JA COMMUNITY FOUNDATION: Form 990PF, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
JA COMMUNITY FOUNDATION (EIN 47-5147963)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-10
IRS object ID
201723149349101472
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)
Return2017-11-10T16:56:30-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN261367143PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1NAVOLIO & TALLMAN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1201 MISSION ST STE 650AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94105ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN475147963EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JA COMMUNITY FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlJACOBusinessNameControlTxt
Phone8004006633PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1180 GRAND AVENUE NO 1530AddressLine1Txt
CityOAKLANDCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94612ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSTEPHEN DIVIZICHPersonNm
Person TitleCHIEF EXECUTIVEPersonTitleTxt
Phone8004006633PhoneNum
Signature2017-11-07SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTHOMAS J PARRYPreparerPersonNm
PTINP00154906PTIN
Phone4159561750PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address72.28.108.90IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-07IPDt
IP Tm16:07:00IPTm
IP TimezonePSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id7A2C0EB56CEE5C9DC23AA4A5E63077300E38FC51AtSubmissionCreationDeviceId
At Submission Filing Device Id62C35B9A7E4AE90371098F02B2B47DE4AA8CB699AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$3,631,736FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$2,699,518ContriRcvdRevAndExpnssAmt
Dividends Rev And Expnss$45,156DividendsRevAndExpnssAmt
Dividends Net Invst Incm$45,156DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$46,865NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$610,495GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$46,865CapGainNetIncmNetInvstIncmAmt
Total Rev And Expnss$2,791,539TotalRevAndExpnssAmt
Total Net Invst Incm$92,021TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$0CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$0CompOfcrDirTrstDsbrsChrtblAmt
Legal Fees Rev And Expnss$1,946LegalFeesRevAndExpnssAmt
Legal Fees Net Invst Incm$0LegalFeesNetInvstIncmAmt
Legal Fees Dsbrs Chrtbl$0LegalFeesDsbrsChrtblAmt
Accounting Fees Rev And Expnss$2,725AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$1,363AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$0AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$2,934OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$0OtherProfFeesNetInvstIncmAmt
Other Prof Fees Dsbrs Chrtbl$0OtherProfFeesDsbrsChrtblAmt
Other Expenses Rev And Expnss$139,319OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$12,913OtherExpensesNetInvstIncmAmt
Other Expenses Dsbrs Chrtbl$0OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$146,924TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$14,276TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$0TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$112,500ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$112,500ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$259,424TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$14,276TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$112,500TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$2,532,115ExcessRevenueOverExpensesAmt
Net Investment Income$77,745NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Cash BOY$2,430CashBOYAmt
Cash EOY$68,516CashEOYAmt
Cash EOYFMV$68,516CashEOYFMVAmt
Sav And Temp Cash Invst BOY$1,029,219SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$172,628SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$172,628SavAndTempCashInvstEOYFMVAmt
Corporate Stock BOY$0CorporateStockBOYAmt
Corporate Stock EOY$1,907,198CorporateStockEOYAmt
Corporate Stock EOYFMV$1,994,752CorporateStockEOYFMVAmt
Corporate Bonds BOY$0CorporateBondsBOYAmt
Corporate Bonds EOY$1,415,422CorporateBondsEOYAmt
Corporate Bonds EOYFMV$1,395,840CorporateBondsEOYFMVAmt
Total Assets BOY$1,031,649TotalAssetsBOYAmt
Total Assets EOY$3,563,764TotalAssetsEOYAmt
Total Assets EOYFMV$3,631,736TotalAssetsEOYFMVAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind
Capital Stock BOY$0CapitalStockBOYAmt
Capital Stock EOY$0CapitalStockEOYAmt
Additional Paid In Capital BOY$0AdditionalPaidInCapitalBOYAmt
Additional Paid In Capital EOY$0AdditionalPaidInCapitalEOYAmt
