FURP.ORG / PUBLIC DATA EXPLORER

HUGHSON SAMARITAN VILLAGE: Form 990PF, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
HUGHSON SAMARITAN VILLAGE (EIN 46-0469127)
Tax period
2021-10-01 to 2022-09-30
Filed
2023-01-31
IRS object ID
202310319349100211
Schema version
2021v4.2
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

FieldValueIRS element (for citing)
Return2023-01-31T14:07:55-06:00ReturnTs
Tax Period End2022-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN941239084PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ATHERTON & ASSOCIATES LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 4339AddressLine1Txt
CityMODESTOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP953524339ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2021-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN460469127EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HUGHSON SAMARITAN VILLAGEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHUGHBusinessNameControlTxt
Phone2098833000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17700 FOX ROADAddressLine1Txt
CityHUGHSONCityNm
State AbbreviationCAStateAbbreviationCd
ZIP953261090ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonWILLIAM RAEBERPersonNm
Person TitleCFOPersonTitleTxt
Phone2098833000PhoneNum
Signature2023-01-31SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstWILLIAMPersonFirstNm
Person LastRAEBERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJACQUELYN HOWELLPreparerPersonNm
PTINP01327223PTIN
Phone2095774800PhoneNum
Self EmployedYes (X)SelfEmployedInd

