HOSPICE FOUNDATION OF JEFFERSON COUNTY INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
HOSPICE FOUNDATION OF JEFFERSON COUNTY INC (EIN 16-1541636)
Tax period
2019-10-01 to 2020-09-30
Filed
2021-08-13
IRS object ID
202112259349300926
Schema version
2019v5.2
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)
Return2021-08-13T09:03:06-05:00ReturnTs
Tax Period End2020-09-30TaxPeriodEndDt

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 Begin2019-10-01TaxPeriodBeginDt

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
Signature2021-08-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBETTINA LIPPHARDTPreparerPersonNm
PTINP00956232PTIN
Phone3154227109PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
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$580,232GrossReceiptsAmt
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 Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers43TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$889,191PYContributionsGrantsAmt
CY Contributions Grants$338,010CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$127,541PYInvestmentIncomeAmt
CY Investment Income$160,509CYInvestmentIncomeAmt
PY Other Revenue$13,582PYOtherRevenueAmt
CY Other Revenue$12,557CYOtherRevenueAmt
PY Total Revenue$1,030,314PYTotalRevenueAmt
CY Total Revenue$511,076CYTotalRevenueAmt
PY Grants And Similar Paid$200,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$130,020CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$136,895PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$142,018CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$172,430CYTotalFundraisingExpenseAmt
PY Other Expenses$356,748PYOtherExpensesAmt
CY Other Expenses$410,888CYOtherExpensesAmt
PY Total Expenses$693,643PYTotalExpensesAmt
CY Total Expenses$682,926CYTotalExpensesAmt
PY Revenues Less Expenses$336,671PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$171,850CYRevenuesLessExpensesAmt
Total Assets BOY$8,327,340TotalAssetsBOYAmt
Total Assets EOY$8,255,978TotalAssetsEOYAmt
Total Liabilities BOY$25,904TotalLiabilitiesBOYAmt
Total Liabilities EOY$143,382TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$8,301,436NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,112,596NetAssetsOrFundBalancesEOYAmt
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$357,103ExpenseAmt
Grant$130,020GrantAmt
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$357,103TotalProgramServiceExpensesAmt
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 Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
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 (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
DR JAN TURCOTTE
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
REV DONALD ROBINSON
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
STEPHEN SWAIN
TREASURER1.00Yes (X)Yes (X)$0$0$0
CAROLYN OSBORNE
SECRETARY1.00Yes (X)Yes (X)$0$0$0
JEFF COLE
BOARD MEMBER1.00Yes (X)$0$0$0
HOLLY BUSH
BOARD MEMBER1.00Yes (X)$0$0$0
BRIAN ASHLEY
BOARD MEMBER1.00Yes (X)$0$0$0
CHRISTINA STONE
BOARD MEMBER1.00Yes (X)$0$0$0
BRYAN MEHAFFY
BOARD MEMBER1.00Yes (X)$0$0$0
DAVID KELLOG
BOARD MEMBER1.00Yes (X)$0$0$0
EMILY SPRAGUE
BOARD MEMBER1.00Yes (X)$0$0$0
ERIC DELAGARZA
BOARD MEMBER1.00Yes (X)$0$0$0
DIANA WOODHOUSE
CHIEF EXECUTIVE OFFICER20.00Yes (X)$0$117,636$11,43220.00
JORDAN JONES 2019
DIRECTOR OF FINANCE10.00Yes (X)$0$33,190$030.00
FRANCES SOURWINE
DIRECTOR OF FINANCE (2019-2020)10.00Yes (X)$0$14,249$5,94130.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$165,075TotReportableCompRltdOrgAmt
Total Other Compensation$17,373TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$6,032FundraisingAmt
All Other Contributions$331,978AllOtherContributionsAmt
Total Contributions$338,010TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$89,333TotalRevenueColumnAmt
Exclusion$89,333ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$122,149SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$50,973SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$71,176SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$71,176TotalRevenueColumnAmt
Exclusion$71,176ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$30,740FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$6,032ContriRptFundraisingEventAmt
Fundraising Direct Expenses$18,183FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,557TotalRevenueColumnAmt
Exclusion$12,557ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$511,076TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$173,066ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$130,020TotalAmt
Program Services$130,020ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$131,927TotalAmt
Fundraising$131,927FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$10,091TotalAmt
Fundraising$10,091FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$8,024TotalAmt
Management And General$8,024ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$28,772TotalAmt
Management And General$28,772ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$108,143TotalAmt
Program Services$108,143ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,985TotalAmt
Management And General$4,985ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$26,814TotalAmt
Management And General$26,814ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$177,522TotalAmt
Program Services$118,940ProgramServicesAmt
Management And General$58,582ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$13,432TotalAmt
Management And General$13,432ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmtManagement And GeneralManagementAndGeneralAmt
FUNDRAISING$30,412$30,412
PUBLIC RELATIONS$8,823$8,823
OTHER$3,466$3,466
DUES AND LICENSES$495$495

