2023-11-14T16:58:45-06:00 2022-12-31 592922169 SALTMARSH CLEAVELAND AND GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2022-01-01 592208300 COVENANT HOSPICE INC COVE 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 ROLAND CLENEAY CFO 8504332155 2023-11-06 1 ROLAND CLENEAY 999009999 0 ALLISON JONES CPA P02434475 8504358300 2023-11-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JEFF MISLEVY 5041 N 12TH AVE PENSACOLA FL 32504 76075264 0 X WWW.CHOOSECOVENANT.ORG/HOSPICE X 1981 FL COVENANT HOSPICE IS DEDICATED TO PROVIDING COMPREHENSIVE, COMPASSIONATE SERVICES (SEE SCHEDULE O) (CONTINUATION FROM PART I, LINE 1) TO PATIENTS AND THEIR LOVED ONES DURING TIMES OF LIFE-LIMITING ILLNESSES. 10 9 473 300 0 0 684583 4942385 59063943 56910826 3980151 -1894799 1048495 2281102 64777172 62239514 0 0 0 0 22841559 22039071 0 0 0 31068345 33340704 53909904 55379775 10867268 6859739 77009702 80329665 19364640 17250508 57645062 63079157 X COVENANT HOSPICE IS DEDICATED TO PROVIDING COMPREHENSIVE, COMPASSIONATE SERVICES TO PATIENTS AND THEIR LOVED ONES DURING TIMES OF LIFE-LIMITING ILLNESSES. SINCE DYING IS A PART OF THE NORMAL PROCESS OF LIFE, THE FOCUS OF COVENANT HOSPICE (SEE SCHEDULE O) (CONTINUATION FROM PART III, LINE 1) IS TO ENABLE OUR PATIENTS TO LIVE AS FULLY AND COMFORTABLY AS POSSIBLE, TO PROVIDE DIGNIFIED PALLIATIVE CARE, TO ASSIST PATIENT'S LOVED ONES IN COPING WITH END-OF-LIFE ISSUES, AND TO IMPROVE CARE FOR ALL PATIENTS AT THE END OF THEIR LIVES BY EXAMPLE AND EDUCATION. FOR 2022, THE ORGANIZATION PROVIDED $982,223 OF CHARITY CARE TO PATIENTS. 0 0 33703022 56910826 DURING 2022, DIRECT CARE WAS PROVIDED TO 5,301 PATIENTS IN NORTHWEST FLORIDA AND SOUTH ALABAMA. COVENANT HOSPICE, INC. ALSO OFFERS A PREDIATRIC PALLIATIVE CARE PROGRAM. "PARTNERS IN CARE: TOGETHER FOR KIDS", TO CHILDREN FROM BIRTH TO AGE 21 WHO ARE COPING WITH POTENTIALLY LIFE-LIMITING CONDITIONS. 33703022 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 380 0 473 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 FL X ROLAND CLENEAY 8504332155 5401 N 12TH AVE PENSACOLA FL 32504 JEFFREY M MISLEVY PRESIDENT/CEO 40.00 16.00 X X 0 885168 20860 TOM OWENS PAST CHAIR 4.00 12.00 X X 0 0 0 RODNEY GUTMAN CHAIRMAN 4.00 12.00 X X 0 0 0 BRETT PARRA SECRETARY 4.00 12.00 X X 0 0 0 KENT SKOLROOD TREASURER 4.00 4.00 X X 0 0 0 DICK APPLEYARD BOARD MEMBER 4.00 4.00 X 0 0 0 MILLER CALDWELL BOARD MEMBER 4.00 4.00 X 0 0 0 JAMIE CAMPBELL BOARD MEMBER 4.00 4.00 X 0 0 0 PETER JENNINGS BOARD MEMBER 4.00 4.00 X 0 0 0 STEVE SARROS BOARD MEMBER 4.00 4.00 X 0 0 0 ODIN BERG CSO 40.00 16.00 X 0 431257 2496 ROLAND CLENEAY CFO 40.00 12.00 X 0 383130 20719 KRISTEN MCGEHEE COO 40.00 12.00 X 0 252920 18290 ALEXANDER MINNEY PHYSICIAN 40.00 X 284800 0 0 JAMES SMITH PHYSICIAN 40.00 X 271625 0 117 CYNTHIA JONES PHYSICIAN 40.00 X 157138 0 15 SAUL RODRIGUEZ PHYSICIAN 40.00 X 235238 0 0 STEPHEN DILL PHYSICIAN 40.00 X 147677 0 0 TODD FISHER COO 40.00 12.00 X 0 250434 149 1096478 2202909 62646 14 1 1 0 CORE MEDICAL GROUP PO BOX 306478 NASHVILLE TN 37260 TEMP MEDICAL EMPLOYEES 2277904 ENCLARA PHARMECIA 1601 CHERRY STREET SUITE 1800 PHILADELPHIA PA 30374 PATIENT DRUGS 1482603 MEDLINE INDUSTRIES DEPT CH 14400 PALATINE IL 60055 PATIENT MEDICAL SUPPLIES 1325505 APPLEYARD AGENCY 4400 BAYOU BLVD SUITE 34 PENSACOLA FL 32503 ADVERTISING 831586 STATESERV 1201 S ALMA