HOSPICE FOUNDATION OF JEFFERSON COUNTY INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
HOSPICE FOUNDATION OF JEFFERSON COUNTY INC (EIN 16-1541636)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-04-03
IRS object ID
201840939349300604
Schema version
2016v3.0
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)
Return2018-04-03T07:35:12-05:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

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 Begin2016-10-01TaxPeriodBeginDt

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 STREETAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDIANA WOODHOUSEPersonNm
Person TitleCEOPersonTitleTxt
Phone3157887323PhoneNum
Signature2018-02-24SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBETTINA LIPPHARDTPreparerPersonNm
PTINP00956232PTIN
Phone3154764004PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address4.14.157.194IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-02-24IPDt
IP Tm14:59:09IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id5BB96875A42BDAEB41182F9ACBC1B56AEE4C8494AtSubmissionCreationDeviceId
At Submission Filing Device Id385B62C4163776184B0F5685109B012F6B49631DAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDIANA WOODHOUSEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11398 GOTHAM STREETAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$739,498GrossReceiptsAmt
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 Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers45TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$301,159PYContributionsGrantsAmt
CY Contributions Grants$276,945CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$212,718PYInvestmentIncomeAmt
CY Investment Income$253,677CYInvestmentIncomeAmt
PY Other Revenue$16,526PYOtherRevenueAmt
CY Other Revenue$18,613CYOtherRevenueAmt
PY Total Revenue$530,403PYTotalRevenueAmt
CY Total Revenue$549,235CYTotalRevenueAmt
PY Grants And Similar Paid$124,500PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$25,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$133,950PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$136,024CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$17,149CYTotalFundraisingExpenseAmt
PY Other Expenses$353,662PYOtherExpensesAmt
CY Other Expenses$360,603CYOtherExpensesAmt
PY Total Expenses$612,112PYTotalExpensesAmt
CY Total Expenses$521,627CYTotalExpensesAmt
PY Revenues Less Expenses-$81,709PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$27,608CYRevenuesLessExpensesAmt
Total Assets BOY$7,467,450TotalAssetsBOYAmt
Total Assets EOY$7,621,410TotalAssetsEOYAmt
Total Liabilities BOY$51,801TotalLiabilitiesBOYAmt
Total Liabilities EOY$26,719TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,415,649NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$7,594,691NetAssetsOrFundBalancesEOYAmt
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$25,000ExpenseAmt
Grant$25,000GrantAmt
DescFINANCIAL SUPPORT HOSPICE OF JEFFERSON COUNTY, INC. IN ITS OPERATIONS TO PROVIDE MEDICAL CARE AND TREATMENT TO THE TERMINALLY ILL.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$55,198ExpenseAmt
DescSOLICITING, RECEIVING, AND ACKNOWLEDGING ALL FORMS OF CHARITABLE GIFTS FROM INDIVIDUALS, ORGANIZATIONS AND FOUNDATIONS VIA FUNDRAISING EVENTS AND MAIL SOLICITATIONS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$80,198TotalProgramServiceExpensesAmt
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
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
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 Document1IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
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 Line1JORDAN JONESBusinessNameLine1Txt
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 (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
ERIC DELAGARZA
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
AMY DEMAR
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
THEODORE MISIEWICZ
TREASURER1.00Yes (X)Yes (X)$0$0$0
DR JAN TURCOTTE
SECRETARY1.00Yes (X)Yes (X)$0$0$0
CAROLYN OSBORNE
BOARD MEMBER1.00Yes (X)$0$0$0
JEFF COLE
BOARD MEMBER1.00Yes (X)$0$0$0
HOLLY BUSH
BOARD MEMBER1.00Yes (X)$0$0$0
RAEANN CHATTERTON
BOARD MEMBER1.00Yes (X)$0$0$0
LORI GERVERA
BOARD MEMBER1.00Yes (X)$0$0$0
JULIA STORMS
BOARD MEMBER1.00Yes (X)$0$0$0
TODD R DEMAR
BOARD MEMBER1.00Yes (X)$0$0$0
REV DONALD ROBINSON
BOARD MEMBER1.00Yes (X)$0$0$0
EMILY SPRAGUE
BOARD MEMBER1.00Yes (X)$0$0$0
AMY GRUNER
BOARD MEMBER1.00Yes (X)$0$0$0
STEPHEN SWAIN
BOARD MEMBER1.00Yes (X)$0$0$0
DIANA WOODHOUSE
CHIEF EXECUTIVE OFFICER20.00Yes (X)$0$117,555$020.00
JORDAN JONES
DIRECTOR OF FINANCE30.00Yes (X)$0$60,567$010.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$178,122TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$58,043FundraisingAmt
All Other Contributions$218,902AllOtherContributionsAmt
Total Contributions$276,945TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$83,551TotalRevenueColumnAmt
Exclusion$83,551ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$338,982SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$168,856SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$170,126SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$170,126TotalRevenueColumnAmt
Exclusion$170,126ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$40,020FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$58,043ContriRptFundraisingEventAmt
Fundraising Direct Expenses$21,407FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,613TotalRevenueColumnAmt
Exclusion$18,613ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$549,235TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$272,290ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$25,000TotalAmt
Program Services$25,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$76,343TotalAmt
Management And General$76,343ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$56,710TotalAmt
Management And General$56,710ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,971TotalAmt
Management And General$2,971ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,462TotalAmt
Management And General$7,462ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$28,728TotalAmt
Management And General$28,728ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$61,040TotalAmt
Program Services$55,000ProgramServicesAmt
Management And General$6,040ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$14,650TotalAmt
Management And General$14,650ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$2,840TotalAmt
Management And General$2,840ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$24,162TotalAmt
Management And General$24,162ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$90TotalAmt
Management And General$90ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$197,682TotalAmt
Management And General$197,682ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$4,842TotalAmt
Management And General$4,842ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescFUNDRAISINGDesc
Total$17,149TotalAmt
Fundraising$17,149FundraisingAmt