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-03-07 01:45:13ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$26,384,011FMVAssetsEOYAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$10,412InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$10,412InterestOnSavNetInvstIncmAmt
Interest On Savings Adj Net Incm$10,412InterestOnSavingsAdjNetIncmAmt
Gross Rents Rev And Expnss$9,439,402GrossRentsRevAndExpnssAmt
Gross Rents Adj Net Incm$9,439,402GrossRentsAdjNetIncmAmt
Net Rental Income Or Loss$9,439,402NetRentalIncomeOrLossAmt
Cap Gain Net Incm Net Invst Incm$0CapGainNetIncmNetInvstIncmAmt
Net ST Capital Gain Adj Net Incm$0NetSTCapitalGainAdjNetIncmAmt
Other Income Rev And Expnss$3,012,838OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$0OtherIncomeNetInvstIncmAmt
Other Income Adj Net Incm$3,012,838OtherIncomeAdjNetIncmAmt
Total Rev And Expnss$12,462,652TotalRevAndExpnssAmt
Total Net Invst Incm$10,412TotalNetInvstIncmAmt
Total Adj Net Incm$12,462,652TotalAdjNetIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$514,222CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Adj Net Incm$453,748CompOfcrDirTrstAdjNetIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$60,474CompOfcrDirTrstDsbrsChrtblAmt
Oth Empl Slrs Wgs Rev And Expnss$5,167,872OthEmplSlrsWgsRevAndExpnssAmt
Oth Empl Slrs Wgs Net Invst Incm$0OthEmplSlrsWgsNetInvstIncmAmt
Oth Empl Slrs Wgs Adj Net Incm$4,560,120OthEmplSlrsWgsAdjNetIncmAmt
Oth Empl Slrs Wgs Dsbrs Chrtbl$607,752OthEmplSlrsWgsDsbrsChrtblAmt
Pension Empl Bnft Rev And Expnss$754,206PensionEmplBnftRevAndExpnssAmt
Pension Empl Bnft Net Invst Incm$0PensionEmplBnftNetInvstIncmAmt
Pension Empl Bnft Adj Net Incm$665,510PensionEmplBnftAdjNetIncmAmt
Pension Empl Bnft Dsbrs Chrtbl$88,696PensionEmplBnftDsbrsChrtblAmt
Legal Fees Rev And Expnss$71,162LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Adj Net Incm$62,793LegalFeesAdjNetIncmAmt
Legal Fees Dsbrs Chrtbl$8,369LegalFeesDsbrsChrtblAmt
Accounting Fees Rev And Expnss$61,175AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$0AccountingFeesNetInvstIncmAmt
Accounting Fees Adj Net Incm$53,981AccountingFeesAdjNetIncmAmt
Accounting Fees Chrtbl Prps$7,194AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$13,220OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$0OtherProfFeesNetInvstIncmAmt
Other Prof Fees Adj Net Incm$11,665OtherProfFeesAdjNetIncmAmt
Other Prof Fees Dsbrs Chrtbl$1,555OtherProfFeesDsbrsChrtblAmt
Interest Rev And Expnss$874,354InterestRevAndExpnssAmt
Interest Net Invst Incm$0InterestNetInvstIncmAmt
Interest Adj Net Incm$771,528InterestAdjNetIncmAmt
Interest Dsbrs Chrtbl$102,826InterestDsbrsChrtblAmt
Deprec And Dpltn Rev And Expnss$1,814,325DeprecAndDpltnRevAndExpnssAmt
Deprec And Dpltn Net Invst Incm$0DeprecAndDpltnNetInvstIncmAmt
Deprec And Dpltn Adj Net Incm$1,600,957DeprecAndDpltnAdjNetIncmAmt
Trav Conf Meeting Rev And Expnss$14,103TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Net Invst Incm$0TravConfMeetingNetInvstIncmAmt
Trav Conf Meeting Adj Net Incm$12,444TravConfMeetingAdjNetIncmAmt
Trav Conf Meeting Dsbrs Chrtbl$1,659TravConfMeetingDsbrsChrtblAmt
Printing And Pub Rev And Expnss$8,083PrintingAndPubRevAndExpnssAmt
Printing And Pub Net Invst Incm$0PrintingAndPubNetInvstIncmAmt
Printing And Pub Adj Net Incm$7,132PrintingAndPubAdjNetIncmAmt
Printing And Pub Dsbrs Chrtbl$951PrintingAndPubDsbrsChrtblAmt
Other Expenses Rev And Expnss$4,817,347OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$0OtherExpensesNetInvstIncmAmt
Other Expenses Adj Net Incm$4,250,819OtherExpensesAdjNetIncmAmt
Other Expenses Dsbrs Chrtbl$564,044OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$14,110,069TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$0TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm$12,450,697TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$1,443,520TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$1,750ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$1,750ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$14,111,819TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$0TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm$12,450,697TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl$1,445,270TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses-$1,649,167ExcessRevenueOverExpensesAmt
Net Investment Income$10,412NetInvestmentIncomeAmt
Adjusted Net Income$11,955AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$1,503,063CashBOYAmt
Cash EOY$1,299,179CashEOYAmt
Cash EOYFMV$1,299,179CashEOYFMVAmt
Sav And Temp Cash Invst BOY$1,527,016SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$1,557,117SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$1,557,117SavAndTempCashInvstEOYFMVAmt
Acct Rcvbl$215,756AcctRcvblAmt
Acct Rcvbl BOY$99,600AcctRcvblBOYAmt
Acct Rcvbl EOY$215,756AcctRcvblEOYAmt
Acct Rcvbl EOYFMV$215,756AcctRcvblEOYFMVAmt
Inventories BOY$34,908InventoriesBOYAmt
Inventories EOY$29,037InventoriesEOYAmt
Inventories EOYFMV$29,037InventoriesEOYFMVAmt
Prepaid Expenses BOY$268,657PrepaidExpensesBOYAmt
Prepaid Expenses EOY$284,086PrepaidExpensesEOYAmt
Prepaid Expenses EOYFMV$284,086PrepaidExpensesEOYFMVAmt
Corporate Stock BOY$1,324,757CorporateStockBOYAmt
Corporate Stock EOY$1,325,225CorporateStockEOYAmt
Corporate Stock EOYFMV$1,429,293CorporateStockEOYFMVAmt
Land Bldg Equip Cost Or Other Bss$51,115,551LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$31,106,804LandBldgEquipAccumDeprecAmt
Land BOY$21,444,393LandBOYAmt
Land EOY$20,008,747LandEOYAmt
Land EOYFMV$20,008,747LandEOYFMVAmt
Other Assets BOY$1,472,868OtherAssetsBOYAmt
Other Assets EOY$1,560,796OtherAssetsEOYAmt
Other Assets EOYFMV$1,560,796OtherAssetsEOYFMVAmt
Total Assets BOY$27,675,262TotalAssetsBOYAmt
Total Assets EOY$26,279,943TotalAssetsEOYAmt
Total Assets EOYFMV$26,384,011TotalAssetsEOYFMVAmt
Accounts Payable BOY$694,064AccountsPayableBOYAmt
Accounts Payable EOY$692,054AccountsPayableEOYAmt
Deferred Revenue BOY$19,743DeferredRevenueBOYAmt
Deferred Revenue EOY$61,205DeferredRevenueEOYAmt
Other Liabilities BOY$20,353,614OtherLiabilitiesBOYAmt
Other Liabilities EOY$20,568,010OtherLiabilitiesEOYAmt
Total Liabilities BOY$21,067,421TotalLiabilitiesBOYAmt
Total Liabilities EOY$21,321,269TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY$6,607,841NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY$4,958,674NoDonorRstrNetAssestsEOYAmt
Tot Net Ast Or Fund Balances BOY$6,607,841TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$4,958,674TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$27,675,262TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$26,279,943TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$6,607,841TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses-$1,649,167ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$4,958,674SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$4,958,674TotNetAstOrFundBalancesEOYAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Investment Income Excise Tax$145InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$145SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$145TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$320EstimatedPlusOvpmtIncmTxAmt
Exempt Frgn Org Tax Wthld At Srce$0ExemptFrgnOrgTaxWthldAtSrceAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$320TotalPaymentsAndCreditsAmt
Es Penalty$0EsPenaltyAmt
Overpayment$175OverpaymentAmt
Applied To ES Tax$160AppliedToESTaxAmt
Refund$15RefundAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr Satisfied0Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateCAOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating FoundationYes (1)PrivateOperatingFoundationInd
New Substantial Contributors0NewSubstantialContributorsInd
Own Controlled EntityYes (1)OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressWWW.SVLIVING.ORGWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1WILLIAM N RAEBERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2098833000PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line17700 FOX ROADAddressLine1Txt
CityHUGHSONCityNm
State AbbreviationCAStateAbbreviationCd
ZIP95326ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (11 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
JOHN ROGERS
7700 FOX ROADHUGHSONCA95326CHAIRMAN1.00$0$0$0
RANDALL SCHWANTES
7700 FOX ROADHUGHSONCA95326SECRETARY1.00$0$0$0
RAMON BAWANAN
7700 FOX ROADHUGHSONCA95326VICE CHAIRMAN1.00$0$0$0
WILLIAM N RAEBER
7700 FOX ROADHUGHSONCA95326CFO40.00$197,210$6,435$0
DAN AGUILAR
7700 FOX ROADHUGHSONCA95326PRESIDENT & CEO40.00$317,013$6,450$0
JUNE ROGERS
7700 FOX ROADHUGHSONCA95326DIRECTOR1.00$0$0$0
JANET ROGERS
7700 FOX ROADHUGHSONCA95326DIRECTOR1.00$0$0$0
VITO CHIESA
7700 FOX ROADHUGHSONCA95326DIRECTOR1.00$0$0$0
ROBERT FORESTER MD
7700 FOX ROADHUGHSONCA95326DIRECTOR1.00$0$0$0
PATRICIA MASON
7700 FOX ROADHUGHSONCA95326DIRECTOR1.00$0$0$0
WALTER SCHMIDT
7700 FOX ROADHUGHSONCA95326DIRECTOR1.00$0$0$0