SCHOOL RD SUITE 34 MESA AZ 85210 DME EQUIPMENT 793887 5 103280 4839105 4942385 PATIENT SERVICES 621610 56910826 56910826 56910826 23657 23657 544753 29903 514850 514850 514850 11887391 11982571 1823276 -95180 -1823276 -1918456 -1918456 PURCHASE CARD REBATE 900099 1766252 1766252 1766252 62239514 56910826 0 386303 18501513 14278415 4223098 63279 48877 14402 1604381 1201240 403141 1869898 1241933 627965 10862 10862 9357 9357 216970 216970 63821 63821 1218766 1218766 1765933 1765933 1134884 1020483 114401 45637 45637 174443 174443 1243794 1243794 505361 505361 SALARY ALLOCATION 10940691 10940691 ROOM & BOARD 9888992 9888992 MEDICATION AND MEDICAL 3891916 3891916 LAB SERVICES AND TREATM 1287175 1189064 98111 942102 942102 55379775 33703022 21676753 0 10084 9705 3171068 2235846 3532162 7742906 16623136 12458782 70822 83013 1232663 423963 23516583 13027929 13452487 10488654 11943496 47180 268708 251184 26705076 46588432 77009702 80329665 11911149 8002878 50643 0 3013046 5382446 4389802 3865184 19364640 17250508 X 54103014 61019431 3542048 2059726 57645062 63079157 77009702 80329665 X 6859739 39074 -1464718 X 0 0 0 X 1667 283756 3501366 684583 4942385 9413757 52856065 54415040 59063943 56910826 223245874 1667 53139821 57916406 59748526 61853211 232659631 0 0 0 232659631 396583 425488 405736 1023959 568410 2820176 396583 425488 405736 1023959 568410 2820176 51707 69769 45617 419977 1766252 2353322 449957 53635078 58367759 61192462 64187873 237833129 0.97820 0.97720 0.01190 0.01510 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 0 0 PART II-B, LINE 1: LINE 1G DIRECT CONTACT WITH LEGISLATORS, THEIR STAFFS, GOVERNMENT OFFICIALS, OR A LEGISLATIVE BODY: THE ORGANIZATION PAYS CONSULTANTS TO LOBBY FOR LEGISLATION THAT PROMOTES HOSPICES. LINE 1L OTHER ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION ALONG WITH STATE HOSPICE ORGANIZATIONS. A PORTION OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. 1767205 1767205 12087157 7246366 4840791 5496340 3295108 2201232 4147482 2486455 1661027 18399 18399 10488654 CASH VALUE OF LIFE INSURANCE 1838177 DUE FROM ALZHEIMER'S FAMILY SERVICE 2123141 DUE FROM COVENANT HOME CARE 251305 DUE FROM COVENANT HOSPICE FOUNDATIO -3209496 DUE FROM COVENANT HEALTH AND COMMUN 45585305 46588432 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. PART XI AND PART XII THE AUDITED FINANCIAL STATEMENTS FOR DECEMBER 31, 2022 HAVE BEEN DELAYED AND THE FORM 990 IS BEING FILED TO MEET FILING REQUIREMENTS AND WILL BE AMENDED WHEN THE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE. X 0 1 X X X 0 0 0 0 0 0 0 0 0 JEFFREY M MISLEVY PRESIDENT/CEO 0 449897 0 301991 0 133280 0 20500 0 360 0 906028 0 0 ODIN BERG CSO 0 205433 0 97561 0 128263 0 0 0 2496 0 433753 0 0 ROLAND CLENEAY CFO 0 303227 0 63118 0 16785 0 19135 0 1584 0 403849 0 0 ALEXANDER MINNEY PHYSICIAN 284800 0 0 0 0 0 0 0 0 0 284800 0 0 0 JAMES SMITH PHYSICIAN 271508 0 117 0 0 0 0 0 117 0 271742 0 0 0 KRISTEN MCGEHEE COO 0 220860 0 26002 0 6058 0 13110 0 5180 0 271210 0 0 TODD FISHER COO 0 83519 0 58332 0 108583 0 0 0 149 0 250583 0 0 SAUL RODRIGUEZ PHYSICIAN 235238 0 0 0 0 0 0 0 0 0 235238 0 0 0 CYNTHIA JONES PHYSICIAN 138654 0 14715 0 3769 0 0 0 15 0 157153 0 0 0 A ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY 521378815 2005-08-23 900000 RENOVATE INPATIENT FACILITY 0 0 0 B ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY 521378815 2005-08-23 8600000 BUILDING ACQUISITION 0 0 0 A 900000 17900 882100 2008 0 0 1 1 B 8600000 117139 8482861 2007 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/10/2010 ISSUER NAME: ESCAMBIA COUNTY HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/10/2010 STEVE SARROS BOARD MEMBER 66395 STEVE SARROS IS THE CIO OF BAPTIST HEALTH AND COVENANT PAYS BAPTIST HEALTH FOR PATIENT EXPENSES. 