FAIRFIELD COUNTY HOSPICE HOUSE INC: Form 990, tax year 2021
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- Organization
- FAIRFIELD COUNTY HOSPICE HOUSE INC (EIN 45-4166197)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-07
- IRS object ID
- 202223119349302877
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-07T13:39:26-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 061253566 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WALTER J MCKEEVER & COMPANY LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5147 15 VALLEY DRIVE | AddressLine1Txt |
| City | GREENWICH | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06831 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454166197 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRFIELD COUNTY HOSPICE HOUSE INC | BusinessNameLine1Txt |
| Business Name Line2 | D/B/A FAIRFIELD COUNTY HOUSE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FAIR | BusinessNameControlTxt |
| Phone | 2039216405 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE DEN ROAD | AddressLine1Txt |
| City | STAMFORD | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06902 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT J GRANATA | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 2039216405 | PhoneNum |
| Signature | 2022-11-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ROBERT | PersonFirstNm |
| Person Last | GRANATA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DENISE C DORIA | PreparerPersonNm |
| PTIN | P01283182 | PTIN |
| Phone | 2036228625 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
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 | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LARRY WEISMAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE DEN ROAD | AddressLine1Txt |
| City | STAMFORD | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06902 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,234,734 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAIRFIELDCOUNTYHOUSE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | CT | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A WARM AND WELCOMING RESIDENCE FOR PEOPLE AT THE END OF LIFE WHICH PROVIDES PROFESSIONAL AND COMPASSIONATE CARE IN A PLACE TO SPEND MEANINGFUL TIME WITH LOVED ONES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 33 | TotalEmployeeCnt |
| Total Volunteers | 35 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $242,480 | PYContributionsGrantsAmt |
| CY Contributions Grants | $558,933 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $523,841 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $644,425 | CYProgramServiceRevenueAmt |
| PY Investment Income | $950 | PYInvestmentIncomeAmt |
| CY Investment Income | $5 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$5,329 | PYOtherRevenueAmt |
| CY Other Revenue | -$15,047 | CYOtherRevenueAmt |
| PY Total Revenue | $761,942 | PYTotalRevenueAmt |
| CY Total Revenue | $1,188,316 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $708,622 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $736,369 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $38,844 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $243,777 | PYOtherExpensesAmt |
| CY Other Expenses | $270,528 | CYOtherExpensesAmt |
| PY Total Expenses | $952,399 | PYTotalExpensesAmt |
| CY Total Expenses | $1,006,897 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$190,457 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $181,419 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,895,277 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,949,096 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $235,468 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $107,868 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,659,809 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,841,228 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE A WARM AND WELCOMING RESIDENCE FOR PEOPLE AT THE END OF LIFE WHICH PROVIDES PROFESSIONAL AND COMPASSIONATE CARE IN A PLACE TO SPEND MEANINGFUL TIME WITH LOVED ONES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $859,779 | ExpenseAmt |
| Revenue | $644,425 | RevenueAmt |
| Desc | CONSTRUCTION OF THE HOUSE BEGAN IN 2015 AND WAS COMPLETED IN 2017. THE FACILITY OPENED TO THE PUBLIC IN JANUARY 2018. PROVIDING A WARM AND WELCOMING RESIDENCE FOR PEOPLE AT THE END OF LIFE WHICH PROVIDES PROFESSIONAL AND COMPASSIONATE CARE IN A PLACE TO SPEND MEANINGFUL TIME WITH LOVED ONES. | Desc |
| Total Program Service Expenses | $859,779 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | Yes (1) | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 33 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CT | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WALTER J MCKEEVER & CO LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2036228625 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15 VALLEY DRIVE | AddressLine1Txt |
| City | GREENWICH | CityNm |
| State Abbreviation | CT | StateAbbreviationCd |
| ZIP | 06831 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| LARRY WEISMAN | ||||||
| CHAIRMAN | 0.25 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ROBERT J GRANATA | ||||||
| TREASURER | 0.25 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| THERESA CARLUCCI-TYSKA | ||||||
| SECRETARY/FUNDRAISING CONSULTANT | 7.75 | Yes (X) | Yes (X) | $16,557 | $0 | $0 |