Compensation Highest Paid Empl CompensationHighestPaidEmplGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee BenefitsEmployeeBenefitsAmtExpense AccountExpenseAccountAmt
BETTY LOPEZ
7700 FOX ROADHUGHSONCA95326ADMINISTRATOR40.00$199,992$418$0
JANELLE SHEARS
7700 FOX ROADHUGHSONCA95326DIRECTOR OF HUMAN RE40.00$175,290$8,484$0
RIKKI PEREZCHICA
7700 FOX ROADHUGHSONCA95326ADMINISTRATOR40.00$159,615$9,396$0
ALBERTO PEREZ
7700 FOX ROADHUGHSONCA95326DIRECTOR OF IT & SUP40.00$151,492$9,328$0
LORRY QUINTERO
7700 FOX ROADHUGHSONCA95326DIRECTOR OF PATIENT40.00$144,997$3,386$0
FieldValueIRS element (for citing)
Other Employee Paid Over50k18OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdService TypeServiceTypeTxtCompensationCompensationAmt
TRICOUNTY FLOORING INC
481 BELLEVUE ROADATWATERCA95301FLOORING$186,309
LITTLER MENDELSON PC
650 CALIFORNIA STREET 20TH FLOORSAN FRANCISCOCA94108LEGAL$142,014
GP LANDSCAPE
PO BOX 22926SACRAMENTOCA95822LANDSCAPING$104,623
DATA PATH INC
318 MCHENRY AVENUEMODESTOCA95354COMPUTER SERVICES$87,145
ATHERTON & ASSOCIATES LLP
PO BOX 4339MODESTOCA95352ACCOUNTING$61,175
FieldValueIRS element (for citing)
Contractor Paid Over50k0ContractorPaidOver50kCnt

Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp

FieldValueIRS element (for citing)
Description1TO MAKE DISTRIBUTIONS OF ITS INCOME AND ASSETS FOR ITS OWN CHARITABLE ACTIVITIES OR TO OTHER NONPROFIT ORGANIZATIONS. FUNDS WILL BE USED EXCLUSIVELY FOR CHARITABLE PURPOSES.Description1Txt
Expenses1$14,111,819Expenses1Amt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$1,720,823AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$3,100,416AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$4,821,239TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$4,821,239AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$72,319CashDeemedCharitableAmt
Net Vl Noncharitable Assets$4,748,920NetVlNoncharitableAssetsAmt
Minimum Investment Return$237,446MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Sect4942j3j5 Fndtn And Frgn OrgYes (X)Sect4942j3j5FndtnAndFrgnOrgInd

PF Qualifying Distributions PFQualifyingDistributionsGrp

FieldValueIRS element (for citing)
Expenses And Contributions$1,445,270ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Charitable Assets Acquis Paid$378,679CharitableAssetsAcquisPaidAmt
Qualifying Distributions$1,823,949QualifyingDistributionsAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Qualifying Distributions$1,823,949QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$0AppliedToCurrentYearAmt
Remaining Distri From Corpus$1,823,949RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$1,823,949TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$1,823,949ExcessDistriCyovToNextYrAmt
Excess From Current Year$1,823,949ExcessFromCurrentYearAmt

Private Operating Foundations PrivateOperatingFoundationsGrp

FieldValueIRS element (for citing)
Private Operating Fndtn Ruling2002-09-05PrivateOperatingFndtnRulingDt
Section4942j3Yes (X)Section4942j3Ind

Lessor Adj Net Incm Min Invst Ret LessorAdjNetIncmMinInvstRetGrp

FieldValueIRS element (for citing)
Current Year$11,955CurrentYearAmt
Year1$21,809Year1Amt
Year2$25,707Year2Amt
Year3$40,842Year3Amt
Total$100,313TotalAmt

Pct85 Lessor Adj Incm Or Min Ret Pct85LessorAdjIncmOrMinRetGrp

FieldValueIRS element (for citing)
Current Year$10,162CurrentYearAmt
Year1$18,538Year1Amt
Year2$21,851Year2Amt
Year3$34,716Year3Amt
Total$85,266TotalAmt

Qualifying Distributions QualifyingDistributionsGrp

FieldValueIRS element (for citing)
Current Year$1,823,949CurrentYearAmt
Year1$1,565,809Year1Amt
Year2$1,130,583Year2Amt
Year3$867,055Year3Amt
Total$5,387,396TotalAmt

Qualifying Distri Not Used Drt QualifyingDistriNotUsedDrtGrp

FieldValueIRS element (for citing)
Current Year$0CurrentYearAmt
Year1$0Year1Amt
Year2$0Year2Amt
Year3$0Year3Amt
Total$0TotalAmt

Qualifying Distri Made Drt QualifyingDistriMadeDrtGrp

FieldValueIRS element (for citing)
Current Year$1,823,949CurrentYearAmt
Year1$1,565,809Year1Amt
Year2$1,130,583Year2Amt
Year3$867,055Year3Amt
Total$5,387,396TotalAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
Current Year$26,279,943CurrentYearAmt
Year1$27,675,262Year1Amt
Year2$29,236,463Year2Amt
Year3$30,687,791Year3Amt
Total$113,879,459TotalAmt

Total Assets Sect4942j3 Bi TotalAssetsSect4942j3BiGrp

FieldValueIRS element (for citing)
Current Year$26,279,943CurrentYearAmt
Year1$27,675,262Year1Amt
Year2$29,236,463Year2Amt
Year3$30,687,791Year3Amt
Total$113,879,459TotalAmt

Two Thirds Minimum Invst Ret TwoThirdsMinimumInvstRetGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Support TotalSupportGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Public Support Type PublicSupportType

