JERRY RUBIN FOUNDATION FOR CANCER CARE: Form 990EZ, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- JERRY RUBIN FOUNDATION FOR CANCER CARE (EIN 86-3477976)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-03-06
- IRS object ID
- 202320659349201742
- Schema version
- 2022v4.1
- 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 | 2023-03-06T17:59:40-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1188 PADRE DRIVE STE 101 | AddressLine1Txt |
| City | SALINAS | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 93901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 863477976 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JERRY RUBIN FOUNDATION FOR CANCER CARE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JERR | BusinessNameControlTxt |
| Phone | 8316424041 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 HARRIS COURT BUILDING T 201 | AddressLine1Txt |
| City | MONTEREY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 939405750 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | M ZACH KOONTZ MD | PersonNm |
| Person Title | SECRETARY/TREASURER | PersonTitleTxt |
| Phone | 8316424041 | PhoneNum |
| Signature | 2023-03-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | M | PersonFirstNm |
| Person Last | ZACH KOONTZ MD | 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 | KIELY HOLCOMB CPA | PreparerPersonNm |
| PTIN | P01430569 | PTIN |
| Phone | 8317596300 | PhoneNum |
| Preparation | 2023-03-01 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | 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-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Website Address | WWW.JERRYRUBINFOUNDATIONFORCANCERCARE.ORG | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $72,050 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $72,050 | ContributionsGiftsGrantsEtcAmt |
| Total Revenue | $72,050 | TotalRevenueAmt |
| Salaries Other Comp Empl Bnft | $1,407 | SalariesOtherCompEmplBnftAmt |
| Fees And Other Pymt To Ind Cntrct | $4,041 | FeesAndOtherPymtToIndCntrctAmt |
| Occupancy Rent Utlts And Maint | $9,669 | OccupancyRentUtltsAndMaintAmt |
| Other Expenses Total | $1,969 | OtherExpensesTotalAmt |
| Total Expenses | $17,086 | TotalExpensesAmt |
| Excess Or Deficit For Year | $54,964 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $720 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $55,684 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $720 | BOYAmt |
| EOY | $55,735 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $720 | BOYAmt |
| EOY | $55,735 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $51 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $720 | BOYAmt |
| EOY | $55,684 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | THE FOUNDATION IS FORMED TO PROVIDE FINANCIAL AND OTHER ASSISTANCE AND SUPPORT TO CANCER PATIENTS, INCLUDING, WITHOUT LIMITATION, PROGRAMS DESIGNED TO MEET THE PSYCHOLOGICAL AND EMOTIONAL NEEDS OF CANCER PATIENTS, TO PROVIDE EDUCATIONAL PROGRAMS FOR MEDICAL PROFESSIONALS WITH RESPECT TO THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF CANCER, TO ESTABLISH COMMUNITY-BASED EDUCATIONAL INITIATIVES TO PROMOTE THE EARLY DETECTION OF CANCER AND AN INTEGRATED APPROACH TO CANCER TREATMENT, TO PROVIDE SUPPORT GROUPS FOCUSED ON CANCER PATIENTS, CAREGIVERS AND THE BEREAVED, AND TO PROVIDE SUCH OTHER PROGRAMS AS WILL ASSIST CANCER PATIENTS DURING THEIR BATTLE WITH CANCER AND WITH END OF LIFE. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | THE JERRY RUBIN FOUNDATION WAS ESTABLISHED IN DECEMBER 2021 TO ASSIST CANCER PATIENTS THROUGHOUT THEIR CANCER JOURNEY ADDITIONALLY, IT IS STRUCTURED TO HELP PATIENTS WITH END-OF-LIFE CARE.THE FOUNDATION RECEIVED A $20,000 DONATION FROM A GRATEFUL PATIENT WHO FELT STRONGLY ABOUT OUR MISSION AND WHO HAD DR. JERRY RUBIN AS HER PHYSICIAN AT ONE POINT DURING HER CARE. WE ALSO RECEIVED A $200,000 GRANT FROM THE HOSPICE GIVING FOUNDATION TO BE USED TOWARD THE ESTABLISHMENT OF A LOCAL HOSPICE CARE FACILITY.THE HOSPICE FACILITY WE'VE DEVELOPED IS CALLED JERRY'S PLACE. WE RENT 2 PRIVATE ROOMS AND A SHARED BATH FROM MARIPOSA ASSISTED LIVING IN SEASIDE. THESE ROOMS WILL BE USED FOR PATIENTS WHO DON'T HAVE THE ABILITY TO DIE IN PEACE AND COMFORT. WE ADMITTED OUR FIRST PATIENT ON DECEMBER 21, 2022, A 95 YEAR OLD WHO WAS AT END OF LIFE WITH NO PLACE TO GO. HE DIED PEACEFULLY THE FIRST WEEK IN JANUARY. HE WAS ABLE TO SPEND THE HOLIDAY SEASON, WITH HIS WIFE AND GRANDSON BY HIS SIDE, IN JERRY'S PLACE. WE ARE CURRENTLY EVALUATING ADDITIONAL PATIENTS FOR ELIGIBILITY TO STAY AT JERRY'S PLACE. THIS IS THE ONLY FACILITY OF ITS TYPE IN MONTEREY COUNTY AND SURROUNDING COUNTIES. IT IS A TRIBUTE TO DR. JERRY RUBIN'S WORK AND HIS LEGACY. DR. RUBIN WORKED WITH LOCAL REPRESENTATIVES AND POLITICIANS TO CONVINCE MEDICARE TO RECOGNIZE HOSPICE CARE AS A PAID BENEFIT ON A NATIONAL BASIS. IT IS TRULY FITTING THAT THIS FACILITY, AND THIS FOUNDATION, BE NAMED IN HIS HONOR.THE FOUNDATION HAS ALSO HIRED 2 EMPLOYEES TO OVERSEE THE OPERATIONS OF JERRY'S PLACE. THE EMPLOYEES ARE BOTH PARTTIME (10 HOURS PER WEEK). WE HAVE A PROGRAM COORDINATOR WHO MEETS WITH ALL THE HOSPICE AGENCIES AND HOSPITALS REGARDING OUR SERVICES. THIS POSITION ALSO HANDLES THE INCOMING PATIENT REFERRALS. THE SECOND POSITION IS A VOLUNTEER COORDINATOR. THIS POSITION RECRUITS, TRAINS AND DEPLOYS VOLUNTEERS AS NEEDED TO PROVIDE A VARIETY OF SERVICES FOR OUR PATIENTS./RESIDENTS. BOTH POSITIONS ALSO SPEND TIME AT JERRY'S PLACE WITH THE PATIENTS ANDTHEIR FAMILIES.WE WILL BE GROWING JERRY'S PLACE OVER THE NEXT YEAR AS WELL AS DEVELOPING ADDITIONAL PATIENT ASSISTANCE PROGRAMS THROUGH THE FOUNDATION. THERE WILL BE A CONCERTED FUNDRAISING CAMPAIGN DURING 2023 TO ENSURE OUR SUSTAINABILITY AND SUCCESS FOR THE FUTURE. | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $0 | GrantsAndAllocationsAmt |
| Program Service Expenses | $17,086 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $17,086 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (4 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| JOHN HAUSDORFF MD | ||||
| PRESIDENT | 12.00 | $0 | $0 | $0 |
| ROGER SHIFFMAN MD | ||||
| VICE PRESIDENT | 0.50 | $0 | $0 | $0 |
| M ZACH KOONTZ MD | ||||
| TREAS/SECRETARY | 1.00 | $0 | $0 | $0 |
| VALERIA WAREHAM | ||||
| EXECUTIVE DIR. | 15.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALERIA WAREHAM | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5 HARRIS COURT BUILDING T SUITE 201 | AddressLine1Txt |
| City | MONTEREY | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 939405750 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8316424041 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
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 Minus1 Year | $750 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $72,050 | CurrentTaxYearAmt |
| Total | $72,800 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $750 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $72,050 | CurrentTaxYearAmt |
| Total | $72,800 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $72,800 | PublicSupportTotal170Amt |
| Total Support | $72,800 | TotalSupportAmt |
| First5 Years170 | Yes (X) | First5Years170Ind |
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 O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: PAYROLL TAXES. AMOUNT: 143. DESCRIPTION: ADVERTISING. AMOUNT: 428. DESCRIPTION: OFFICE EXPENSE. AMOUNT: 304. DESCRIPTION: INSURANCE. AMOUNT: 1,094. TOTAL TO FORM 990-EZ, LINE 16: 1,969. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: PAYROLL CLEARING. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 51. |
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