HOSPICE FOUNDATION OF JEFFERSON COUNTY INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
HOSPICE FOUNDATION OF JEFFERSON COUNTY INC (EIN 16-1541636)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-15
IRS object ID
202242279349301224
Schema version
2020v4.2
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)
Return2022-08-15T08:44:03-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN161131146PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BONADIO & CO LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1432 NORTH FRANKLIN STREETAddressLine1Txt
CitySYRACUSECityNm
State AbbreviationNYStateAbbreviationCd
ZIP13204ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN161541636EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE FOUNDATION OF JEFFERSON COUNTYBusinessNameLine1Txt
Business Name Line2INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlHOSPBusinessNameControlTxt
Phone3157887323PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11398 GOTHAM STAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDIANA WOODHOUSEPersonNm
Person TitleCEOPersonTitleTxt
Phone3157887323PhoneNum
Signature2022-08-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDIANAPersonFirstNm
Person LastWOODHOUSEPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBETTINA LIPPHARDTPreparerPersonNm
PTINP00956232PTIN
Phone3154227109PhoneNum
Preparation2022-08-08PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDIANA WOODHOUSEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11398 GOTHAM STAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,133,590GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.JEFFHOSPICE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateNYLegalDomicileStateCd
Activity Or MissionTO ENSURE THE HOSPICE SERVICES REMAIN STRONG AND FISCALLY VIABLE TO SERVE AS AN INTEGRAL COMPONENT OF OUR COMMUNITY'S HEALTHCARE DELIVERY SYSTEM.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers43TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$338,010PYContributionsGrantsAmt
CY Contributions Grants$511,144CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$160,509PYInvestmentIncomeAmt
CY Investment Income$509,424CYInvestmentIncomeAmt
PY Other Revenue$12,557PYOtherRevenueAmt
CY Other Revenue$18,729CYOtherRevenueAmt
PY Total Revenue$511,076PYTotalRevenueAmt
CY Total Revenue$1,039,297CYTotalRevenueAmt
PY Grants And Similar Paid$130,020PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$100,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$142,018PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$149,934CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$198,898CYTotalFundraisingExpenseAmt
PY Other Expenses$410,888PYOtherExpensesAmt
CY Other Expenses$450,343CYOtherExpensesAmt
PY Total Expenses$682,926PYTotalExpensesAmt
CY Total Expenses$700,277CYTotalExpensesAmt
PY Revenues Less Expenses-$171,850PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$339,020CYRevenuesLessExpensesAmt
Total Assets BOY$8,255,978TotalAssetsBOYAmt
Total Assets EOY$8,857,328TotalAssetsEOYAmt
Total Liabilities BOY$143,382TotalLiabilitiesBOYAmt
Total Liabilities EOY$72,577TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,112,596NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,784,751NetAssetsOrFundBalancesEOYAmt
MissionTO ENSURE THAT HOSPICE SERVICES REMAIN STRONG AND FISCALLY VIABLE TO SERVE AS AN INTEGRAL COMPONENT OF OUR COMMUNITY'S HEALTHCARE DELIVERY SYSTEM.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$302,173ExpenseAmt
Grant$100,000GrantAmt
DescSOLICITING, RECEIVING, AND ACKNOWLEDGING ALL FORMS OF CHARITABLE GIFTS FROM INDIVIDUALS, ORGANIZATIONS AND FOUNDATIONS VIA FUNDRAISING EVENTS AND MAIL SOLICITATIONS.Desc
Total Program Service Expenses$302,173TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAVID SANFORDBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3157887323PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11398 GOTHAM STREETAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
JEFF COLE
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
EMILY SPRAGUE
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
HOLLY BUSH
BOARD MEMBER1.00Yes (X)$0$0$0
CHRISTINA STONE
SECRETARY1.00Yes (X)Yes (X)$0$0$0
BRIAN ASHLEY
BOARD MEMBER1.00Yes (X)$0$0$0
ERIC DELAGARZA
BOARD MEMBER1.00Yes (X)$0$0$0
PATRICIA GORMAN
BOARD MEMBER1.00Yes (X)$0$0$0
DANA KEEFER
BOARD MEMBER1.00Yes (X)$0$0$0
DAVID KELLOG
BOARD MEMBER1.00Yes (X)$0$0$0
BRIAN MEHAFFY
BOARD MEMBER1.00Yes (X)$0$0$0
FATHER DONALD ROBINSON
BOARD MEMBER1.00Yes (X)$0$0$0
STEVE YELLE
BOARD MEMBER1.00Yes (X)$0$0$0
STEVE SWAIN
TREASURER (THROUGH 5/21)1.00Yes (X)Yes (X)$0$0$0
DIANA WOODHOUSE
CHIEF EXECUTIVE OFFICER20.00Yes (X)$0$117,519$12,61720.00
DAVID SANFORD
DIRECTOR OF FINANCE (2020-PRESENT)10.00Yes (X)$0$13,462$49030.00
FRANCES SPRINGER
DIRECTOR OF FINANCE (2019-2020)10.00Yes (X)$0$41,652$030.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$172,633TotReportableCompRltdOrgAmt
Total Other Compensation$13,107TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$511,144AllOtherContributionsAmt
Noncash Contributions$10,000NoncashContributionsAmt
Total Contributions$511,144TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$354,074TotalRevenueColumnAmt
Exclusion$354,074ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$249,428SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$94,078SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$155,350SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$155,350TotalRevenueColumnAmt
