FARIBAULT AREA HOSPICE FOUNDATION: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- FARIBAULT AREA HOSPICE FOUNDATION (EIN 47-1693199)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202113199349310586
- Schema version
- 2020v4.1
- 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 | 2021-11-15T12:06:41-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL WEST TOWER STE | AddressLine1Txt |
| Address Line2 | 1200 | AddressLine2Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554022526 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471693199 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FARIBAULT AREA HOSPICE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FARI | BusinessNameControlTxt |
| Phone | 5074973731 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 STATE AVENUE | AddressLine1Txt |
| City | FARIBAULT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55021 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MORRIS R MILLER | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 5074973731 | PhoneNum |
| Signature | 2021-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MORRIS | PersonFirstNm |
| Person Last | MILLER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KACIE MCEWEN | PreparerPersonNm |
| PTIN | P01599614 | PTIN |
| Phone | 6123324300 | PhoneNum |
| Preparation | 2021-11-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PATTY VOEGELE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 STATE AVENUE | AddressLine1Txt |
| City | FARIBAULT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $53,297 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | FARIBAULTAREAHOSPICEFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2014 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE QUALITY OF LIFE FOR PATIENTS AND THEIR LOVED ONES IN THE DISTRICT ONE HOSPITAL AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $39,075 | PYContributionsGrantsAmt |
| CY Contributions Grants | $45,089 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,949 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,208 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $50,024 | PYTotalRevenueAmt |
| CY Total Revenue | $53,297 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $140,881 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $94,874 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,441 | PYOtherExpensesAmt |
| CY Other Expenses | $4,440 | CYOtherExpensesAmt |
| PY Total Expenses | $148,322 | PYTotalExpensesAmt |
| CY Total Expenses | $99,314 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$98,298 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$46,017 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $969,078 | TotalAssetsBOYAmt |
| Total Assets EOY | $923,061 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $969,078 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $923,061 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | FARIBAULT AREA HOSPICE FOUNDATION IS ORGANIZED AND OPERATED IN ACCORDANCE WITH IRC 501(C)(3) TO RAISE FUNDS FROM THE PUBLIC THAT ARE USED TO ENHANCE THE SCOPE AND QUALITY AND OTHERWISE SUPPORT THE MISSION OF FARIBAULT AREA HOSPICE, WHICH IS TO IMPROVE THE QUALITY OF LIFE THROUGH COMFORT, CARE, SUPPORT AND COMPASSION FOR PATIENTS AND THEIR LOVED ONES IN THE DISTRICT ONE HOSPITAL SERVICE AREA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $80,117 | ExpenseAmt |
| Grant | $78,074 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION PROVIDES SUPPORT FOR INDIVIDUAL HOSPICE PATIENTS AND THEIR LOVED ONES TO IMPROVE THE QUALITY OF LIFE THROUGH COMFORT CARE, SUPPORT AND COMPASSION. THE FOUNDATION PROVIDED FINANCIAL ASSISTANCE TO HOSPICE PATIENTS AND THEIR FAMILIES TO ASSIST WITH EXPENSES, SUCH AS PAYMENT OF UTILITY BILLS, GIFT CARDS FOR GROCERIES AND OTHER HOUSEHOLD EXPENSES, ETC. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $16,800 | ExpenseAmt |
| Grant | $16,800 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | THE FOUNDATION ALSO MAKES DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS PUBLIC CHARITIES TO SUPPORT THE EXEMPT PURPOSE OF PROVIDING FINANCIAL SUPPORT FOR ENHANCING THE SCOPE AND QUALITY AND OTHERWISE SUPPORTING THE MISSION OF THE FARIBAULT AREA HOSPICE FOUNDATION, WHICH IS TO IMPROVE THE QUALITY OF LIFE THROUGH COMFORT CARE, SUPPORT AND COMPASSION FOR PATIENTS AND THEIR LOVED ONES IN THE DISTRICT ONE HOSPICE SERVICE AREA. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $96,917 | 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 | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | 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 | 0 | 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| 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 | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | 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 | Yes (1) | 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 | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICK MILLER DISTRICT ONE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5074973731 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 STATE AVENUE | AddressLine1Txt |
| City | FARIBAULT | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55021 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| RICK MILLER | ||||||
| EXECUTIVE DIRECTOR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KEN BETSINGER | ||||||
| CHAIR | 0.60 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| PATTY VOEGELE | ||||||
| VICE CHAIR | 0.60 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| GARY VOEGELE | ||||||
