UPPER ROOM DINING HALL INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
UPPER ROOM DINING HALL INC (EIN 47-4732040)
Tax period
2020-07-01 to 2021-06-30
Filed
2022-05-16
IRS object ID
202231369349312958
Schema version
2020v4.0
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

FieldValueIRS element (for citing)
Return2022-05-16T15:30:39-05:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN942798193PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ROBERTS & COMPANY INCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13182 CEDAR RAVINE RDAddressLine1Txt
CityPLACERVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95667ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN474732040EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UPPER ROOM DINING HALL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlUPPEBusinessNameControlTxt
Phone5309191036PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 484AddressLine1Txt
CityPLACERVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95667ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJENNIFER MOUZISPersonNm
Person TitleCHAIRWOMANPersonTitleTxt
Phone5302179147PhoneNum
Signature2021-05-16SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJENNIFERPersonFirstNm
Person LastMOUZISPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSTEPHEN W MILLER CPAPreparerPersonNm
PTINP00163460PTIN
Phone5306225445PhoneNum
Preparation2022-05-16PreparationDt
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJENNIFER MOUZISPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12709 BARNESTEAD PLACEAddressLine1Txt
CityPLACERVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95667ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$601,894GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressUPPERROOMDININGHALL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2015FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionOUR MISSION IS TO PROVIDE MEALS AND SUPPORT SERVICES TO THE HOMELESS AND OTHER MEMBERS OF OUR COMMUNITY LIVING UNDER THE STRAIN OF POVERTY.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee6TotalEmployeeCnt
Total Volunteers350TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$377,819PYContributionsGrantsAmt
CY Contributions Grants$549,125CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$7,945PYInvestmentIncomeAmt
CY Investment Income$36,189CYInvestmentIncomeAmt
CY Other Revenue$16,580CYOtherRevenueAmt
PY Total Revenue$385,764PYTotalRevenueAmt
CY Total Revenue$601,894CYTotalRevenueAmt
CY Grants And Similar Paid$11,416CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$88,807PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$109,627CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$4,175CYTotalFundraisingExpenseAmt
PY Other Expenses$167,208PYOtherExpensesAmt
CY Other Expenses$211,400CYOtherExpensesAmt
PY Total Expenses$256,015PYTotalExpensesAmt
CY Total Expenses$332,443CYTotalExpensesAmt
PY Revenues Less Expenses$129,749PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$269,451CYRevenuesLessExpensesAmt
Total Assets BOY$418,634TotalAssetsBOYAmt
Total Assets EOY$729,515TotalAssetsEOYAmt
Total Liabilities BOY$16,580TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$402,054NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$729,515NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS TO PROVIDE MEALS AND SUPPORT SERVICES TO THE HOMELESS AND OTHER MEMBERS OF OUR COMMUNITY LIVING UNDER THE STRAIN OF POVERTY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$292,396ExpenseAmt
Grant$11,416GrantAmt
DescWE PROVIDE MEALS AND OTHER SUPPORT SERVICES TO HELP THE HOMELESS AND THOSE AT RISK OF BECOMING HOMELESS.Desc
Total Program Service Expenses$292,396TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G3IRPDocumentW2GCnt
Backup Wthld CompliancefalseBackupWthldComplianceInd
Employee6EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyfalseConflictOfInterestPolicyInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMAUREEN JULIANPersonNm
Phone5309191036PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 484AddressLine1Txt
CityPLACERVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95667ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
GINA DEAN
DIRECTORYes (X)$0$0$0
JOHN FITZPATRICK
DIRECTORYes (X)$0$0$0
JAMES GASPER
DIRECTORYes (X)$0$0$0
MAUREEN JULIAN
TREASURERYes (X)$0$0$0
CARLA MILHOMME
DIRECTORYes (X)$0$0$0
DERRELL ROBERTS
DIRECTORYes (X)$0$0$0
PAM TENORIO
DIRECTORYes (X)$0$0$0
LUCILLE VILLALOBOS
DIRECTORYes (X)$0$0$0
EUGENE HAYDU
VICE-CHAIRMA$0$0$0Yes (X)
DEBBIE KIERSEY
SECRETARY$0$0$0Yes (X)
JENNIFER MOUZIS
CHAIRWOMAN$0$0$0Yes (X)
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Government Grants$96,570GovernmentGrantsAmt
All Other Contributions$452,555AllOtherContributionsAmt
Total Contributions$549,125TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$36,189TotalRevenueColumnAmt
Exclusion$36,189ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescPPP LOAN FORGIVENESSDesc
Total Revenue Column$16,580TotalRevenueColumnAmt
Exclusion$16,580ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$16,580OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$601,894TotalRevenueColumnAmt
Exclusion$52,769ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$11,416TotalAmt
Program Services$11,416ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$93,941TotalAmt
Program Services$93,941ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,536TotalAmt
Program Services$8,536ProgramServicesAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$7,150TotalAmt
Program Services$7,150ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$2,950TotalAmt
Management And General$2,950ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$3,450TotalAmt
Management And General$3,450ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$2,259TotalAmt
Fundraising$2,259FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,848TotalAmt
Management And General$2,848ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$27,758TotalAmt
Program Services$27,758ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$67,602TotalAmt
Program Services$60,738ProgramServicesAmt
Management And General$6,864ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$12,986TotalAmt
Program Services$6,377ProgramServicesAmt
Management And General$6,609ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
FOOD EXPENSE$40,673$40,673
SUPPLIES$25,793$25,793
REPAIRS$5,881$5,881
SOFTWARE$4,582$4,582

