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  5. COVENANT HOSPICE, INC.

COVENANT HOSPICE, INC. - Florida Company Profile

Headquarter

Company Details

Entity Name: COVENANT HOSPICE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 04 Aug 1981 (44 years ago)
Last Event: AMENDMENT
Event Date Filed: 02 Dec 2019 (5 years ago)
Document Number: 759452
FEI/EIN Number 592208300

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 5041 N 12TH AVENUE, PENSACOLA, FL, 32504, US
Mail Address: 5041 N 12TH AVENUE, PENSACOLA, FL, 32504, US
ZIP code: 32504
County: Escambia
Place of Formation: FLORIDA

Links between entities

Type Company Name Company Number State
Headquarter of COVENANT HOSPICE, INC., ALABAMA 000-917-433 ALABAMA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1598274664 2017-09-21 2017-09-21 5041 N 12TH AVE, PENSACOLA, FL, 325048916, US 5151 N 9TH AVE FL 1, PENSACOLA, FL, 325048721, US

Contacts
Phone +1 850-433-2155
Fax 8502025803
Phone +1 850-262-7830
Fax 8505982753

Authorized person
Name MR. ODIN G. BERG
Role CFO
Phone 8504332155

Taxonomy
Taxonomy Code 315D00000X - Inpatient Hospice
License Number 5025095
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 015986100
State FL

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
549300ZVXZ38B3FIM232 759452 US-FL GENERAL ACTIVE -

Addresses
Legal C/O Dale Knee, 5041 North 12th Avenue, Pensacola, US-FL, US, 32504
Headquarters C/O Dale Knee, 5041 North 12th Avenue, Pensacola, US-FL, US, 32504

Registration details
Registration Date 2013-03-29
Last Update 2023-08-04
Status LAPSED
Next Renewal 2014-03-29
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 759452

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
COVENANT HOSPICE INC EMPLOYEE BENEFIT PLAN 2022 592208300 2023-07-28 COVENANT HOSPICE 467
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2019-01-01
Business code 621610
Sponsor’s telephone number 8503659642
Plan sponsor’s mailing address 5041 N 12TH AVE, PENSACOLA, FL, 325048916
Plan sponsor’s address 5041 N 12TH AVE, PENSACOLA, FL, 325048916

Number of participants as of the end of the plan year
Active participants 421
Retired or separated participants receiving benefits 16
Other retired or separated participants entitled to future benefits 66

Signature of
Role Plan administrator
Date 2023-07-28
Name of individual signing BRIAN TIEMAN
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-07-28
Name of individual signing BRIAN TIEMAN
Valid signature Filed with authorized/valid electronic signature
GROUP HEALTH TALL 2014 592208300 2015-07-17 COVENANT HOSPICE, INC. 77
File View Page
Three-digit plan number (PN) 509
Effective date of plan 2004-06-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Plan administrator’s name and address
Administrator’s EIN 592208300
Plan administrator’s name COVENANT HOSPICE, INC.
Plan administrator’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Administrator’s telephone number 8504332155

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing AMY BAJJALY
Valid signature Filed with authorized/valid electronic signature
GROUP HEALTH AL 2014 592208300 2015-07-17 COVENANT HOSPICE, INC. 85
File View Page
Three-digit plan number (PN) 508
Effective date of plan 2003-06-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing AMY BAJJALY
Valid signature Filed with authorized/valid electronic signature
METLIFE LIFE 2014 592208300 2015-07-17 COVENANT HOSPICE, INC. 1388
File View Page
Three-digit plan number (PN) 516
Effective date of plan 2012-01-01
Business code 621399
Sponsor’s telephone number 8502020337
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing AMY BAJJALY
Valid signature Filed with authorized/valid electronic signature
L/T DISABILITY 2014 592208300 2015-07-17 COVENANT HOSPICE, INC. 81
File View Page
Three-digit plan number (PN) 507
Effective date of plan 2003-07-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Plan administrator’s name and address
Administrator’s EIN 592208300
Plan administrator’s name COVENANT HOSPICE, INC.
Plan administrator’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Administrator’s telephone number 8504332155

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing AMY BAJJALY
Valid signature Filed with authorized/valid electronic signature
COVENANT HOSPICE, INC. 2014 592208300 2015-07-17 COVENANT HOSPICE, INC. 160
File View Page
Three-digit plan number (PN) 505
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Plan administrator’s name and address
Administrator’s EIN 592208300
Plan administrator’s name COVENANT HOSPICE, INC.
Plan administrator’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Administrator’s telephone number 8504332155

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing AMY BAJJALY
Valid signature Filed with authorized/valid electronic signature
BLUE OPTIONS 2014 592208300 2015-07-17 COVENANT HOSPICE, INC. 291
File View Page
Three-digit plan number (PN) 510
Effective date of plan 2007-01-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Number of participants as of the end of the plan year
Active participants 0
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2015-07-17
Name of individual signing AMY BAJJALY
Valid signature Filed with authorized/valid electronic signature
L/T DISABILITY 2013 592208300 2014-07-17 COVENANT HOSPICE, INC. 98
File View Page
Three-digit plan number (PN) 507
Effective date of plan 2003-07-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Plan administrator’s name and address
Administrator’s EIN 592208300
Plan administrator’s name COVENANT HOSPICE, INC.
Plan administrator’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Administrator’s telephone number 8504332155

Number of participants as of the end of the plan year
Active participants 93

Signature of
Role Plan administrator
Date 2014-07-17
Name of individual signing ODIN BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-17
Name of individual signing ODIN BERG
Valid signature Filed with authorized/valid electronic signature
COVENANT HOSPICE, INC. 2013 592208300 2014-07-17 COVENANT HOSPICE, INC. 211
File View Page
Three-digit plan number (PN) 505
Effective date of plan 1996-01-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Plan administrator’s name and address
Administrator’s EIN 592208300
Plan administrator’s name COVENANT HOSPICE, INC.
Plan administrator’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Administrator’s telephone number 8504332155

