Murfreesboro nonprofit to pull funds from Alive Hospice if board sells to for-profit company

A Murfreesboro charitable foundation that gave more than $3 million to help Alive Hospice build a facility in Rutherford County has told Alive it wants its money back if the nonprofit is sold to a for-profit company.

The Christy-Houston Foundation also made its concerns known to the Tennessee Attorney General in a letter and attachments sent last week. It is among 11 complaints filed this month with the attorney general’s office, which has oversight of the state’s nonprofits. 

The complaints followed news reports that surfaced late last month about a possible sale of Alive to a for-profit company. In a statement, Alive Hospice said it is acting only in the best interests of the organization, cannot comment on the reports and it would “never do anything to harm the people or legacy of Alive.” (The full statement is included below.)

“At this point, we can say we are looking into this, but it would be premature to comment further,” a spokeswoman for the Tennessee Attorney General’s office said in a May 11 email.

The Murfreesboro residential hospice has been years in the making.

In July 2014, Alive announced plans to build a 10-bed hospice facility in Murfreesboro, the Murfreesboro Post reported. Alive had already been providing home hospice care and grief support services in the county. A free-standing 10-bed hospice facility would be the first of its kind there, the Post said; healthcare providers and area residents had asked Alive to expand south of Nashville because of population growth.

In August 2016, Alive broke ground for The Residence at Alive Hospice Murfreesboro. The planned $8.1 million, 20,592-square-foot facility also had enough open space to be converted into six more rooms if needed. The hospice had raised 95% of its $8.1 million fundraising goal, the Daily News Journal reported. 

The Murfreesboro facility opened in late May 2017, and the financial support of the Christy-Houston Foundation helped make the facility possible.

The May 12 letter from foundation President Anne C. Davis to Attorney General Jonathan Skrmetti states that it made a $3 million grant to Alive Hospice in 2016 to help build the Alive Murfreesboro facility, plus another $245,000 in 2022 to convert open space to six new patient rooms. 

Under the grant contract between the foundation and Alive Hospice, the letter says, “the Facility may not be sold, transferred, or conveyed to any other person or organization without the Foundation’s prior written consent.” The letter also says Alive Hospice agrees to return the full amount of the grant to the Foundation within 30 days of a sale of the facility, with or without the foundation’s written approval.

“Please be advised that The Christy-Houston Foundation, Inc. will expect the repayment of $3,245,000 in grants made to Alive Hospice, should their Board of Directors sell to a for-profit entity,” Davis wrote to Skrmetti. Davis also sent the attorney general’s office copies of letters she had sent to Alive Hospice President and CEO Kimberly Goessele and to Alive’s board chairman stating the foundation expected to be repaid the $3,245,000.

Davis did not return phone calls and an email seeking comment. Alive Hospice was asked specifically about the Christy-Houston Foundation letter and responded with the May 9 statement below issued by Alive’s governing board executive committee on behalf of the board.

Hospices have existed throughout history to provide people with care at the end of their lives. The original hospice was a “church or charitable organization that is essentially ministering to the dying” and providing palliative care to patients, said attorney Tim Takacs of Takacs McGinnis Elder Care Law PLLC of Hendersonville. That’s still part of the hospice ethos, he said, and it’s important to patients.

“Alive is kind of the big dog in town; it has been around for a long time,” Takacs said, adding that it offers residential care and provides services other hospices don’t.

What has changed over the years nationally is who provides hospice care. The Wall Street Journal reported earlier this month that nonprofits once dominated the field but today “nearly two-thirds of hospice companies are for-profit.” 

Alive Hospice was founded in 1975 as a nonprofit. 

Alive’s website, in its section on its history, calls its founders “local visionaries who knew in their hearts that there must be a better way to care for the dying and their loved ones. 

“They envisioned a model of excellent clinical care delivered hand in hand with the emotional and spiritual support needed to navigate the end of a life. They saw a space where laughter could coexist with tears, where life would be celebrated, even as death was prepared for.

“Alive was the third hospice in the country and the first in the Southeast. … We are proud to carry on (its founders’) legacy.

“Today, Alive is a trusted community institution with the privilege of providing comfort and peace to thousands at the end of life. We have given millions to help families with medical bills, built two residences that provide 24/7 care, established the only grief center in the area to help families heal, and developed community partnerships that are a source of mutual pride and strength.”

One of the three founders, Dr. John Flexner, died in 2011. Founders Drs. David and Lynn Barton serve on Alive Hospice’s advisory board and want to keep Alive Hospice a nonprofit organization. (The advisory board doesn’t vote on board actions and is separate from the board of directors.) The Bartons signed the initial complaint filed with the office of the Tennessee Attorney General.

They and others wanting to keep Alive Hospice nonprofit have cited a RAND Corporation study that found patients receiving care from for-profit hospices had worse care experiences than those receiving care from nonprofit hospices. They also say the current management and board of Alive Hospice has not told the advisory board about any possible sale or change in its organization.

Alive Hospice serves patients in Nashville-Davidson County and 11 other Midstate counties, its online annual report states. Alive served 4,719 patients and their families in 2021, including pediatric hospice care for 21 young patients. Nine in ten patients are treated in their homes; others are served in Alive’s two residential facilities, a 30-room residence in Nashville and another with 10 rooms in Murfreesboro. Alive volunteers gave more than 11,000 hours of service, saving $259,511 in costs.

As a nonprofit and income-tax exempt organization, Alive also must file a Form 990, showing revenue, expenses and other information, with the Internal Revenue Service each year. 

Its most recent 990, filed in September 2022, reported contributions and grants of more than $3 million in 2021. Program service revenue for 2021 was about $32.4 million. The nonprofit finished 2021 with about $1 million more in revenue than expense.

The 990 for 2021 also reported that Alive Hospice’s assets totaled about $38.9 million at the end of the year. Liabilities were about $4.5 million, with assets exceeding liabilities by about $34.3 million. 

Among the assets is the land and buildings Alive Hospice owns in the 1700 block of Patterson Street in midtown Nashville. There is a residential facility on 3.8 acres at 1710 Patterson Street and a separate building at 1721 Patterson Street. The hospice reports assets of land, buildings and equipment valued at about $19.6 million at the end of 2021.

The Nashville Assessor of Property’s website lists a total appraised value of about $22.5 million for the 3.8 acres plus building at 1710 Patterson Street. It gives a total appraised value of about $4.5 million for .58 acres and a building at 1721 Patterson Street. The two sites were last appraised in 2021. 

Alive Hospice also has real estate in Murfreesboro. The Rutherford County Property Assessor’s website lists a total market appraisal of just over $5 million, with about $1.1 million for the land and $3.9 million for the building, which opened in 2017.