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,958TotalAmt
Program Services$198ProgramServicesAmt
Management And General$1,760ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$521,627TotalAmt
Program Services$80,198ProgramServicesAmt
Management And General$424,280ManagementAndGeneralAmt
Fundraising$17,149FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$67,849BOYAmt
EOY$26,172EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,000BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$350BOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,519,809LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,078,222LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,613,481BOYAmt
EOY$3,441,587EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,574,389BOYAmt
EOY$2,824,834EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,201,381BOYAmt
EOY$1,328,817EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,467,450BOYAmt
EOY$7,621,410EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$51,801BOYAmt
EOY$26,719EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$51,801BOYAmt
EOY$26,719EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,245,417BOYAmt
EOY$7,427,198EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$120,232BOYAmt
EOY$117,493EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$50,000BOYAmt
EOY$50,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,415,649BOYAmt
EOY$7,594,691EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,467,450BOYAmt
EOY$7,621,410EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$27,608ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$151,434NetUnrlzdGainsLossesInvstAmt
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$1,226,214CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$728,023CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$264,501CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$301,159CurrentTaxYearMinus1YearAmt
Current Tax Year$276,945CurrentTaxYearAmt
Total$2,796,842TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,226,214CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$728,023CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$264,501CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$301,159CurrentTaxYearMinus1YearAmt
Current Tax Year$276,945CurrentTaxYearAmt
Total$2,796,842TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$2,796,842PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$46,665CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$61,008CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$69,885CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$84,678CurrentTaxYearMinus1YearAmt
Current Tax Year$83,551CurrentTaxYearAmt
Total$345,787TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$150CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$320CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15CurrentTaxYearMinus2YearsAmt
Total$485TotalAmt
FieldValueIRS element (for citing)
Total Support$3,143,114TotalSupportAmt
Public Support CY1700.88980PublicSupportCY170Pct
Public Support PY1700.91170PublicSupportPY170Pct
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$115,851BeginningYearBalanceAmt
Contributions$1,750ContributionsAmt
Investment Earnings Or Losses$12,549InvestmentEarningsOrLossesAmt
End Year Balance$130,150EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$94,360BeginningYearBalanceAmt
Contributions$11,500ContributionsAmt
Investment Earnings Or Losses$9,991InvestmentEarningsOrLossesAmt
End Year Balance$115,851EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$62,909BeginningYearBalanceAmt
Contributions$35,300ContributionsAmt
Investment Earnings Or Losses-$3,849InvestmentEarningsOrLossesAmt
End Year Balance$94,360EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$50,000ContributionsAmt
Investment Earnings Or Losses$12,909InvestmentEarningsOrLossesAmt
End Year Balance$62,909EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.46400BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.38400PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.15200TermEndowmentBalanceEOYPct
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$940,077DepreciationAmt
Book Value$3,336,605BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$190,413OtherCostOrOtherBasisAmt
Depreciation$138,145DepreciationAmt
Book Value$52,268BookValueAmt