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$682,926TotalAmt
Program Services$357,103ProgramServicesAmt
Management And General$153,393ManagementAndGeneralAmt
Fundraising$172,430FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$344,021BOYAmt
EOY$524,545EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$294,809BOYAmt
EOY$190,309EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,534,373LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,643,596LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,062,909BOYAmt
EOY$2,890,777EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$3,130,908BOYAmt
EOY$3,130,451EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,494,693BOYAmt
EOY$1,519,896EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,327,340BOYAmt
EOY$8,255,978EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$25,904BOYAmt
EOY$143,382EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$25,904BOYAmt
EOY$143,382EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,542,299BOYAmt
EOY$7,268,897EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$759,137BOYAmt
EOY$843,699EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,301,436BOYAmt
EOY$8,112,596EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,327,340BOYAmt
EOY$8,255,978EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$171,850ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$31,990NetUnrlzdGainsLossesInvstAmt
Donated Services And Use Fclts$15,000DonatedServicesAndUseFcltsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
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$301,159CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$276,945CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$445,309CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$889,191CurrentTaxYearMinus1YearAmt
Current Tax Year$353,010CurrentTaxYearAmt
Total$2,265,614TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$301,159CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$276,945CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$445,309CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$889,191CurrentTaxYearMinus1YearAmt
Current Tax Year$353,010CurrentTaxYearAmt
Total$2,265,614TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$2,265,614PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$84,678CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$83,551CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$90,690CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$97,488CurrentTaxYearMinus1YearAmt
Current Tax Year$89,333CurrentTaxYearAmt
Total$445,740TotalAmt
FieldValueIRS element (for citing)
Total Support$2,711,354TotalSupportAmt
Public Support CY1700.83560PublicSupportCY170Pct
Public Support PY1700.88560PublicSupportPY170Pct
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$153,216BeginningYearBalanceAmt
Investment Earnings Or Losses$5,111InvestmentEarningsOrLossesAmt
End Year Balance$158,327EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$115,851BeginningYearBalanceAmt
Contributions$1,750ContributionsAmt
Investment Earnings Or Losses$12,549InvestmentEarningsOrLossesAmt
End Year Balance$130,150EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$94,360BeginningYearBalanceAmt
Contributions$11,500ContributionsAmt
Investment Earnings Or Losses$9,991InvestmentEarningsOrLossesAmt
End Year Balance$115,851EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.51120BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.31580PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.17300TermEndowmentBalanceEOYPct
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$1,454,695DepreciationAmt
Book Value$2,821,987BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$204,977OtherCostOrOtherBasisAmt
Depreciation$188,901DepreciationAmt
Book Value$16,076BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$13,214OtherCostOrOtherBasisAmt
Book Value$13,214BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,890,777TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescINVESTMENT IN THE COMMUNITY FOUNDATIONDesc
Book Value$1,519,896BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$1,519,896TotalBookValueSecuritiesAmt
Total Rev Etc Audited Fincl Stmt$483,497TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$31,990NetUnrealizedGainsInvstAmt
Donated Services And Use Fclts$15,000DonatedServicesAndUseFcltsAmt
Other Revenue$18,183OtherRevenueAmt
Revenue Not Reported$1,193RevenueNotReportedAmt
Revenue Subtotal$482,304RevenueSubtotalAmt
Investment Expenses Not Incld$28,772InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$28,772RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$511,076TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$672,337TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$18,183OtherExpensesIncludedAmt
Expenses Not Reported$18,183ExpensesNotReportedAmt
Expenses Subtotal$654,154ExpensesSubtotalAmt
Investment Expenses Not Incld2$28,772InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$28,772ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$682,926TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSE 18,183.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS 18,183.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$6,497GrossReceiptsEvent1Amt
Gross Revenue Event1$6,497GrossRevenueEvent1Amt
Other Direct Expenses Event1$4,313OtherDirectExpensesEvent1Amt
Event2BALLEvent2Nm
Gross Receipts Event2$19,884GrossReceiptsEvent2Amt
Gross Revenue Event2$19,884GrossRevenueEvent2Amt
Food And Beverage Event2$9,777FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$3,878OtherDirectExpensesEvent2Amt
Other Events Total2OtherEventsTotalCnt
Gross Receipts Other Events$10,391GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$6,032CharitableContriOtherEventsAmt
Gross Revenue Other Events$4,359GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$215OthDirectExpnssOtherEventsAmt
Gross Receipts Total$36,772GrossReceiptsTotalAmt
Charitable Contributions Tot$6,032CharitableContributionsTotAmt
Gross Revenue Total Events$30,740GrossRevenueTotalEventsAmt
Food And Beverage Total Events$9,777FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$8,406OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$18,183DirectExpenseSummaryEventsAmt
Net Income Summary$12,557NetIncomeSummaryAmt

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$130,020CashGrantAmt
Valuation Method UsedCOSTValuationMethodUsedDesc
Purpose Of GrantFINANCIAL SUPPORT TO HOSPICE OF JEFFERSON COUNTY, INC. IN ITSPurposeOfGrantTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 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.

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$127,132COST INCURRED
HOSPICE OF JEFFERSON COUNTY INC
B$130,020CASH RECEIVED

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