FieldValueIRS element (for citing)
Total$0TotalAmt

Largest Support From EO LargestSupportFromEOGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Gross Investment Income GrossInvestmentIncomeGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (2 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
UNITED SAMARITANS FOUNDATION
220 S BROADWAYTURLOCKCA95380NONEPCCHARITABLE CONTRIBUTION$1,250
HUGHSON FIRE DEPARTMENT
2316 3RD STREETHUGHSONCA95326NONEPCCHARITABLE CONTRIBUTION$500
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$1,750TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$10,412ExclusionAmt

Net Rntl Incm Re Debt Fincd Prop NetRntlIncmReDebtFincdPropGrp

FieldValueIRS element (for citing)
Exclusion30ExclusionCd
Exclusion$9,439,402ExclusionAmt

Other Revenue Described OtherRevenueDescribedGrp (2 entries)

DescDescExclusionExclusionCdExclusionExclusionAmt
OTHER REVENUE03$590,901
RESIDENT CARE SERVICES03$2,421,937

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$12,462,652ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$12,462,652TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$61,175Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$53,981AdjustedNetIncomeAmt
Disbursements Charitable Prps$7,194DisbursementsCharitablePrpsAmt

Depreciation Schedule DepreciationSchedule

Depreciation Property DepreciationPropertyGrp (6 entries)

PropertyPropertyDescAcquiredAcquiredDtCost Or Other BasisCostOrOtherBasisAmtComputation MethodComputationMethodTxtCurrent Year ExpenseCurrentYearExpenseAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtPrior Year DepreciationPriorYearDepreciationAmtLifeLifeRt
LAND2001-01-01$627,846L$0$0$0
LAND IMPROVEMENTS2001-01-01$4,040,003SL$149,855$0$149,855$2,490,36515.000000000000
BUILDINGS & IMPROVEMENTS2001-01-01$41,438,853SL$1,497,981$0$1,497,981$22,527,95439.000000000000
FURNITURE AND FIXTURES2001-01-01$1,798,908SL$28,096$0$28,096$1,645,7857.000000000000
EQUIPMENT2001-01-01$2,879,500SL$114,244$0$114,244$2,426,6305.000000000000
VEHICLES2001-01-01$330,441SL$24,149$0$24,149$201,7455.000000000000

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanationGrp

FieldValueIRS element (for citing)
IdentifierOWNERSHIP OF CONTROLLED ENTITIESIdentifierTxt
Form And Line ReferenceFORM 990-PF, PAGE 5, PART VII-A, LINE 11FormAndLineReferenceDesc
Medium ExplanationNAME: HUGHSON SAMARITAN VILLAGE HOLDINGS, LLCADDRESS: 7700 FOX ROAD, HUGHSON CA, 95326EIN: 90-1011736 EXCESS BUSINESS HOLDING: NONAME: HUGHSON SAMARITAN HOME CARE, LLC ADDRESS: 7700 FOX ROAD, HUGHSON CA, 95326 EIN: 35-2578444 EXCESS BUSINESS HOLDING: NOMediumExplanationTxt

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp

FieldValueIRS element (for citing)
StockEQUITIES & SECURITIESStockNm
EOY Book Value$1,325,225EOYBookValueAmt
EOYFMV$1,429,293EOYFMVAmt

Land Etc Schedule2 LandEtcSchedule2

Land Etc LandEtcGrp (5 entries)

Category Or ItemCategoryOrItemTxtCost Or Other BasisCostOrOtherBasisAmtAccumulated DepreciationAccumulatedDepreciationAmtBook ValueBookValueAmt
BUILDINGS$45,478,856$26,666,155$18,812,701
FURNITURE & FIXTURES$1,798,908$1,673,881$125,027
LAND$627,846$0$627,846
MACHINERY & OTHER EQUIPMENT$2,879,500$2,540,874$338,626
TRANSPORTATION EQUIPMENT$330,441$225,894$104,547

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGAL FEESCategoryTxt
Legal Fees$71,162LegalFeesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$62,793AdjustedNetIncomeAmt
Disbursements Charitable Prps$8,369DisbursementsCharitablePrpsAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp (4 entries)

DescDescBOY Book ValueBOYBookValueAmtEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
DEPOSITS HELD WITH VENDORS$114,355$116,752$116,752
REPLACEMENT RESERVE$1,291,779$1,373,391$1,373,391
ESCROW DEPOSITS$18,343$70,653$70,653
DEPOSITS HELD WITH LENDER$48,391$0$0

