GENESIS HOUSE INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- GENESIS HOUSE INC (EIN 23-7297769)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-15
- IRS object ID
- 202401369349318920
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-15T21:01:09-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PATRICIA A WINTROATH CPA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2121 N CALIFORNIA BLVD SUITE 290 | AddressLine1Txt |
| City | WALNUT CREEK | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94596 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237297769 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GENESIS HOUSE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GENE | BusinessNameControlTxt |
| Phone | 7075525295 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1149 WARREN AVENUE | AddressLine1Txt |
| City | VALLEJO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94591 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERRI RAIFORD | PersonNm |
| Person Title | EXECUTIVE DIRECTOR/TREASURER | PersonTitleTxt |
| Phone | 7075525295 | PhoneNum |
| Signature | 2024-05-14 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TERRI | PersonFirstNm |
| Person Last | RAIFORD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PATRICIA A WINTROATH | PreparerPersonNm |
| PTIN | P00430440 | PTIN |
| Phone | 9259743310 | PhoneNum |
| Preparation | 2024-05-14 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERRI RAIFORD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1149 WARREN AVENUE | AddressLine1Txt |
| City | VALLEJO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94591 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $661,513 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE IN-PATIENT ALCOHOL AND DRUG TREATMENT PROGRAMS, RELATED COUNSELING AND SUPPORT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 23 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $35,545 | PYContributionsGrantsAmt |
| CY Contributions Grants | $26,381 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $250,016 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $246,304 | CYProgramServiceRevenueAmt |
| PY Investment Income | $17 | PYInvestmentIncomeAmt |
| CY Investment Income | $335,200 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,554 | PYOtherRevenueAmt |
| CY Other Revenue | $3,618 | CYOtherRevenueAmt |
| PY Total Revenue | $295,132 | PYTotalRevenueAmt |
| CY Total Revenue | $611,503 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $321,831 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $275,070 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $14,717 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $175,485 | PYOtherExpensesAmt |
| CY Other Expenses | $198,573 | CYOtherExpensesAmt |
| PY Total Expenses | $497,316 | PYTotalExpensesAmt |
| CY Total Expenses | $473,643 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$202,184 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $137,860 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $618,371 | TotalAssetsBOYAmt |
| Total Assets EOY | $746,849 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $161,558 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $152,176 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $456,813 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $594,673 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE IN-PATIENT ALCOHOL AND DRUG TREATMENT PROGRAMS, RELATED COUNSELING AND SUPPORT SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $391,257 | ExpenseAmt |
| Revenue | $249,898 | RevenueAmt |
| Desc | LONG TERM RESIDENTIAL DRUG AND ALCOHOL TREATMENT AND REHABILITATION SERVICES - OVER 7,000 PATIENT DAYS | Desc |
| Total Program Service Expenses | $391,257 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 23 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GAIL MOON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7075525295 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1149 WARREN AVE | AddressLine1Txt |
| City | VALLEJO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94591 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| JIMMY SMITH | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |
| SHAWN CARTER | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| KESTER MCDONALD | ||||||
| EXECUTIVE DIRECTOR/SECRETA | 40.00 | Yes (X) | $60,000 | $0 | $6,000 | Yes (X) |
| DANIEL BARWELA | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL PRITCHARD | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |
| LARS WOHLER | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |
| GEORGE MARISCAL | ||||||
| PRESIDENT | 0.30 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| GAIL MOON | ||||||
| TREASURER | 3.30 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| JOEL HART | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |
| BRITTANY CARDINALE | ||||||
| DIRECTOR | 0.30 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $60,000 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $6,000 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $26,381 | AllOtherContributionsAmt |
| Total Contributions | $26,381 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| SERVICE FEES | 623990 | $200,850 | $200,850 |
| PROCEEDS FROM JOBS | 623990 | $24,939 | $24,939 |
| SOBER LIVING FEES | 623990 | $20,515 | $20,515 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $246,304 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $84 | TotalRevenueColumnAmt |
| Exclusion | $84 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $385,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $49,884 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $335,116 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $335,116 | TotalRevenueColumnAmt |
| Exclusion | $335,116 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $150 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $126 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24 | TotalRevenueColumnAmt |
| Exclusion | $24 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 623990 | BusinessCd |
| Total Revenue Column | $3,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,594 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,594 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $611,503 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $249,898 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $335,224 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,000 | TotalAmt |
| Program Services | $48,000 | ProgramServicesAmt |
| Management And General | $9,000 | ManagementAndGeneralAmt |
| Fundraising | $3,000 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,562 | TotalAmt |
| Program Services | $133,928 | ProgramServicesAmt |
