2019-11-15T08:29:34-06:00 2018-12-31 592922169 SALTMARSH CLEAVELAND & GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2018-01-01 592208300 COVENANT HOSPICE INC COVE 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 MARTY FRANKLIN CFO 8504332155 2019-11-15 1 CHARLES F GUND JR CPA P00138367 8504358300 2019-10-25 170.249.129.82 2019-11-15 08:09:04 CS P 485E2A1375944CFBAB9FA0C6BA2180630D642600 485E2A1375944CFBAB9FA0C6BA2180630D642600 2018 2020-04-17 16:48:07Z JEFF MISLEVY 5041 N 12TH AVE PENSACOLA FL 32504 65335983 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. 15 14 650 1118 0 0 0 3057568 53616441 54727869 862758 2248915 760468 51707 55239667 60086059 0 0 0 0 27587407 25348102 0 0 0 26844401 31191691 54431808 56539793 807859 3546266 55500060 58835656 20670117 23596459 34829943 35239197 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 2018, THE ORGANIZATION PROVIDED $473,075 OF CHARITY CARE TO PATIENTS. 0 0 39179146 54727869 DURING 2018, DIRECT CARE WAS PROVIDED TO 5,999 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. 39179146 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 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 1 226 0 1 650 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARTY FRANKLIN 8504332155 5401 N 12TH AVE PENSACOLA FL 32504 TOM OWENS CHAIRMAN 4.00 12.00 X X 0 0 0 RODNEY GUTMAN 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 JEFFREY M MISLEVY PRESIDENT/CEO 40.00 16.00 X X 0 774470 58427 SUSAN DAVIS 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 PARA MD 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 ODIN BERG CSO 40.00 16.00 X 0 328853 20589 MARTIN FRANKLIN CFO 40.00 12.00 X 0 179624 16832 TODD FISHER CIO 40.00 12.00 X 0 279239 30248 JAMES SMITH PHYSICIAN 40.00 X 311317 0 35365 SAUL RODRIGUEZ PHYSICIAN 40.00 X 258731 0 1601 STEPHEN DILL PHYSICIAN 40.00 X 233100 0 4237 RICK HARRELSON PHYSICIAN 40.00 X 249429 0 4267 JAMES TORRISI PHYSICIAN 40.00 X 211097 0 7887 1263674 1562186 179453 5 0 1 0 ENCLARA PHARMECIA 1601 CHERRY STREET PHILADELPHIA PA 19102 PATIENT DRUGS 1679809 NATIONAL HME INC 7501 ESTERS BLVD IRVING TX 75063 PATIENT DME 1461990 ENTERPRISE FLEET MANAGEMENT PO BOX 800089 KANSAS CITY MO 641800089 FLEET CARS 586636 FIRST CHOICE MEDICAL SUPPLY 127 INTERSTATE DR RICHLAND MS 39218 PATIENT MEDICAL SUPPLIES 573304 APPLEYARD AGENCY 4400 BAYOU BLVD SUITE 34 PENSACOLA FL 32503 ADVERTISING 571409 50 3055901 1667 3057568 PATIENT SERVICES 621610 54417578 54417578 RENTAL FROM AFFILIATES 632299 310291 310291 54727869 396583 396583 7102256 5249924 1852332 1852332 1852332 PURCHASE CARD REBATE 900099 51707 51707 51707 60086059 54727869 0 2300622 20921720 17889358 3032362 145328 123643 21685 2268345 1914853 353492 2012709 1784416 228293 254272 254272 76667 76667 24911 24911 237962 237962 392703 392703 2325810 2325810 2440375 2440375 1446159 1040006 406153 20671 20671 360788 360788 1733205 1733205 413025 413025 ROOM & BOARD 9937685 9937685 MEDICATION AND MEDICAL 4375561 4375561 SALARY ALLOCATION 4186950 4186950 LAB SERVICES AND TREATM 1362690 1362690 1602257 750934 851323 56539793 39179146 17360647 0 8150 2594 1151489 3500696 2568083 2082461 9286848 12171777 136992 102683 986819 1413121 30309883 14606305 17221365 15703578 17245944 15047600 435169 390779 6459201 8420367 55500060 58835656 13616221 13002338 5951892 5134569 399664 3878625 702340 1580927 20670117 23596459 X 32261311 33163657 2568632 2075540 34829943 35239197 55500060 58835656 X 3546266 -2672406 -464606 X X 0 1 X 1 0 X 2160698 1579900 1270186 0 1667 5012451 2160698 1579900 1270186 1667 5012451 5012451 702211 583030 422365 387513 396583 2491702 82531 116624 253751 760468 51707 1265081 8769234 0.57160 0.68460 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. 