0 KENT SKOLROOD BOARD MEMBER 66395 KENT SKOLROOD IS THE PRESIDENT OF BAPTIST HEALTH AND COVENANT PAYS BAPTIST HEALTH FOR PATIENT EXPENSES. 0 DICK APPLEYARD BOARD MEMBER 831596 DICK APPLEYARD IS THE CEO OF APPLEYARD AGENCY AND COVENANT PAYS APPLEYARD AGENCY FOR ADVERTISING EXPENSES. 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, INC. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH AND COMMUNITY SERVICES, INC. ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE APPROVAL FROM COVENANT HEALTH AND COMMUNITY SERVICES, INC.: - THE APPOINTMENT OR REMOVAL OF A MEMBER OF THE BOARD OF DIRECTORS; - THE INCURRENCE OF ANY SINGLE INDEBTNESS OR OTHER OBLIGATIONS IN EXCESS OF $500,000 OR IN THE AGGREGATE DURING ANY 12 MONTHS OF INDEBTNESS 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 TRANSFER IN THE PRECEDING 12 MONTHS EXCEEDS A VALUE IS EXCESS OF $2,000,000; - ANY SINGLE CAPITAL EXPENDITURE IN EXCESS OF $500,000 OR ANY CAPITAL EXPENDITURES 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; AND - 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 HEALTH AND COMMUNITY SERVICES, INC. TO DETERMINE THE CEO'S, OTHER OFFICERS', AND OTHER EMPLOYEES' COMPENSATION, COVENANT HEALTH AND COMMUNITY SERVICES, 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 2019. 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 18 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON WRITTEN REQUEST. THE AUDITED FINANCIAL STATEMENTS FOR DECEMBER 31, 2022 HAVE BEEN DELAYED AND THE FORM 990 IS BEING FILED TO MEET FILING REQUIREMENTS AND WILL BE AMENDED WHEN THE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE. 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 XI, LINE 9: CHANGE IN CASH SURRENDER VALUE 17,603. CHANGE IN VALUE OF TRUST RECEIVABLE -1,482,321. COVENANT HOSPICE FOUNDATION INC 5041 N 12TH AVE PENSACOLA FL 32504 593060139 FUNDRAISING FL 501(C)(3) LINE 12A, I COVENANT HEALTH AND COMMUNITY SERVICES INC 0 ALZHEIMER'S FAMILY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 593394242 SUPPORT TO ALZHEIMERS PATIENTS AND FAMILIES FL 501(C)(3) LINE 7 COVENANT HEALTH AND COMMUNITY SERVICES INC 0 COVENANT AT HOME INC 5041 N 12TH AVE PENSACOLA FL 32504 352543765 HOME HEALTH CARE FL 501(C)(3) LINE 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 0 COVENANT HEALTH AND COMMUNITY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 465132177 PALLIATIVE AND HOME HEALTH CARE SERVICES FL 501(C)(3) LINE 10 N/A 0 CHARITABLE REMAINDER TRUST 5041 N 12TH AVE PENSACOLA FL 32504 TRUST FL COVENANT HOSPICE INC T 1 0 0 1 1 1 0 0 0 0 1 0 0 1 1 1 0 0 0 0 COVENANT HOSPICE FOUNDATION INC C 103280 FMV COVENANT ALZHEIMER'S FAMILY SERVICES D 2123141 FMV COVENANT HEALTH AND COMMUNITY SERVICES D 45585305 FMV COVENANT AT HOME D 251305 FMV COVENANT HOSPICE FOUNDATION INC E 3209496 FMV COVENANT ALZHEIMER'S FAMILY SERVICES J 267108 FMV COVENANT HEALTH AND COMMUNITY SERVICES O 10940691 FMV