2023-11-15T11:41:13-06:00 2022-12-31 592922169 SALTMARSH CLEAVELAND AND GUND 900 NORTH 12TH AVENUE PENSACOLA FL 32501 990 2022-01-01 593060139 COVENANT HOSPICE FOUNDATION INC COVE 8504332155 5041 N 12TH AVENUE PENSACOLA FL 32504 ROLAND CLENEAY CFO 8504332155 2023-11-14 1 ROLAND CLENEAY 999009999 0 ALLISON JONES CPA P02434475 8504358300 2023-11-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JEFF MISLEVY 5041 N 12TH AVENUE PENSACOLA FL 32504 1708902 0 X WWW.CHOOSECOVENANT.ORG/HOSPICE X 1991 FL THE ORGANIZATION'S MISSION IS TO PROVIDE FUNDING TO COVENANT HOSPICE, INC. IN ORDER (SEE SCHEDULE O) (CONTINUATION FROM PART I, LINE 1) TO SUPPLEMENT CHARITY AND INDIGENT CARE. 13 10 0 0 0 0 2352021 1679698 0 0 625154 17253 -79954 -146215 2897221 1550736 886280 855550 0 0 118346 118079 0 0 0 1134251 1179992 2138877 2153621 758344 -602885 4647990 4001614 48947 33100 4599043 3968514 THE ORGANIZATIONS MISSION IS TO PROVIDE FUNDING TO COVENANT HOSPICE, INC. IN ORDER TO SUPPLEMENT CHARITY AND INDIGENT CARE. 0 0 1927490 855550 THE PURPOSE OF COVENANT HOSPICE FOUNDATION, INC IS TO RECEIVE AND MAINTAIN A FUND OR FUNDS OF REAL OR PERSONAL PROPERTY, TO USE PRIMARILY FOR THE FINANCIAL SUPPORT AND ENCOURAGEMENT OF THE HEALTH CARE AND COMMUNITY SUPPORT PROGRAMS OF COVENANT HOSPICE, INC. THE AMOUNT TRANSFERRED HELPED SUPPORT THE COSTS OF UNFUNDED PROGRAMS OF COVENANT HOSPICE, INC., COVENANT MEMORY CARE, INC., AND COVENANT ALZHEIMER'S SERVICES, INC. THESE UNFUNDED PROGRAMS INCLUDES SERVICES FROM THE FOLLOWING DEPARTMENTS: CHAPLAINS, BEREAVEMENT, CHILDREN, AND VOLUNTEERS. PALLIATIVE CARE SERVICES ARE ALSO OFFERED TO PATIENT AFTER LIFE-LIMITING DIAGNOSES, BUT BEFORE THEY ARE READY FOR HOSPICE. 1927490 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 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 0 0 0 1 12 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 FL X ROLAND CLEANEY 8504332155 5041 N 12TH AVE PENSACOLA FL 32504 JEFF MISLEVY PRESIDENT/CEO 4.00 52.00 X X 0 885168 20860 ODIN BERG CSO/TREASURER 4.00 52.00 X X 0 431257 2496 JOE BOYLES CHAIRMAN 4.00 X X 0 0 0 JESSICA LEE PAST CHAIR 4.00 X X 0 0 0 SUE STRAUGHN SECRETARY 4.00 X X 0 0 0 DENNIS BARNES VICE CHAIR 4.00 X X 0 0 0 RICK APPLEYARD BOARD MEMBER 4.00 X 0 0 0 JANE LAUTER BOARD MEMBER 4.00 X 0 0 0 ANDREW HOBBS BOARD MEMBER 4.00 X 0 0 0 WHITNEY LUCAS BOARD MEMBER 4.00 X 0 0 0 HONG POTOMSKI BOARD MEMBER 4.00 X 0 0 0 BRIAN WILLIAMS BOARD MEMBER 4.00 X 0 0 0 AARON WEST VP ADVANCEMENT 4.00 40.00 X X 0 312367 16600 KRISTEN MCGEHEE COO 4.00 52.00 X 0 252920 18290 ROLAND CLENEAY CFO 4.00 52.00 X 0 383130 20719 TODD FISHER COO 4.00 52.00 X 0 250434 149 0 2515276 79114 0 1 1 0 0 178886 1500812 12165 1679698 8057 8057 21147 11951 9196 9196 9196 0 178886 146215 -146215 -146215 1550736 0 0 -128962 855550 855550 93828 93828 18003 18003 6248 6248 6000 6000 145488 145488 4912 4912 15665 15665 FAMILY SUPPORT 675479 675479 SALARY ALLOCATION 330983 104852 226131 SPONSORSHIPS 1465 1465 2153621 1927490 226131 0 2550627 586433 302904 255738 1002006 1369512 6169 11020 786284 1778911 4647990 4001614 14197 -120 34750 33220 48947 33100 X 2230796 1422799 2368247 2545715 4599043 