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$14,618TotalAmt
Program Services$4,133ProgramServicesAmt
Management And General$8,569ManagementAndGeneralAmt
Fundraising$1,916FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$332,443TotalAmt
Program Services$292,396ProgramServicesAmt
Management And General$35,872ManagementAndGeneralAmt
Fundraising$4,175FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$159,178BOYAmt
EOY$83,038EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
EOY$1,189EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$193,610LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$80,398LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$64,775BOYAmt
EOY$113,212EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$194,681BOYAmt
EOY$526,040EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$6,036EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$418,634BOYAmt
EOY$729,515EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,580BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,580BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$357,954BOYAmt
EOY$729,515EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$44,100BOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$402,054BOYAmt
EOY$729,515EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$418,634BOYAmt
EOY$729,515EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$269,451ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$58,010OtherChangesInNetAssetsAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$137,979CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$152,311CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$150,413CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$377,819CurrentTaxYearMinus1YearAmt
Current Tax Year$549,125CurrentTaxYearAmt
Total$1,367,647TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Current Tax Year$16,580CurrentTaxYearAmt
Total$16,580TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$137,979CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$152,311CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$150,413CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$377,819CurrentTaxYearMinus1YearAmt
Current Tax Year$565,705CurrentTaxYearAmt
Total$1,384,227TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$1,384,227PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,130CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,137CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,955CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,945CurrentTaxYearMinus1YearAmt
Current Tax Year$36,189CurrentTaxYearAmt
Total$72,356TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,130CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$9,137CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$14,955CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,945CurrentTaxYearMinus1YearAmt
Current Tax Year$36,189CurrentTaxYearAmt
Total$72,356TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$142,109CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$161,448CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$165,368CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$385,764CurrentTaxYearMinus1YearAmt
Current Tax Year$601,894CurrentTaxYearAmt
Total$1,456,583TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.95030PublicSupportCY509Pct
Public Support PY5090.95520PublicSupportPY509Pct
Investment Income CY0.05000InvestmentIncomeCYPct
Investment Income PY0.04000InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

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 D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$123,340OtherCostOrOtherBasisAmt
Depreciation$38,390DepreciationAmt
Book Value$84,950BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$70,270OtherCostOrOtherBasisAmt
Depreciation$42,008DepreciationAmt
Book Value$28,262BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$113,212TotalBookValueLandBuildingsAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedfalseGrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1EL DORADO COMMUNITY FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1312 MAIN ST 201AddressLine1Txt
CityPLACERVILLECityNm
State AbbreviationCAStateAbbreviationCd
ZIP95667ZIPCd
FieldValueIRS element (for citing)
Recipient EIN680255556RecipientEIN
IRC Section501(C)IRCSectionDesc
Cash Grant$11,416CashGrantAmt
Purpose Of GrantHOUSING EL DORADOPurposeOfGrantTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 11BCOPY OF FORM 990 PROVIDED TO BOARD PRIOR TO FILING TAX RETURN.
FORM 990, PAGE 6, PART VI, LINE 19UPON REQUEST
FORM 990, PART XI, LINE 9BOOK / TAX DEPRECIATION DIFFERENCE 58,010

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