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$3,441,587TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescINVESTMENT IN THE COMMUNITY FOUNDATIONDesc
Book Value$1,328,817BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$1,328,817TotalBookValueSecuritiesAmt
Total Rev Etc Audited Fincl Stmt$722,076TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$151,434NetUnrealizedGainsInvstAmt
Other Revenue$21,407OtherRevenueAmt
Revenue Not Reported$172,841RevenueNotReportedAmt
Revenue Subtotal$549,235RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$549,235TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$543,034TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$21,407OtherExpensesIncludedAmt
Expenses Not Reported$21,407ExpensesNotReportedAmt
Expenses Subtotal$521,627ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$521,627TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSE 21,407.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS 21,407.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1REGATTAEvent1Nm
Gross Receipts Event1$30,806GrossReceiptsEvent1Amt
Charitable Contri Event1$19,706CharitableContriEvent1Amt
Gross Revenue Event1$11,100GrossRevenueEvent1Amt
Non Cash Prizes Event1$250NonCashPrizesEvent1Amt
Rent Facility Costs Event1$2,000RentFacilityCostsEvent1Amt
Other Direct Expenses Event1$1,250OtherDirectExpensesEvent1Amt
Event2BALLEvent2Nm
Gross Receipts Event2$16,702GrossReceiptsEvent2Amt
Charitable Contri Event2$7,932CharitableContriEvent2Amt
Gross Revenue Event2$8,770GrossRevenueEvent2Amt
Rent Facility Costs Event2$2,500RentFacilityCostsEvent2Amt
Food And Beverage Event2$3,844FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$1,585OtherDirectExpensesEvent2Amt
Other Events Total3OtherEventsTotalCnt
Gross Receipts Other Events$50,555GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$30,405CharitableContriOtherEventsAmt
Gross Revenue Other Events$20,150GrossRevenueOtherEventsAmt
Non Cash Prizes Other Events$500NonCashPrizesOtherEventsAmt
Rent Fclty Costs Other Events$494RentFcltyCostsOtherEventsAmt
Oth Direct Expnss Other Events$8,984OthDirectExpnssOtherEventsAmt
Gross Receipts Total$98,063GrossReceiptsTotalAmt
Charitable Contributions Tot$58,043CharitableContributionsTotAmt
Gross Revenue Total Events$40,020GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$750NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$4,994RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$3,844FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$11,819OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$21,407DirectExpenseSummaryEventsAmt
Net Income Summary$18,613NetIncomeSummaryAmt

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$25,000CashGrantAmt
Valuation Method UsedCOSTValuationMethodUsedDesc
Purpose Of GrantFINANCIAL SUPPORT HOSPICE OF JEFFERSON COUNTY, INC. IN ITS OPERATIONS TO PROVIDE MEDICAL CARE AND TREATMENT TO THE TERMINALLY ILL.PurposeOfGrantTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2VICE PRESIDENT AMY DEMAR AND BOARD MEMBER TODD DEMAR ARE RELATED. AMY IS TODD'S SISTER-IN-LAW.
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 10PublicCharityStatusTxt

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$136,024COST INCURRED
HOSPICE OF JEFFERSON COUNTY INC
B$25,000COST INCURRED

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