3968514 4647990 4001614 X -602885 -24316 -3328 X 0 0 0 X X 4 COVENANT HOSPICE INC 592208300 10 0 103280 0 ALZHEIMERS FAMILY SERVICES INC 593394242 7 0 270576 0 COVENANT HEALTH AND COMMUNITY SERVICES INC 465132177 10 1 481694 0 COVENANT AT HOME INC 352543765 10 0 0 0 4 855550 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 DUE FROM COVENANT AT HOME 4 DUE TO ALZHEIMERS FAMILY SERVICES -905552 DUE FROM COVENANT HOSPICE 3209496 DUE FROM CHCS -525037 1778911 GIFT ANNUITY OBLIGATION 33220 33220 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. MASK PARADE 99067 99067 88771 ART OF FASHION 62780 62780 57444 1 17039 17039 178886 178886 146215 146215 -146215 1 COVENANT HOSPICE INC 5041 N 12TH AVE PENSACOLA FL 32504 592208300 501(C)(3) 103280 0 FMV TO SUPPORT OPERATIONS ALZHEIMER'S FAMILY SERVICES 5041 N 12TH AVE PENSACOLA FL 32504 593394242 501(C)(3) 481694 0 FMV TO SUPPORT OPERATIONS COVENANT MEMORY CARE CENTER AT THE JOYCE GOLDENBERG CAMPUS 5041 N 12TH AVE PENSACOLA FL 32504 812591039 501(C)(3) 270576 0 FMV TO SUPPORT OPERATIONS X X X 0 0 0 0 0 0 0 0 0 JEFF MISLEVY PRESIDENT/CEO 0 449897 0 301991 0 133280 0 20500 0 360 0 906028 0 0 ODIN BERG CSO/TREASURER 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 AARON WEST VP ADVANCEMENT 0 246993 0 47345 0 18029 0 16077 0 523 0 328967 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 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 FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7A COVENANT HEALTH AND COMMUNITY SERVICES, INC. ELECTS THE BOARD MEMBERS OF COVENANT HOSPICE FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE WRITTEN APPROVAL FROM COVENANT HEALTH AND COMMUNITY SERVICES, INC: -THE APPOINTMENT OR THE REMOVAL OF A MEMBER OF THE BOARD OF DIRECTORS. -THE INCURRENCE OF ANY SINGLE INDEBTEDNESS OR OTHER OBLIGATIONS IN EXCESS OF $500,000 OR IN THE AGGREGATE DURING ANY 12 MONTHS OF INDEBTEDNESS 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 TRANSFERS IN THE PRECEDING 12 MONTHS EXCEEDS A VALUE OF $2,000,000. -ANY SINGLE CAPITAL EXPENDITURE IN EXCESS OF $500,000 OR ANY CAPITAL EXPENDITURE 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. -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 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 ORGANIZATIONS CONFLICT OF INTEREST POLICY ARE AVAILABLE ON WRITTEN REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN SPLIT INTEREST -3,328. COVENANT HOSPICE INC 5041 N 12TH AVE PENSACOLA FL 32504 592208300 PROVIDES CARE TO TERMINALLY ILL PATIENTS FL 501(C)(3) LINE 10 COVENANT HEALTH AND COMMUNITY SERVICES INC 1 ALZHEIMERS 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 1 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 1 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 1 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 COVENANT HOSPICE INC B 103280 FMV COVENANT HEALTH AND COMMUNITY SERVICES INC B 481694 FMV ALZHEIMERS FAMILY SERVICES B 270576 FMV COVENANT HOSPICE INC D 3209496 FMV COVENANT HEALTH AND COMMUNITY SERVICES INC E 525037 FMV COVENANT AT HOME INC D 4 FMV ALZHEIMERS FAMILY SERVICES E 905552 FMV COVENANT HEALTH AND COMMUNITY SERVICES INC O 330983 FMV