A PATTERN: Form 990EZ, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: A PATTERN (EIN 45-5094420)
Tax period: 2020-01-01 to 2020-12-31
Filed: 2021-09-15
IRS object ID: 202142589349200629
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
Form 990-EZ
Schedule A
Schedule B
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-09-15T10:03:21-04:00	ReturnTs
Tax Period End	2020-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	271750037	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	R & J ACCOUNTING & TAX SERVICES	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	2601 CR 3260	AddressLine1Txt
City	SALEM	CityNm
State Abbreviation	MO	StateAbbreviationCd
ZIP	65560	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990EZ	ReturnTypeCd
Tax Period Begin	2020-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	455094420	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	A PATTERN INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	APAT	BusinessNameControlTxt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	250 RICHTER ROAD	AddressLine1Txt
City	BOURBON	CityNm
State Abbreviation	MO	StateAbbreviationCd
ZIP	65441	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ANDREW S GRIVAS	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	8559761888	PhoneNum
Signature	2021-09-14	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	ANDREW	PersonFirstNm
Person Last	GRIVAS	PersonLastNm

Field	Value	IRS element (for citing)
SSN	XXX-XX-XXXX	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	DIANA J LETTMAN	PreparerPersonNm
PTIN	P01201478	PTIN
Phone	5732472554	PhoneNum
Self Employed	Yes (X)	SelfEmployedInd

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	0	TrustedCustomerCd
OOB Security Verification	00	OOBSecurityVerificationCd
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-EZ IRS990EZ

Field	Value	IRS element (for citing)
Method Of Accounting Cash	Yes (X)	MethodOfAccountingCashInd
Organization501c3	Yes (X)	Organization501c3Ind
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Gross Receipts	$170,757	GrossReceiptsAmt
Info In Schedule O Part I	Yes (X)	InfoInScheduleOPartIInd
Contributions Gifts Grants Etc	$29,242	ContributionsGiftsGrantsEtcAmt
Investment Income	$57	InvestmentIncomeAmt
Other Revenue Total	$141,458	OtherRevenueTotalAmt
Total Revenue	$170,757	TotalRevenueAmt
Salaries Other Comp Empl Bnft	$47,649	SalariesOtherCompEmplBnftAmt
Fees And Other Pymt To Ind Cntrct	$2,422	FeesAndOtherPymtToIndCntrctAmt
Occupancy Rent Utlts And Maint	$23,819	OccupancyRentUtltsAndMaintAmt
Printing Publications Postage	$341	PrintingPublicationsPostageAmt
Other Expenses Total	$38,384	OtherExpensesTotalAmt
Total Expenses	$112,615	TotalExpensesAmt
Excess Or Deficit For Year	$58,142	ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY	$346,483	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$404,625	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part II	Yes (X)	InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

Field	Value	IRS element (for citing)
BOY	$46,282	BOYAmt
EOY	$53,590	EOYAmt

Land And Buildings LandAndBuildingsGrp

Field	Value	IRS element (for citing)
BOY	$375,686	BOYAmt
EOY	$375,686	EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

Field	Value	IRS element (for citing)
BOY	$22,660	BOYAmt
EOY	$22,660	EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$444,628	BOYAmt
EOY	$451,936	EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$98,145	BOYAmt
EOY	$47,311	EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

Field	Value	IRS element (for citing)
BOY	$346,483	BOYAmt
EOY	$404,625	EOYAmt

Field	Value	IRS element (for citing)
Primary Exempt Purpose	Provide health and medical education	PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp (3 entries)

Description Program Srvc AccomDescriptionProgramSrvcAccomTxt
Provided 520 health and wellness lectures, 32 cooking classes, 32 home remedies classes for 282 days of the year.
Staff participated in a Disaster Responses operation following the floods in Missouri.
Participation in spiritual and health classes was provided to a local correctional facility for 40 classes once weekly during the year.

