2011-02-06T11:57:23-06:00 2010-09-30 DIXON HUGHES PLLC 500 Ridgefield Court Asheville NC 28806 990 2009-10-01 591940256 COMMUNITY HOSPICE OF NORTHEAST FLORIDA COMM 9042685200 4266 SUNBEAM RD JACKSONVILLE FL 32257 CARLOS BOSQUE 9042685200 2011-02-06 Amy Bibby 8282542254 2009 2016-02-24 21:20:13Z carlos bosque 4266 SUNBEAM RD JACKSONVILLE FL 32257 79305457 0 X WWW.COMMUNITYHOSPICE.COM X 1984 FL HOSPICE IN HOME CARE OF TERMINALLY ILL PATIENTS AND COMPREHENSIVE GUIDANCE AND SUPPORT FOR PATIENTS AND THEIR FAMILIES. 30 30 952 1017 0 0 2181745 4143926 66686742 74775457 316145 258718 103498 106823 69288130 79284924 100000 100000 0 35010945 36984864 0 0 28793454 32969783 63904399 70054647 5383731 9230277 45470912 56343866 4990200 6555376 40480712 49788490 TO IMPROVE THE QUALITY OF LIFE FOR PATIENTS AND FAMILIES AND BE THE COMPASSIONATE GUIDE FOR END-OF-LIFE CARE IN OUR COMMUNITY. 0 0 59869296 100000 74775457 THE COMMUNITY HOSPICE OF NORTHEAST FLORIDA PROVIDED MEDICAL AND PALLIATIVE CARE, PSYCHOLOGICAL, PHYSICAL AND SPIRITUAL SERVICES TO TERMINALLY ILL PATIENTS AND THEIR FAMILIES REGARDLESS OF THEIR ABILITY TO PAY. EDUCATION AND TRAINING IS PROVIDED TO EXPAND AND ENHANCE KNOWLEDGE OF DEATH AND DYING CARE TO PATIENTS, FAMILY MEMBERS AND THE COMMUNITY. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2010, 6,382 PATIENTS AND THEIR FAMILIES WERE SERVED TOTALING 335,600 DAYS OF CARE. NUMEROUS COMMUNITY EVENTS WERE HOSTED TO ALLOW ALL MEMBERS OF THE 5 COUNTY AREA THE OPPORTUNITY TO GET A BETTER UNDERSTANDING OF HOSPICE AND PALLIATIVE CARE. DURING THE YEAR, THE HOSPICE BEGAN A PALLIATIVE CARE PROGRAM WITHIN LOCAL HOSPITALS. 59869296 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 1 117 0 952 1 0 0 0 0 0 0 0 0 0 30 30 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X CARLOS BOSQUE CPA CFO 9042685200 4266 SUNBEAM ROAD jacksonville FL 32257 JAMES R BURKHART 3.00 X X 0 0 0 JOE MITRICK 2.00 X X 0 0 0 SCOTT C CAIRNS 2.00 X X 0 0 0 BARBARA CONE 2.00 X X 0 0 0 JOHN W LOGUE 2.00 X X 0 0 0 FERNANDO ACOSTA-RUA 1.00 X 0 0 0 JILL BUIE 1.00 X 0 0 0 DR CHARLES CLINE 1.00 X 0 0 0 YANK D COBLE JR MD 1.00 X 0 0 0 BETTY CROSBY 1.00 X 0 0 0 DR BARBARA DARBY 1.00 X 0 0 0 JOHN D HARMOND 1.00 X 0 0 0 CHRISTOPHER EMANS 1.00 X 0 0 0 LARRY J FREEMAN 1.00 X 0 0 0 CAROLE GARDNER 1.00 X 0 0 0 JOE GORDY 1.00 X 0 0 0 JOHN HAYT 1.00 X 0 0 0 HON MARCIA M HOWARD 1.00 X 0 0 0 CAL JACKSON 1.00 X 0 0 0 JOY KORMAN 1.00 X 0 0 0 MARTY LANAHAN 1.00 X 0 0 0 RABBI JOSHUA LIEF 1.00 X 0 0 0 HILARY MATHEWS 1.00 X 0 0 0 JOSH MCGRAW 1.00 X 0 0 0 ESTELLE MCKISSICK 1.00 X 0 0 0 KELLY S MILES 1.00 X 0 0 0 TEALA MILTON JOHNSON 1.00 X 0 0 0 REV ROBERT L MORRIS 1.00 X 0 0 0 JAMES O'REILLY 1.00 X 0 0 0 PAULA RINGHAVER 1.00 X 0 0 0 LAWRENCE A SOLBERG JR 1.00 X 0 0 0 SUSAN PONDER-STANSEL 40.00 X 266177 0 50254 PHIL WARD 40.00 X 195319 0 45597 CARLOS BOSQUE 30.00 X 155582 0 34573 KATHY JOHNSON 40.00 X 184817 0 38005 JOHN MCILVAINE 40.00 X 154882 0 11662 ANDREA FRITZ 40.00 X 153023 0 37548 FRANK SANTAMARIA 40.00 X 226288 0 12730 ELEANOR SORRESO 40.00 X 160904 0 6114 DAVID YARIAN 40.00 X 164788 0 5821 REUBEN SMITH 40.00 X 172002 0 11510 PAUL BORGMAN 40.00 X 186841 0 20125 DONALD TWIGGS 40.00 X 187812 0 17446 2208435 0 291385 12 