Exclusion$155,350ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$18,944FundraisingGrossIncomeAmt
Fundraising Direct Expenses$215FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,729TotalRevenueColumnAmt
Exclusion$18,729ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,039,297TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$528,153ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$100,000TotalAmt
Program Services$100,000ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$129,000TotalAmt
Fundraising$129,000FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$20,934TotalAmt
Fundraising$20,934FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$500TotalAmt
Management And General$500ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,625TotalAmt
Management And General$7,625ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$48,752TotalAmt
Management And General$48,752ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$83,699TotalAmt
Program Services$83,699ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,808TotalAmt
Management And General$4,808ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$42,147TotalAmt
Management And General$42,147ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$176,827TotalAmt
Program Services$118,474ProgramServicesAmt
Management And General$58,353ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$23,325TotalAmt
Management And General$23,325ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmtManagement And GeneralManagementAndGeneralAmt
FUNDRAISING$48,964$48,964
OTHER$8,341$8,341
PUBLIC RELATIONS$3,953$3,953
DUES AND LICENSES$1,402$1,402

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$700,277TotalAmt
Program Services$302,173ProgramServicesAmt
Management And General$199,206ManagementAndGeneralAmt
Fundraising$198,898FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$524,545BOYAmt
EOY$681,959EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$190,309BOYAmt
EOY$149,501EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
EOY$3,604EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,648,612LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,820,423LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,890,777BOYAmt
EOY$2,828,189EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,130,451BOYAmt
EOY$3,385,010EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,519,896BOYAmt
EOY$1,809,065EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,255,978BOYAmt
EOY$8,857,328EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$143,382BOYAmt
EOY$72,577EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$143,382BOYAmt
EOY$72,577EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,268,897BOYAmt
EOY$7,876,695EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$843,699BOYAmt
EOY$908,056EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,112,596BOYAmt
EOY$8,784,751EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,255,978BOYAmt
EOY$8,857,328EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$339,020ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$318,135NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$15,000DonatedServicesAndUseFcltsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

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$276,945CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$445,309CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$889,191CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$353,010CurrentTaxYearMinus1YearAmt
Current Tax Year$521,144CurrentTaxYearAmt
Total$2,485,599TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$276,945CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$445,309CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$889,191CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$353,010CurrentTaxYearMinus1YearAmt
Current Tax Year$521,144CurrentTaxYearAmt
Total$2,485,599TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$2,485,599PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$83,551CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$90,690CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$97,488CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$89,333CurrentTaxYearMinus1YearAmt
Current Tax Year$354,074CurrentTaxYearAmt
Total$715,136TotalAmt
FieldValueIRS element (for citing)
Total Support$3,200,735TotalSupportAmt
Public Support CY1700.77660PublicSupportCY170Pct
Public Support PY1700.83560PublicSupportPY170Pct
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 D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$158,327BeginningYearBalanceAmt
Investment Earnings Or Losses$30,122InvestmentEarningsOrLossesAmt
End Year Balance$188,449EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$153,216BeginningYearBalanceAmt
Investment Earnings Or Losses$5,111InvestmentEarningsOrLossesAmt
End Year Balance$158,327EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$142,946BeginningYearBalanceAmt
Contributions$3,500ContributionsAmt
Investment Earnings Or Losses$6,770InvestmentEarningsOrLossesAmt
End Year Balance$153,216EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$130,150BeginningYearBalanceAmt
Contributions$3,500ContributionsAmt
Investment Earnings Or Losses$9,296InvestmentEarningsOrLossesAmt
