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HEAD AND NECK FOUNDATION: Form 990EZ, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
HEAD AND NECK FOUNDATION (EIN 46-1801893)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-05-16
IRS object ID
202211369349205536
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)
Return2022-05-16T14:07:01-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN930567723PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MAGINNIS & CAREY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 NW 2ND AVE SUITE 1000AddressLine1Txt
CityPORTLANDCityNm
State AbbreviationORStateAbbreviationCd
ZIP972093971ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN461801893EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HEAD AND NECK FOUNDATIONBusinessNameLine1Txt
Business Name Line2C/O DR ERIC J DIERKSBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlHEADBusinessNameControlTxt
Phone5032241371PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11849 NW KEARNEY STE 300AddressLine1Txt
CityPORTLANDCityNm
State AbbreviationORStateAbbreviationCd
ZIP972091453ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonALLEN C CHENG MD DDSPersonNm
Person TitleDIRECTORPersonTitleTxt
Phone5032241371PhoneNum
Signature2022-05-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstALLENPersonFirstNm
Person LastCHENG MD DDSPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARK A JOHNSON CPAPreparerPersonNm
PTINP00085240PTIN
Phone5032270519PhoneNum

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 TS2022-09-23 18:48:47ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Website AddressN/AWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Gross Receipts$23,572GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Contributions Gifts Grants Etc$23,572ContributionsGiftsGrantsEtcAmt
Total Revenue$23,572TotalRevenueAmt
Grants And Similar Amounts Paid$6,772GrantsAndSimilarAmountsPaidAmt
Fees And Other Pymt To Ind Cntrct$1,890FeesAndOtherPymtToIndCntrctAmt
Other Expenses Total$6,743OtherExpensesTotalAmt
Total Expenses$15,405TotalExpensesAmt
Excess Or Deficit For Year$8,167ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$98,937NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY$107,104NetAssetsOrFundBalancesEOYAmt

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$98,937BOYAmt
EOY$107,104EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$98,937BOYAmt
EOY$107,104EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$98,937BOYAmt
EOY$107,104EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
Primary Exempt PurposeTO ENSURE QUALITY PATIENT CARE BY PROVIDING TRAINING, EDUCATION, AND RESEARCH IN TRAUMA, CANCER, CONGENITAL DEFECTS OF THE HEAD AND NECK, AND RELATED MEDICAL AREAS.PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp (2 entries)

Description Program Srvc AccomDescriptionProgramSrvcAccomTxtGrants And AllocationsGrantsAndAllocationsAmtProgram Service ExpensesProgramServiceExpensesAmt
PROVIDING TRAINING, EDUCATION, AND RESEARCH IN TRAUMA, CANCER, CONGENITAL DEFECTS OF THE HEAD AND NECK, AND RELATED MEDICAL AREAS.$5,363$0
EVENTS/PROGRAMS TO CELEBRATE PAST, PRESENT AND FUTURE SERVICE IN HEAD AND NECK CANCER AND TRAUMA CARE.$0$5,363
FieldValueIRS element (for citing)
Total Program Service Expenses$5,363TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (7 entries)

TitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
ERIC J DIERKS MDDMDFACS
PRESIDENT, DIRECTOR1.00$0$0$0
ERIC J DIERKS MDDMDFACS
SECRETARY/TREAS, DIRECTOR0.25$0$0$0
R BRYAN BELL MDDDS FACS
DIRECTOR0.25$0$0$0
ALLEN C CHENG MD DDS
DIRECTOR0.25$0$0$0
ASHISH A PATEL MD DDS
DIRECTOR0.25$0$0$0
BRIAN D BRAY DMD
DIRECTOR0.25$0$0$0
WILLIAM B LONG III MD
DIRECTOR0.25$0$0$0
FieldValueIRS element (for citing)
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt0ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI0OrganizationHadUBIInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Direct Indirect Pltcl Expend$0DirectIndirectPltclExpendAmt
Made Loans To From Officers0MadeLoansToFromOfficersInd
Tax Imposed Under IRC4911$0TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912$0TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955$0TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr$0TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization$0TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
States Where Copy Of Return Is FldORStatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ERIC J DIERKSBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11849 NW KEARNEY SUITE 300AddressLine1Txt
CityPORTLANDCityNm
State AbbreviationORStateAbbreviationCd
ZIP97209ZIPCd
FieldValueIRS element (for citing)
Phone5032241371PhoneNum
FieldValueIRS element (for citing)
Foreign Financial Account0ForeignFinancialAccountInd
Foreign Office0ForeignOfficeInd
Donor Advised Fnds0DonorAdvisedFndsInd
Operate Hospital0OperateHospitalInd
Tanning Services Provided0TanningServicesProvidedInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
School Operating0SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof SrvcNONEPartVIHghstPdCntrctProfSrvcTxt
Filed Schedule AYes (1)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$24,656CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$72,750CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$31,429CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$59,850CurrentTaxYearMinus1YearAmt
Current Tax Year$23,572CurrentTaxYearAmt
Total$212,257TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$24,656CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$72,750CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$31,429CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$59,850CurrentTaxYearMinus1YearAmt
Current Tax Year$23,572CurrentTaxYearAmt
Total$212,257TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$212,257PublicSupportTotal170Amt
Total Support$212,257TotalSupportAmt
Public Support CY1701.00000PublicSupportCY170Pct
Public Support PY1701.00000PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceFORM 990-EZ, PART I, LINE 16 - OTHER EXPENSESFormAndLineReferenceDesc
ExplanationDESCRIPTION: OREGON TAXES AND LICENSES. AMOUNT: 150. DESCRIPTION: ANNUAL EVENTS/LECTURES. AMOUNT: 5,363. DESCRIPTION: ADMINISTRATIVE/OFFICE EXPENSE. AMOUNT: 1,230. TOTAL TO FORM 990-EZ, LINE 16: 6,743.ExplanationTxt

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

FieldValueIRS element (for citing)
DeclarationTHE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.DeclarationDesc

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