0 1 0 NEWELL TERRY & DOUGLAS PA 817 N GADSDEN ST TALLAHASSEE FL 32303 LEGAL SERVICES 103442 1 4088575 55351 4143926 PATIENT SERVICE REVENU 623000 58898086 58898086 NURSING HOME SUPPORT 623000 15877371 15877371 74775457 279251 279251 10980 9553 -10980 -9553 -20533 -20533 MISCELLANOUS REVENUE 623000 60047 60047 CAFE REVENUE 722210 46776 46776 106823 79284924 74775457 0 365541 100000 100000 1346544 402065 944479 28929105 22630441 6298664 830642 542274 288368 3669425 2974666 694759 2209148 1824896 384252 17098 17098 179696 179696 72732 72732 10777 10777 1367896 1225978 141918 521536 119695 401841 24589430 24209171 380259 257176 257176 1663833 1663833 814420 670439 143981 174988 100903 74085 11438 11438 1895582 1895582 152442 152442 CHARITY CARE EXPENSES 812066 812066 BAD DEBT 427465 427465 MISCELLANEOUS 1208 1208 70054647 59869296 10185351 0 2050 9963073 13090169 5934949 7914965 52083 54583 526692 526072 1765966 1802745 40341388 11784407 26729510 28556981 496589 4290746 107605 45470912 56343866 4780571 6434130 209629 121246 4990200 6555376 X 40480712 49788490 40480712 49788490 45470912 56343866 X 0 1 1 X 0 X 1210771 2660445 2928342 2181745 4143926 13125229 62832608 67749281 63536122 66686742 74775457 335580210 64043379 70409726 66464464 68868487 78919383 348705439 0 0 0 348705439 396471 303545 114564 129706 279251 1223537 396471 303545 114564 129706 279251 1223537 64439850 70713271 66579028 68998193 79198634 349928976 0.99650 0.99670 0.00350 0.00330 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 40964 0 0 40964 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE ORGANIZATION INCURRED EXPENSES LOBBYING FOR A LEGISLATIVE AMENDMENT THAT WOULD POTENTIALLY ALLOW FLORIDA HOSPICES TO PRACTICE PALLIATIVE CARE UNDER EXISTING FLORIDA HOSPICE LICENSES. LOBBYING WAS PERFORMED VIA PERSONAL VISITS TO STATE SENATORS. 886925 886925 26496378 5993798 20502580 10059999 5790609 4269390 2898086 2898086 28556981 79284924 70054647 9230277 77501 77501 9307778 79362425 77501 77501 79284924 0 79284924 70054647 0 70054647 0 70054647 1 MAYO CLINIC 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 411937751 501(C)(3) 100000 PALLIATIVE CARE FELLOWSHIP 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE ORGANIZATION FUNDS A FELLOWSHIP THROUGH THE MAYO CLINIC THAT HELPS SUBSIDIZES A FELLOW TO PERFORM ROUNDS AT THE HOSPICE'S INPATIENT FACILITY. THE FELLOW ALSO HANDLES THE INTERDISCIPLINARY TEAM MEETING EACH WEEK, AND IS OVERSEEN BY THE HOSPICE'S MEDICAL STAFF WHEN ON SITE. WHILE THE FUNDS ARE USED TO SUBSIDIZE A FELLOW'S SALARY AND BENEFITS, THE FELLOWSHIP IS CONSIDERED A GRANT TO THE MAYO CLINIC FOR USE IN THIS ESTABLISHED PROGRAM, AS THERE IS NO DIRECT RELATIONSHIP BETWEEN THE GRANT AND THE SERVICE BY A FELLOW AT THE HOSPICE. ALL SIGNIFICANT DEVIATIONS IN THE USE OF THE GRANT FROM THE PURPOSE DESCIRBED ABOVE MUST BE APPROVED BY THE ORGANIZATION. THE FELLOWSHIP PROGRAM IS A WELL-ESTABLISHED PROGRAM WITHIN THE MAYO CLINIC, AND UPDATES AND REPORTS ON THE USE OF FUNDS IS READILY AVAILABLE FOR THE ORGANIZATION TO OBTAIN. X X X X 0 0 0 0 0 0 0 0 0 SUSAN PONDER-STANSEL 266177 0 0 0 0 0 29730 0 20524 0 316431 0 0 0 PHIL WARD 195319 0 0 0 0 0 25391 0 20206 0 240916 0 0 0 CARLOS BOSQUE 155582 