End Year Balance$142,946EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$115,851BeginningYearBalanceAmt
Contributions$1,750ContributionsAmt
Investment Earnings Or Losses$12,549InvestmentEarningsOrLossesAmt
End Year Balance$130,150EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.53530BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.26530PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.19940TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$39,500OtherCostOrOtherBasisAmt
Book Value$39,500BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,276,682OtherCostOrOtherBasisAmt
Depreciation$1,625,929DepreciationAmt
Book Value$2,650,753BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$216,618OtherCostOrOtherBasisAmt
Depreciation$194,494DepreciationAmt
Book Value$22,124BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$115,812OtherCostOrOtherBasisAmt
Book Value$115,812BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,828,189TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescINVESTMENT IN THE COMMUNITY FOUNDATIONDesc
Book Value$1,809,065BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$1,809,065TotalBookValueSecuritiesAmt
Total Rev Etc Audited Fincl Stmt$1,323,895TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$318,135NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$15,000DonatedServicesAndUseFcltsAmt
Other Revenue$215OtherRevenueAmt
Revenue Not Reported$333,350RevenueNotReportedAmt
Revenue Subtotal$990,545RevenueSubtotalAmt
Investment Expenses Not Incld$48,752InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$48,752RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$1,039,297TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$651,740TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$215OtherExpensesIncludedAmt
Expenses Not Reported$215ExpensesNotReportedAmt
Expenses Subtotal$651,525ExpensesSubtotalAmt
Investment Expenses Not Incld2$48,752InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$48,752ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$700,277TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSE 215.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS 215.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1REGATTAEvent1Nm
Gross Receipts Event1$9,367GrossReceiptsEvent1Amt
Gross Revenue Event1$9,367GrossRevenueEvent1Amt
Other Direct Expenses Event1$215OtherDirectExpensesEvent1Amt
Event2MEMORY TREEEvent2Nm
Gross Receipts Event2$9,577GrossReceiptsEvent2Amt
Gross Revenue Event2$9,577GrossRevenueEvent2Amt
Gross Receipts Total$18,944GrossReceiptsTotalAmt
Gross Revenue Total Events$18,944GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$215OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$215DirectExpenseSummaryEventsAmt
Net Income Summary$18,729NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF JEFFERSON COUNTY INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11398 GOTHAM STREETAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd
FieldValueIRS element (for citing)
Recipient EIN161266041RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$100,000CashGrantAmt
Valuation Method UsedCOSTValuationMethodUsedDesc
Purpose Of GrantFINANCIAL SUPPORT TO HOSPICE OF JEFFERSON COUNTY, INC.PurposeOfGrantTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 7ASOLE CORPORATE MEMBER, HOSPICE OF JEFFERSON COUNTY, INC. ELECTS BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7BJEFFERSON COUNTY HOSPICE HAS THE EXCLUSIVE POWER AND AUTHORITY TO AMEND, REPEAL, OR ADOPT BY-LAWS OF THE FOUNDATION. IN ADDITION THE JEFFERSON COUNTY HOSPICE HAS ALL RIGHTS AND POWERS RELATED TO ELECTION OF FOUNDATION DIRECTORS, AMENDING THE CERTIFICATE OF INCORPORATION OF THE FOUNDATION, APPROVE ANY MERGER OR CONSOLIDATION OF THE FOUNDATION, APPROVE THE DISSOLUTION OF THE FOUNDATION, AND APPROVE THE SALE OR ENCUMBRANCE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE FOUNDATION.
FORM 990, PART VI, SECTION B, LINE 11BTHE FOUNDATION PROVIDES DRAFT COPIES OF THE IRS FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO COMPLETION AND FILING WITH THE INTERNAL REVENUE SERVICE AT THEIR REGULARLY SCHEDULED MEETINGS.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY. THE EXECUTIVE DIRECTOR AND BOARD PRESIDENT REVIEW AND FOLLOW UP ON DISCLOSURES OF CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE EXECUTIVE DIRECTOR. ALL OTHER EMPLOYEES ARE EVALUATED ANNUALLY BY MANAGEMENT. AN ANNUAL SURVEY OF LOCAL HEALTHCARE AGENCIES AND CENTRAL NEW YORK HOSPICES IS PERFORMED FOR PAY SCALES AT ALL STAFFING LEVELS.
FORM 990, PART VI, SECTION C, LINE 19A HIGH LEVEL FINANCIAL PICTURE IS PROVIDED IN THE ANNUAL REPORT, WHICH IS AVAILABLE TO THE PUBLIC. OTHER FINANCIAL DATA AND POLICY INFORMATION IS AVAILABLE UPON REQUEST AND ON A NEED TO KNOW BASIS.
FORM 990, PART XII, LINE 2C:THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF JEFFERSON COUNTYBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11398 GOTHAM STAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd
FieldValueIRS element (for citing)
EIN161266041EIN
Primary ActivitiesHOSPICE CAREPrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 11PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF JEFFERSON COUNTY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
HOSPICE OF JEFFERSON COUNTY INC
O$73,089COST INCURRED
HOSPICE OF JEFFERSON COUNTY INC
B$100,000CASH RECEIVED

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