| SHARON BRADLEY | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| CHRISTOPHER M FARRUGIO | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL LAMAGNA | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| KEN BERNHARD | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| NICOLE ENSLEIN | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| LYNDA TUCKER | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| STEPHEN CORMAN | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| BRUCE MOORE JR | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| DONNA E COLETTI | ||||||
| DIRECTOR | 0.25 | Yes (X) | $0 | $0 | $0 | |
| JULIA PORTALE EX-OFFICIO | ||||||
| EXEC DIRECTOR | 25.00 | Yes (X) | $75,215 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $91,772 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $93,596 | FundraisingAmt |
| Government Grants | $263,847 | GovernmentGrantsAmt |
| All Other Contributions | $201,490 | AllOtherContributionsAmt |
| Noncash Contributions | $2,742 | NoncashContributionsAmt |
| Total Contributions | $558,933 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RESIDENCE FEES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $644,425 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $644,425 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $644,425 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5 | TotalRevenueColumnAmt |
| Exclusion | $5 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $31,371 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $93,596 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $46,418 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,047 | TotalRevenueColumnAmt |
| Exclusion | -$15,047 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,188,316 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $644,425 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$15,042 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,772 | TotalAmt |
| Program Services | $58,067 | ProgramServicesAmt |
| Management And General | $12,939 | ManagementAndGeneralAmt |
| Fundraising | $20,766 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $541,783 | TotalAmt |
| Program Services | $514,095 | ProgramServicesAmt |
| Management And General | $27,496 | ManagementAndGeneralAmt |
| Fundraising | $192 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,149 | TotalAmt |
| Program Services | $48,657 | ProgramServicesAmt |
| Management And General | $3,059 | ManagementAndGeneralAmt |
| Fundraising | $433 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,665 | TotalAmt |
| Program Services | $47,273 | ProgramServicesAmt |
| Management And General | $2,972 | ManagementAndGeneralAmt |
| Fundraising | $420 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,176 | TotalAmt |
| Program Services | $3,044 | ProgramServicesAmt |
| Management And General | $6,088 | ManagementAndGeneralAmt |
| Fundraising | $3,044 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,922 | TotalAmt |
| Program Services | $6,676 | ProgramServicesAmt |
| Management And General | $3,246 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,290 | TotalAmt |
| Program Services | $2,599 | ProgramServicesAmt |
| Management And General | $2,599 | ManagementAndGeneralAmt |
| Fundraising | $8,092 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,489 | TotalAmt |
| Program Services | $1,497 | ProgramServicesAmt |
| Management And General | $1,496 | ManagementAndGeneralAmt |
| Fundraising | $1,496 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,658 | TotalAmt |
| Program Services | $18,927 | ProgramServicesAmt |
| Management And General | $4,724 | ManagementAndGeneralAmt |
| Fundraising | $7 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $350 | TotalAmt |
| Program Services | $315 | ProgramServicesAmt |
| Fundraising | $35 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,699 | TotalAmt |
| Management And General | $1,699 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,529 | TotalAmt |
| Program Services | $80,887 | ProgramServicesAmt |
| Management And General | $20,405 | ManagementAndGeneralAmt |
| Fundraising | $2,237 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,858 | TotalAmt |
| Program Services | $14,255 | ProgramServicesAmt |
| Management And General | $11,542 | ManagementAndGeneralAmt |
| Fundraising | $61 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| UTILITIES | $29,922 | $23,938 | $5,984 | |
| SUPPLIES & FOOD - RESID | $23,623 | $23,623 | ||
| SUPPLIES - OFFICE & HOU | $13,030 | $10,424 | $1,303 | $1,303 |
| TELEPHONE | $5,666 | $3,844 | $1,064 | $758 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,316 | TotalAmt |
| Program Services | $1,658 | ProgramServicesAmt |
| Management And General | $1,658 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,006,897 | TotalAmt |
| Program Services | $859,779 | ProgramServicesAmt |
| Management And General | $108,274 | ManagementAndGeneralAmt |
| Fundraising | $38,844 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,247 | BOYAmt |
| EOY | $422,616 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,557 | BOYAmt |
| EOY | $536 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,932,932 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $412,488 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,598,973 | BOYAmt |
| EOY | $2,520,444 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,500 | BOYAmt |
| EOY | $5,500 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,895,277 | BOYAmt |