1936722 1936722 14667880 14606305 61575 4166334 4166334 9434525 9434525 104422 104422 15703578 CASH VALUE OF LIFE INSURANCE 1259130 DUE FROM COVENANT HOSPICE FOUNDATIO 66144 DUE FROM ALZHEIMER'S FAMILY SERVICE 534382 DUE FROM COVENANT HEALTH AND COMMUN 4327822 DUE FROM COVENANT HOME HEALTH HOLDI 989839 DUE FROM MEMORY CARE CLINIC 799216 DUE FROM COVENANT HOME CARE 259605 DUE FROM COVENANT PALLIATIVE CARE 184229 8420367 DUE TO PEOPLES HOME HEALTH 1580927 1580927 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. X 0 1 X X X 0 0 0 0 0 0 0 0 0 JEFFREY M MISLEVY PRESIDENT/CEO 0 393283 0 345613 0 35574 0 2700 0 55727 0 832897 0 0 ODIN BERG CSO 0 254285 0 64542 0 10026 0 2700 0 17889 0 349442 0 0 MARTIN FRANKLIN CFO 0 157327 0 22297 0 0 0 0 0 16832 0 196456 0 0 TODD FISHER CIO 0 213758 0 56827 0 8654 0 1663 0 28585 0 309487 0 0 JAMES SMITH PHYSICIAN 293554 0 17763 0 0 0 2313 0 33052 0 346682 0 0 0 SAUL RODRIGUEZ PHYSICIAN 258731 0 0 0 0 0 0 0 1601 0 260332 0 0 0 STEPHEN DILL PHYSICIAN 233100 0 0 0 0 0 0 0 4237 0 237337 0 0 0 RICK HARRELSON PHYSICIAN 233661 0 0 0 15768 0 0 0 4267 0 253696 0 0 0 JAMES TORRISI PHYSICIAN 211097 0 0 0 0 0 0 0 7887 0 218984 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 SUSAN DAVIS BOARD MEMBER SUSAN DAVIS IS THE CEO OF SACRED HEART HEALTH SYSTEM. COVENANT HOSPICE PAYS SACRED HEART HEALTH SYSTEM FOR PATIENT RELATED EXPENSES. 0 ROGER POITRAS BOARD MEMBER ROGER POITRAS IS THE CSO OF GULF COAST HEALTH SYSTEM. COVENANT HOSPICE PAYS GULF COAST HEALTH SYSTEM FOR PATIENT RELATED EXPENSES. 0 DON HAFERKAMP BOARD MEMBER DON HAFERKAMP IS THE CEO CROWN HEALTH CARE LAUNDRY SERVICES. COVENANT HOSPICE PAYS CROWN HEALTH CARE LAUNDRY SERVICES FOR PATIENT RELATED 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 2018. 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 ON WRITTEN REQUEST. 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 28,036. CHANGE IN VALUE OF TRUST RECEIVABLE -492,642. FORM 990, PART XII, LINE 2C: THE EXECUTIVE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED DURING THE YEAR. COVENANT HOSPICE FOUNDATION INC 5041 N 12TH AVE PENSACOLA FL 32504 593060139 FUNDRAISING FL 501(C)(3) 7 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) 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) 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 0 COVENANT HEALTH AND COMMUNITY SERVICES INC 5041 N 12TH AVE PENSACOLA FL 32504 465132177 SEE SCHEDULE R, PART VII FL 501(C)(3) 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 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 COVENANT HOSPICE FOUNDATION INC C 3055901 FMV MEMORY CARE CLINIC J 263160 FMV COVENANT ALZHEIMER'S FAMILY SERVICES J 6000 FMV COVENANT HOME HEALTH CARE J 36756 FMV PRIVATE DUTY J 4375 FMV COVENANT HEALTH AND COMMUNITY SERVICES O 4186950 FMV