Number of participants as of the end of the plan year
Active participants 215

Signature of
Role Plan administrator
Date 2014-07-17
Name of individual signing ODIN BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-17
Name of individual signing ODIN BERG
Valid signature Filed with authorized/valid electronic signature
GROUP HEALTH AL 2013 592208300 2014-07-17 COVENANT HOSPICE, INC. 270
File View Page
Three-digit plan number (PN) 508
Effective date of plan 2003-06-01
Business code 621399
Sponsor’s telephone number 8504332155
Plan sponsor’s mailing address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Plan sponsor’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504

Plan administrator’s name and address
Administrator’s EIN 592208300
Plan administrator’s name COVENANT HOSPICE, INC.
Plan administrator’s address 5041 N. 12TH AVE., PENSACOLA, FL, 32504
Administrator’s telephone number 8504332155

Number of participants as of the end of the plan year
Active participants 229

Signature of
Role Plan administrator
Date 2014-07-17
Name of individual signing ODIN BERG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-07-17
Name of individual signing ODIN BERG
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
MISLEVY JEFFREY M President 5041 N 12TH AVENUE, PENSACOLA, FL, 32504
GUTTMANN RODNEY HPhd Director UNIVERSITY OF WEST FLORIDA, PENSACOLA, FL, 32514
OWENS THOMAS F Director BB&T, PENSACOLA, FL, 32504
CALDWELL MILLER Director 116 N TARRAGONA ST, PENSACOLA, FL, 32502
JENNINGS PETER MD Director 5153 N 9TH AVE, PENSACOLA, FL, 32504
PARRA BRETT MMD Director 4724 N DAVIS HWY, PENSACOLA, FL, 32503
JONES ROBERT LIII, ES Agent 501 COMMENDENCIA ST, PENSACOLA, FL, 32502

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G11000031865 THE HOSPICE OR NORTHWEST FLORIDA EXPIRED 2011-03-30 2016-12-31 - 5041 N. 12TH AVENUE, PENSACOLA, FL, 32504

Events

Event Type Filed Date Value Description
AMENDMENT 2019-12-02 - -
REGISTERED AGENT ADDRESS CHANGED 2019-12-02 501 COMMENDENCIA ST, PENSACOLA, FL 32502 -
REGISTERED AGENT NAME CHANGED 2019-12-02 JONES, ROBERT L, III, ESQ -
CHANGE OF PRINCIPAL ADDRESS 2005-04-25 5041 N 12TH AVENUE, PENSACOLA, FL 32504 -
CHANGE OF MAILING ADDRESS 2005-04-25 5041 N 12TH AVENUE, PENSACOLA, FL 32504 -
NAME CHANGE AMENDMENT 2001-03-30 COVENANT HOSPICE, INC. -
AMENDMENT 1993-03-25 - -
REINSTATEMENT 1990-06-29 - -
INVOLUNTARILY DISSOLVED 1985-11-01 - -

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J13000326513 TERMINATED 1000000469826 ESCAMBIA 2013-01-30 2033-02-06 $ 18,937.81 STATE OF FLORIDA, DEPARTMENT OF REVENUE, PENSACOLA SERVICE CENTER, 3670 N L ST STE C, PENSACOLA FL325055254
J11000238910 TERMINATED 1000000211318 LEON 2011-04-12 2031-04-20 $ 382.77 STATE OF FLORIDA, DEPARTMENT OF REVENUE, PENSACOLA SERVICE CENTER, 3670 N L ST STE C, PENSACOLA FL325055254

Documents

Name Date
ANNUAL REPORT 2024-04-10
ANNUAL REPORT 2023-04-06
AMENDED ANNUAL REPORT 2022-11-21
AMENDED ANNUAL REPORT 2022-04-28
ANNUAL REPORT 2022-03-09
ANNUAL REPORT 2021-04-16
AMENDED ANNUAL REPORT 2020-10-19
ANNUAL REPORT 2020-03-18
ANNUAL REPORT 2019-04-15
ANNUAL REPORT 2018-04-03

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
59-2208300 Corporation Unconditional Exemption 5041 N 12TH AVE, PENSACOLA, FL, 32504-8916 1982-10
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2022-12
Asset 50,000,000 to greater
Income 50,000,000 to greater
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Dec
Asset Amount 80329665
Income Amount 76075264
Form 990 Revenue Amount 62239514
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 202212
Filing Type E
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 202112
Filing Type E
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 202012
Filing Type E
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 201912
Filing Type E
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 201812
Filing Type E
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 201712
Filing Type E
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 201612
Filing Type P
Return Type 990
File View File
Organization Name COVENANT HOSPICE INC
EIN 59-2208300
Tax Period 201512
Filing Type E
Return Type 990
File View File

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JONES ROBERT LIII, ES

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Florida Limited Liability Co. (2019 )
COVENANT HOME HEALTH CARE 8, LLC - Active
Florida Limited Liability Co. (2019 )
CASTLE CHARTER, INC. - Inactive
Domestic Profit (2013 - 2021)
DEPENDUS CARE, LLC - Inactive
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Companies related by address

5041 N 12TH AVENUE, PENSACOLA, FL, 32504, US

THE HOSPICE OF NORTHWEST FLORIDA, INC.

5041 N 12TH AVENUE, PENSACOLA, FL, 32504, US

THE HOSPICE OF NORTHWEST FLORIDA, INC.

Date of last update: 01 Mar 2025

Sources: Florida Department of State

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