| EOY | $2,949,096 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,000 | BOYAmt |
| EOY | $100,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,468 | BOYAmt |
| EOY | $7,868 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $235,468 | BOYAmt |
| EOY | $107,868 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,646,935 | BOYAmt |
| EOY | $2,828,376 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,874 | BOYAmt |
| EOY | $12,852 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,659,809 | BOYAmt |
| EOY | $2,841,228 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,895,277 | BOYAmt |
| EOY | $2,949,096 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $181,419 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $333,440 | OtherCostOrOtherBasisAmt |
| Book Value | $333,440 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,510,449 | OtherCostOrOtherBasisAmt |
| Depreciation | $360,258 | DepreciationAmt |
| Book Value | $2,150,191 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $89,043 | OtherCostOrOtherBasisAmt |
| Depreciation | $52,230 | DepreciationAmt |
| Book Value | $36,813 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,520,444 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CREDIT CARD PAYABLE | $2,549 |
| EMPLOYEE RETIREMENT CONTRIBUTIONS PAYABLE | $5,319 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,868 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $1,206,924 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $18,608 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $18,608 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,188,316 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,188,316 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $1,025,505 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $18,608 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $18,608 | ExpensesNotReportedAmt |
| Expenses Subtotal | $1,006,897 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $1,006,897 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ORGANIZATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS IN THE FINANCIAL STATEMENTS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF 12/31/20, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $105,015 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $73,644 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $31,371 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,689 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $34,371 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $7,727 | OtherDirectExpensesEvent1Amt |
| Event2 | FLIGHT OF LIFE | Event2Nm |
| Gross Receipts Event2 | $17,577 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $17,577 | CharitableContriEvent2Amt |
| Other Direct Expenses Event2 | $2,131 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 1 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $2,375 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $2,375 | CharitableContriOtherEventsAmt |
| Oth Direct Expnss Other Events | $500 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $124,967 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $93,596 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $31,371 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $1,689 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $34,371 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $10,358 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $46,418 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$15,047 | NetIncomeSummaryAmt |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHEN CORMAN | PersonNm |
| Relationship With Org | BOARD MEMBER | RelationshipWithOrgTxt |
| Loan Purpose | WORKING CAPITAL | LoanPurposeTxt |
| Loan To Organization | Yes (X) | LoanToOrganizationInd |
| Original Principal | $100,000 | OriginalPrincipalAmt |
| Balance Due | $100,000 | BalanceDueAmt |
| Default | 0 | DefaultInd |
| Board Or Committee Approval | Yes (1) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (1) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $100,000 | TotalBalanceDueAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT COPY OF THE 990 IS REVIEWED IN DETAIL BY THE TREASURER BEFORE FILING. THE TREASURER REPORTS THE RESULTS TO THE BOARD AND A COPY IS AVAILABLE TO ALL BOARD MEMBERS EITHER BY PAPER OR ELECTRONICALLY. |
| FORM 990, PART VI, SECTION B, LINE 12C | UPON JOINING THE BOARD, EVERY BOARD MEMBER IS EDUCATED ABOUT THE CONFLICT OF INTEREST POLICY AND IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT. BOARD MEMBERS UPDATE THESE FORMS AS NECESSARY. ANNUALLY THE BOARD MEMBERS ARE REMINDED OF THE IMPORTANCE OF THE POLICY AND ITS PURPOSE. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION FOR THE EXECUTIVE DIRECTOR IS DETERMINED BY THE BOARD IN CONJUNCTION WITH THE ORGANIZATION'S BUDGET IN COMPARISION TO REASONABLENESS FOR THE DUTIES AND THE REPSONSIBILITIES. THE PROCESS IS DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE TREASURER COORDINATES THE SELECTION OF THE AUDITOR AND SIGNS THE ENGAGEMENT LETTER UPON APPROVAL BY THE BOARD OF DIRECTORS. OVERSIGHT OF THE AUDIT IS PROVIDED PRIMARILY BY THE TREASURER IN CONJUNCTION WITH THE ORGANIZATION'S BOOKKEEPER/ACCOUNTANT. THE TREASURER PERFORMS THE DETAIL REVIEW OF THE DRAFT OF THE AUDITED FINANCIAL STATEMENTS. UPON THE TREASURER'S APPROVAL, THE DRAFT IS CIRCULATED TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. |