 2244 36816 82444 108440 X 5661639 5722290 71833 138584 423192 423244 6156664 6284118 6239108 6392558 774263 -646809 0 X X 0 1 X 1 0 X X 1 COMMUNITY HOSPICE INC 942638213 9 1 248418 0 1 248418 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 552733 2752 -40565 514920 510920 3213 38600 552733 470320 8577 32023 510920 422502 3426 44392 470320 440781 -11770 -6509 422502 0 0 26104 25604 500 27581 27234 347 847 LIMITED PARTNERSHIP 2826000 F PUBLICLY TRADED SECURITIES 2203884 F 5029884 INVESTMENT PROPERTY 4000 ENDOWMENT INVESTMENTS 508745 512745 DEFERRED REVENUE 1817 RELATED PARTY PAYABLE 34999 36816 X 992629 -646809 188524 -458285 1450914 2700 2700 1453614 616757 188524 188524 428233 251118 251118 679351 PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS ARE TO FUND FUTURE OPERATING EXPENSES. 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: EVENT REVENUE PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT PART XII, LINE 2D - OTHER ADJUSTMENTS: EVENT EXPENSES INCLUDED PART VIII LINE 8B PART XII, LINE 4B - OTHER ADJUSTMENTS: SUPPORT TRANSFERRED TO OTHER PARTIES NOT INCLUDED IN EXPENSES ON F/S BAD DEBT 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 274615 39105 235510 23730 24954 63533 GOLF FORE HOSPICE 76699 2615 74084 808 20125 12804 8 94797 2032 92765 9759 10693 22118 446111 43752 402359 34297 55772 98455 188524 213835 23491 1 0.95000 23491 23491 CA 1 0 0 0 1.00000 RICK DAHLSEID CPA 4368 SPYRES WAY MODESTO CA 95356 0 LYNIS CHAFFEY 89905 REGISTRATION AND OPERATION OF RAFFLES. X 0 1 COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 501(C)(3) 248418 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 1 0 0 0 0 0 0 0 0 CHARLOTTE D MCLEOD CHIEF EXECUTIVE OFFICER 0 219690 0 0 0 0 0 4492 0 0 0 224182 0 0 SHAILESH KANTILAL VP CHIEF INFORMATION OFFICER 0 151849 0 0 0 0 0 7230 0 0 0 159079 0 0 CHERYL KIRK RN CASE MANAGER 0 153172 0 0 0 0 0 7931 0 0 0 161103 0 0 X PRIZES 0 43752 BASED ON DONORS REPR 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, A RELATED ENTITY. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS BY THE ORGANIZATION MAY BE SUBJECT TO APPROVAL BY THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE CHIEF FINANCIAL OFFICER (CFO) OBTAINS THE COMPLETED FORM 990 FROM THE PREPARER AND REVIEWS IT FOR ACCURACY AND COMPLETENESS. ONCE CONSIDERED ACCURATE AND COMPLETE, THE FORM 990 IS CONVERTED TO A PDF FILE FOR ELECTRONIC STORAGE AND VIEWING. A PDF COPY IS FORWARDED TO EACH MEMBER OF THE AUDIT COMMITTEE FOR THEIR REVIEW. THE AUDIT COMMITTEE IS COMPRISED OF 1 INDIVIDUAL FROM EACH RELATED ENTITY (COMMUNITY HOSPICE, CHI MANAGEMENT, AND COMMUNITY HOSPICE FOUNDATION.) AFTER THE AUDIT COMMITTEE REVIEWS THE FORM 990, THE PREPARER WILL ADDRESS ANY QUESTIONS OR CONCERNS THEY MAY HAVE. ABSENT ANY QUESTIONS OR CONCERNS OF THE AUDIT COMMITTEE, THE FORM 990 WILL BE ELECTRONICALLY SENT TO EACH BOARD MEMBER WITH A RECOMMENDATION OF THE AUDIT COMMITTEE AND A REQUEST FOR COMMENT. AFTER 72 HOURS THE FORM 990 WILL BE CONSIDERED READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 COMMUNITY HOSPICE INC R 248418 FAIR MARKET VALUE COMMUNITY HOSPICE MANAGEMENT INC O 57023 FAIR MARKET VALUE