Field	Value	IRS element (for citing)
Total Program Service Expenses	$0	TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (6 entries)

TitleTitleTxt	Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt	CompensationCompensationAmt	Employee Benefit ProgramEmployeeBenefitProgramAmt	Expense Account Other AllwncExpenseAccountOtherAllwncAmt
ANDREW S GRIVAS
PRESIDENT	40.00	$0	$0	$0
JOYCE GRIVAS
SECRETARY-TREASURER	40.00	$0	$0	$0
PAUL ROSS
GENERAL BUSINESS MANAGER	0.00	$0	$0	$0
MARTHA ROSS
ADMINISTRATIVE DIRECTOR	0.00	$0	$0	$0
CHARLES CLEVELAND
HER RESOURCE MANAGER	0.00	$0	$0	$0
VAUGHAN H SPARROW
DIRECTOR	0.00	$0	$0	$0

Field	Value	IRS element (for citing)
Activities Not Previously Rpt	false	ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt	false	ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI	false	OrganizationHadUBIInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Organization Dissolved Etc	false	OrganizationDissolvedEtcInd
Form1120 Pol Filed	false	Form1120PolFiledInd
Made Loans To From Officers	false	MadeLoansToFromOfficersInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	JOYCE GRIVAS	PersonNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	250 RICHTER ROAD	AddressLine1Txt
City	BOURBON	CityNm
State Abbreviation	MO	StateAbbreviationCd
ZIP	65441	ZIPCd

Field	Value	IRS element (for citing)
Phone	8559761888	PhoneNum

Field	Value	IRS element (for citing)
Foreign Financial Account	false	ForeignFinancialAccountInd
Foreign Office	false	ForeignOfficeInd
Donor Advised Fnds	false	DonorAdvisedFndsInd
Operate Hospital	false	OperateHospitalInd
Tanning Services Provided	false	TanningServicesProvidedInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	false	TransactionWithControlEntInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	false	LobbyingActivitiesInd
School Operating	false	SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd Empl	NONE	PartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof Srvc	NONE	PartVIHghstPdCntrctProfSrvcTxt
Filed Schedule A	Yes (true)	FiledScheduleAInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	Yes (X)	PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$149,070	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$32,895	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$80,688	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$38,599	CurrentTaxYearMinus1YearAmt
Current Tax Year	$29,242	CurrentTaxYearAmt
Total	$330,494	TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$40,436	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$58,207	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$67,964	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$86,490	CurrentTaxYearMinus1YearAmt
Current Tax Year	$125,561	CurrentTaxYearAmt
Total	$378,658	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$189,506	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$91,102	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$148,652	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$125,089	CurrentTaxYearMinus1YearAmt
Current Tax Year	$154,803	CurrentTaxYearAmt
Total	$709,152	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total509	$709,152	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$55	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$133	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$108	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$68	CurrentTaxYearMinus1YearAmt
Current Tax Year	$57	CurrentTaxYearAmt
Total	$421	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$55	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$133	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$108	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$68	CurrentTaxYearMinus1YearAmt
Current Tax Year	$57	CurrentTaxYearAmt
Total	$421	TotalAmt

Other Income509 OtherIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$19,600	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$11,113	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$12,250	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$12,875	CurrentTaxYearMinus1YearAmt
Current Tax Year	$16,175	CurrentTaxYearAmt
Total	$72,013	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$209,161	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$102,348	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$161,010	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$138,032	CurrentTaxYearMinus1YearAmt
Current Tax Year	$171,035	CurrentTaxYearAmt
Total	$781,586	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.90730	PublicSupportCY509Pct
Public Support PY509	0.00000	PublicSupportPY509Pct
Investment Income CY	0.00000	InvestmentIncomeCYPct
Investment Income PY	0.00000	InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509	Yes (X)	ThirtyThrPctSuprtTestsCY509Ind

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 O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Description of other revenue Part I line 8	Description AmountLIFESTYLE INCOME 95,903PHONE CONSULTATIONS 8,479REFUNDS 4,624RENTAL INCOME 16,175PROVIDER SERVICES 15,800MISCELLANEOUS 477
Description of other expenses Part I line 16	Description AmountADVERTISING 2,966BANK FEES 4,250TRAVEL 7,223LICENSE/TAXES 9,466INTEREST 3,916REFUND 1,462FOOD/SUPPLIES 8,751INSURANCE 350
Description of other assets Part II line 24	Category Beginning of Year End of YearSTEAM SHOWER 1,437 1,437EQUIPMENT 3,893 3,893MOWER 5,330 5,330TRACTOR 7,000 7,000MOWER 5,000 5,000
Description of total liabilities Part II line 26	Category Beginning of Year End of YearBUILDING AND LAND 98,145 47,311
Other program services Part III line 31	One overseas event was engaged in, with health classes, health consultations, and area-wide TV broadcasts. Monthly participation was provided by the staff physician to another health and wellness facility to provide health consultations to interested health guests and training to other health providers.

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