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (27 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
ADVERTISING$151,055$0$133,291$17,764
BANK AND PAYROLL CHARGES$55,814$0$49,250$6,564
BOOKS AND SUBSCRIPTIONS$12,236$0$10,797$1,439
CABLE$33,002$0$29,121$3,881
COMPUTER$60,801$0$53,651$7,150
CONTRACT SERVICES$403,334$0$355,901$47,433
DUES AND EVENTS$29,446$0$25,983$3,463
EMPLOYEE RELATED$59,450$0$52,459$6,991
FOOD$740,217$0$653,166$87,051
LIABILITY INSURANCE$346,398$0$305,661$40,737
LICENSES$80,338$0$70,890$9,448
MISCELLANEOUS$1,754$0$1,548$206
OFFICE SUPPLIES$18,433$0$16,265$2,168
POSTAGE$7,466$0$6,588$878
REPAIRS AND MAINTENANCE$348,701$0$307,693$41,008
SUPPLIES$265,021$0$233,854$31,167
TELEPHONE$84,456$0$74,524$9,932
UNIFORMS$2,717$0$2,397$320
UTILITIES$815,317$0$719,434$95,883
WORKERS' COMPENSATION INSURANCE$283,369$0$250,044$33,325
EQUIPMENT RENTAL$34,067$0$30,061$4,006
EMPLOYER CONTRIBUTION$49,939$0$44,066$5,873
MORTGAGE INSURANCE$101,676$0$89,719$11,957
COVID-19 RELATED EXPENSES$22,834$0$20,149$2,685
BAD DEBT EXPENSE$63,386$0$55,932$7,454
SETTLEMENT EXPENSE$725,000$0$639,739$85,261
AMORTIZATION$21,120$0$18,636$0

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail (2 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtAdjusted Net IncomeAdjustedNetIncomeAmt
OTHER REVENUE$590,901$590,901
RESIDENT CARE SERVICES$2,421,937$2,421,937

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail (4 entries)

DescDescBOY Book ValueBOYBookValueAmtEOY Book ValueEOYBookValueAmt
RESIDENT DEPOSITS PAYABLE$189,450$178,580
LOAN PAYABLE$20,056,614$19,664,430
PAYABLE TO LENDER$107,550$0
CONTINGENCY$0$725,000

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryCONSULTING FEESCategoryTxt
Amt$13,220Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$11,665AdjustedNetIncomeAmt
Disbursements Charitable Prps$1,555DisbursementsCharitablePrpsAmt

Transfers Frm Controlled Entities TransfersFrmControlledEntities

Transfers From Controlled Ent TransfersFromControlledEntGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINDescDescAmtAmt
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736REIMBURSED AUDIT FEES FROM HUGHSON SAMARITAN VILLAGE HOLDINGS, LLC TO HUGHSON SAMARITAN VILLAGE$0
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736REPLACEMENT RESERVE CHECK FROM ORIX REAL ESTATE CAPITAL, LLC$0
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736RESIDUAL RECEIPTS CHECK FROM ORIX REAL ESTATE CAPITAL, LLC$0
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736REPLACEMENT OF STOP PAYMENT FEE PAID BY HUGHSON SAMARITAN VILLAGE$0
HUGHSON SAMARITAN HOME CARE LLC
7700 FOX ROADHUGHSONCA95326352578444MISCELLANEOUS INCOME$0
FieldValueIRS element (for citing)
Total$231,546TotalAmt

Transfers To Controlled Entities TransfersToControlledEntities

Transfers To Controlled Ent TransfersToControlledEntGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINDescDescAmtAmt
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736PROPERTY AND EQUIPMENT LEASE INCOME$1,852,719
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736FIXED ASSET ACQUISITIONS$377,644
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736AUDIT FEES$13,750
HUGHSON SAMARITAN VILLAGE HOLDINGS LLC
7700 FOX ROADHUGHSONCA95326901011736TAX FEES$1,300
HUGHSON SAMARITAN HOME CARE LLC
7700 FOX ROADHUGHSONCA95326352578444MISCELLANEOUS EXPENSES$882,763
FieldValueIRS element (for citing)
Total$3,128,176TotalAmt