0 0 0 0 0 20616 0 13957 0 190155 0 0 0 KATHY JOHNSON 184817 0 0 0 0 0 24434 0 13571 0 222822 0 0 0 JOHN MCILVAINE 154882 0 0 0 0 0 4664 0 6998 0 166544 0 0 0 ANDREA FRITZ 153023 0 0 0 0 0 20804 0 16744 0 190571 0 0 0 FRANK SANTAMARIA 226288 0 0 0 0 0 6829 0 5901 0 239018 0 0 0 ELEANOR SORRESO 160904 0 0 0 0 0 4840 0 1274 0 167018 0 0 0 DAVID YARIAN 164788 0 0 0 0 0 4944 0 877 0 170609 0 0 0 REUBEN SMITH 172002 0 0 0 0 0 5220 0 6290 0 183512 0 0 0 PAUL BORGMAN 186841 0 0 0 0 0 5684 0 14441 0 206966 0 0 0 DONALD TWIGGS 187812 0 0 0 0 0 7579 0 9867 0 205258 0 0 0 KATHRYN MCILVAINE FAMILY RELATIONSHIP WITH KEY EMPLOYEE JOHN MCILVAINE 141969 COMPENSATION AS EMPLOYEE 0 Form 990, Part VI, Section B, line 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED IN ITS ENTIRETY BY THE BUDGET FINANCE COMMITTEE OF THE BOARD, FOLLOWED BY A PRESENTATION TO THE FULL BOARD FOR APPROVAL. FOLLOWING APPROVAL, THE RETURN WAS FILED WITH THE IRS. Form 990, Part VI, Section B, line 12c MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED ANNUALLY TO COMPLETE AND SIGN A CONFLICT OF INTEREST POLICY IDENTIFYING RELATIONSHIPS THAT MAY GIVE RISE TO CONFLICT. OFFICERS AND KEY MANAGEMENT PERSONNEL ALSO COMPLETE A SURVEY REGARDING POTENTIAL BUSINESS RELATIONSHIPS WITH OTHER OFFICERS, DIRECTORS, AND KEY PERSONNEL. Form 990, Part VI, Section B, line 15 USING CURRENT JOB DESCRIPTIONS FOR THE EXECUTIVE POSITIONS, COMPETITIVE COMPENSATION DATA IS COLLECTED FROM PUBLISHED SALARY SURVEYS, THE FORM 990 OF SIMILAR HOSPICES, AND THROUGH DATA SUPPLIED BY EXTERNAL COMPENSATION CONSULTANTS. THIS INFORMATION IS ORGANIZED AND PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD BY THE DIRECTOR OF HUMAN RESOURCES. THE EXECUTIVE COMMITTEE IN TURN DETERMINES AND APPROVES INDIVIDUAL SALARY ADJUSTMENTS IT BELIEVES ARE WARRANTED. THE EXECUTIVE COMMITTEE REVIEWS COMPENSATION FOR THE CEO, COO, CFO, DEPUTY CFO, CMO, CNO, VP OF WORKFORCE DEVELOPMENT, VP OF MARKETING DEVELOPMENT, VP OF MARKETING & COMMUNICATIONS, VP OF BUSINESS DEVELOPMENT, AND THE EXECUTIVE DIRECTOR OF THE RELATED FOUNDATION. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part VI, Section C, line 19 THE ORGANIZATION WILL PROVIDE ANY GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS UPON REQUEST. THIS CAN BE DONE IN PERSON, BY PHONE, VIA OUR WEBSITE OR ON WWW.GUIDESTAR.COM. THE ORGANIZATION PUBLISHES A COMMUNITY REPORT IN THE LOCAL SUNDAY NEWSPAPER THAT PROVIDES SUMMARY INFORMATION OF THE PREVIOUS YEAR. COMMUNITY HOSPICE OF NORTHEAST FLORIDA FOUNDATION FOR CARING 4266 SUNBEAM ROAD JACKSONVILLE FL 32257 593583920 FUNDRAISING FOR COMMUNITY HOSPICE OF NORTHEAST FLORIDA FL 501(C)(3) 13, TYPE I N/A 1 0 1 1 0 0 0 1 0 0 0 1 1 1 0 1 0 0 COMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION A 8783 cOMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION C 4088575 cOMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION H cOMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION L 259214 cOMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION M cOMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION N 157462 cOMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION P COMMUNITY HOSPICE OF NORTHEASR FLORIDA FOUNDATION D 107605