| Management And General | $23,634 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,507 | TotalAmt |
| Program Services | $15,606 | ProgramServicesAmt |
| Management And General | $2,926 | ManagementAndGeneralAmt |
| Fundraising | $975 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,001 | TotalAmt |
| Program Services | $35,274 | ProgramServicesAmt |
| Management And General | $2,497 | ManagementAndGeneralAmt |
| Fundraising | $230 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,150 | TotalAmt |
| Management And General | $6,150 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,219 | TotalAmt |
| Program Services | $6,219 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,737 | TotalAmt |
| Fundraising | $6,737 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,671 | TotalAmt |
| Management And General | $5,671 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,194 | TotalAmt |
| Program Services | $28,955 | ProgramServicesAmt |
| Management And General | $5,429 | ManagementAndGeneralAmt |
| Fundraising | $1,810 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,114 | TotalAmt |
| Program Services | $3,291 | ProgramServicesAmt |
| Management And General | $617 | ManagementAndGeneralAmt |
| Fundraising | $206 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238 | TotalAmt |
| Program Services | $238 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,602 | TotalAmt |
| Program Services | $7,682 | ProgramServicesAmt |
| Management And General | $1,440 | ManagementAndGeneralAmt |
| Fundraising | $480 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,513 | TotalAmt |
| Program Services | $15,610 | ProgramServicesAmt |
| Management And General | $2,927 | ManagementAndGeneralAmt |
| Fundraising | $976 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,172 | TotalAmt |
| Program Services | $29,896 | ProgramServicesAmt |
| Management And General | $5,276 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| DIRECT PATIENT CARE | $57,306 | $55,623 | $1,683 |
| REPAIRS & MAINTENANCE | $9,941 | $9,941 | |
| JOB COSTS | $994 | $994 | |
| BANK CHARGES | $419 | $419 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $303 | TotalAmt |
| Fundraising | $303 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $473,643 | TotalAmt |
| Program Services | $391,257 | ProgramServicesAmt |
| Management And General | $67,669 | ManagementAndGeneralAmt |
| Fundraising | $14,717 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,755 | BOYAmt |
| EOY | $199,101 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $94,690 | BOYAmt |
| EOY | $157,653 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,230 | BOYAmt |
| EOY | $10,270 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,656 | BOYAmt |
| EOY | $19,416 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $876,793 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $516,384 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $405,040 | BOYAmt |
| EOY | $360,409 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $618,371 | BOYAmt |
| EOY | $746,849 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,914 | BOYAmt |
| EOY | $9,089 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,994 | BOYAmt |
| EOY | $143,087 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,650 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $161,558 | BOYAmt |
| EOY | $152,176 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,813 | BOYAmt |
| EOY | $594,673 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,813 | BOYAmt |
| EOY | $594,673 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $618,371 | BOYAmt |
| EOY | $746,849 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $137,860 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $301,915 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $354,982 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,224 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $35,545 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,381 | CurrentTaxYearAmt |
| Total | $740,047 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $301,915 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $354,982 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,224 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $35,545 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $26,381 | CurrentTaxYearAmt |
| Total | $740,047 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $740,047 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $43 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $84 | CurrentTaxYearAmt |
| Total | $152 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,909 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,540 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $80,110 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $3,595 | CurrentTaxYearAmt |
| Total | $106,154 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $846,353 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $1,191,922 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.87440 | PublicSupportCY170Pct |
| Public Support PY170 | 0.90850 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $65,629 | OtherCostOrOtherBasisAmt |
| Book Value | $65,629 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $571,090 | OtherCostOrOtherBasisAmt |
| Depreciation | $280,394 | DepreciationAmt |
| Book Value | $290,696 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $240,074 | OtherCostOrOtherBasisAmt |
| Depreciation | $235,990 | DepreciationAmt |
| Book Value | $4,084 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $360,409 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $611,503 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $611,503 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $611,503 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $473,643 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $473,643 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $473,643 | TotalExpensesPerForm990Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE EXECUTIVE DIRECTOR AND FISCAL OFFICER REVIEW THE FORM 990 PRIOR TO FILING THE FORM. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION NOTIFIES THE BOARD MEMBERS OF THE CONFLICT OF INTEREST POLICY AT A BOARD MEETING ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS DETERMINED BY COMPARISON WITH LIKE ORGAINZATIONS IN THE REGION, THROUGH SOURCES SUCH AS CALIFONRIA HEALTH CARE ALMANAC - EMPLOYER HEALTH BENEFITS SURVEY, AND A PERCENT OF INFLATION IS ALSO USED IN DETERMINING THE PAY RAISES, WHICH ARE SUBJECT TO BOARD APPROVAL. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE ON THE CALIFORNIA REGISTRY OF CHARITABLE TRUST'S WEBSITE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
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