| TREASURER | 0.60 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| KEN KANGAS | ||||||
| DIRECTOR | 0.60 | Yes (X) | $0 | $0 | $0 | |
| KRIS DREVLOW | ||||||
| DIRECTOR | 0.60 | Yes (X) | $0 | $0 | $0 | |
| AUDREY TEBO | ||||||
| DIRECTOR | 0.60 | Yes (X) | $0 | $0 | $0 | |
| NORMA SHULTZ | ||||||
| DIRECTOR | 0.60 | Yes (X) | $0 | $0 | $0 | |
| CALISTA VOS | ||||||
| DIRECTOR | 0.60 | Yes (X) | $0 | $0 | $0 | |
| SARAH EDWARDS | ||||||
| DIRECTOR | 0.60 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | 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 |
| All Other Contributions | $45,089 | AllOtherContributionsAmt |
| Total Contributions | $45,089 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,208 | TotalRevenueColumnAmt |
| Exclusion | $8,208 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,297 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,208 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,800 | TotalAmt |
| Program Services | $16,800 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,074 | TotalAmt |
| Program Services | $78,074 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,622 | TotalAmt |
| Management And General | $1,622 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $769 | TotalAmt |
| Program Services | $769 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,274 | TotalAmt |
| Program Services | $1,274 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $750 | TotalAmt |
| Management And General | $750 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAXES & LICENSES | Desc |
| Total | $25 | TotalAmt |
| Management And General | $25 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,314 | TotalAmt |
| Program Services | $96,917 | ProgramServicesAmt |
| Management And General | $2,397 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $217,846 | BOYAmt |
| EOY | $163,621 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $751,232 | BOYAmt |
| EOY | $759,440 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $969,078 | BOYAmt |
| EOY | $923,061 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | 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 | $969,078 | BOYAmt |
| EOY | $923,061 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $969,078 | BOYAmt |
| EOY | $923,061 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $969,078 | BOYAmt |
| EOY | $923,061 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$46,017 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,966 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $22,042 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $25,212 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $39,075 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $45,089 | CurrentTaxYearAmt |
| Total | $156,384 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,966 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $22,042 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $25,212 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $39,075 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $45,089 | CurrentTaxYearAmt |
| Total | $156,384 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $22,932 | SubstantialContributorsTotAmt |
| Public Support Total170 | $133,452 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $718 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $717 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,908 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,949 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,208 | CurrentTaxYearAmt |
| Total | $22,500 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $178,884 | TotalSupportAmt |
| Public Support CY170 | 0.74600 | PublicSupportCY170Pct |
| Public Support PY170 | 0.85210 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART VI, LIST OF UNUSUAL GRANTS: | FormAndLineReferenceDesc |
| Explanation | DESCRIPTION: AMOUNT: 0. DESCRIPTION: AMOUNT: 0. | ExplanationTxt |
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 I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLINA HEALTH SYSTEM OWATANA HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 43 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55440 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 363261413 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $16,800 | CashGrantAmt |
| Purpose Of Grant | OWATONNA HOPSITAL FOUNDATION - PROGRAM SUPPORT FOR HONORING CHOICES MINNESOTA OF FARIBAULT - OWATONNA - PROVIDING ADVANCED CARE DIRECTIVES, INCLUDING A CONVERSATION ABOUT HOSPICE CARE & SERVICES. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | HOSPICE SUPPORT | GrantTypeTxt |
| Recipient | 43 | RecipientCnt |
| Cash Grant | $78,074 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FARIBAULT AREA HOSPICE FOUNDATION PROVIDES SUPPORT FOR INDIVIDUAL HOSPICE PATIENTS AND THIER LOVED ONES. FINANCIAL ASSISTANCE IS PROVIDED TO HOSPICE PATIENTS TO ASSIST WITH EXPENSES (HOSPICE SUPPORT, THERAPY, TRANSPORTATION, ETC.) PAYMENTS ARE MADE DIRECTLY TO THE SERVICE PROVIDER AND NOT THE INDIVIDUAL PATIENT. INDIVIDUALS IN NEED OF ASSISTANCE MUST SUBMIT THE COMPLETED APPLICATION; WHICH IS THEN REVIEWED AND APPROVED OR DENIED BY A COMMITTEE, BASED UPON THE REQUESTS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS REVIEWED BY RICK MILLER OF DISTRICT ONE HOSPITAL AND THEN PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST ACKNOWLEDGEMENT/QUESTIONNAIRE ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). |
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