Retained Earning BOY$1,031,649RetainedEarningBOYAmt
Retained Earning EOY$3,563,764RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$1,031,649TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$3,563,764TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$1,031,649TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$3,563,764TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$1,031,649TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$2,532,115ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$3,563,764SubtotalAmt
Other Decreases$0OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$3,563,764TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)

PropertyPropertyDescHow AcquiredHowAcquiredCdGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
UNION BANK #0740P$574,406$563,630$10,776$10,776
UNION BANK #0740P$36,089$36,089$36,089
FieldValueIRS element (for citing)
Capital Gain Net Income$46,865CapitalGainNetIncomeAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 Tax0LiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$0AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$290,336NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.000000DistributionYr1Rt
Total Distribution0.000000TotalDistributionRt
Average Distribution0.000000AverageDistributionRt
Net Vl Noncharitable Assets$2,815,944NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$0AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$777NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$777AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$112,500QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$777InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$777SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$777TaxBasedOnInvestmentIncomeAmt
Applied To Es Tax$1,200AppliedToEsTaxAmt
Total Payments And Credits$1,200TotalPaymentsAndCreditsAmt
Es Penalty$23EsPenaltyAmt
Overpayment$400OverpaymentAmt
Applied To ES Tax$400AppliedToESTaxAmt
Refund$0RefundAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateCAOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial ContributorsYes (1)NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt
Individual With BooksJA HEALTH BENEFITS TRUSTIndividualWithBooksNm
Phone8004006633PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1180 GRAND AVENUE NO 1530AddressLine1Txt
CityOAKLANDCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94612ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified Prsn0PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
DR LEROY MORISHITA
180 GRAND AVENUE NO 1530OAKLANDCA94612PRESIDENT & DIRECTOR0.50$0$0$0
DOUG URATA
180 GRAND AVENUE NO 1530OAKLANDCA94612VICE-PRESIDENT & DIRECTOR2.00$0$0$0
CAROL NISHITA
180 GRAND AVENUE NO 1530OAKLANDCA94612SECRETARY & DIRECTOR2.00$0$0$0
JAMES OSHIMA
180 GRAND AVENUE NO 1530OAKLANDCA94612TREASURER & DIRECTOR1.00$0$0$0
KEVIN NAGATA
180 GRAND AVENUE NO 1530OAKLANDCA94612DIRECTOR2.00$0$0$0
EDWARD ODA
180 GRAND AVENUE NO 1530OAKLANDCA94612DIRECTOR2.00$0$0$0
SHIG NAITO
180 GRAND AVENUE NO 1530OAKLANDCA94612DIRECTOR0.50$0$0$0
KIKUO NAKAHARA
180 GRAND AVENUE NO 1530OAKLANDCA94612DIRECTOR0.50$0$0$0
CAROLE YAMAKOSHI
180 GRAND AVENUE NO 1530OAKLANDCA94612DIRECTOR2.00$0$0$0
STEPHEN DIVIZICH
180 GRAND AVENUE NO 1530OAKLANDCA94612CHIEF EXECUTIVE20.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$2,152,232AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$706,594AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$2,858,826TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$2,858,826AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$42,882CashDeemedCharitableAmt
Net Vl Noncharitable Assets$2,815,944NetVlNoncharitableAssetsAmt
Minimum Investment Return$140,797MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$140,797MinimumInvestmentReturnAmt
Tax Based On Investment Income$777TaxBasedOnInvestmentIncomeAmt
Total Tax$777TotalTaxAmt
Distributable Before Adj$140,020DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$140,020DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$140,020DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$112,500ExpensesAndContributionsAmt
Program Related Invst Total$0ProgramRelatedInvstTotalAmt
Qualifying Distributions$112,500QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$777PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$111,723AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$140,020DistributableAsAdjustedAmt
Undistributed Income PY$4,335UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Total Excess Distribution Cyov$0TotalExcessDistributionCyovAmt
Qualifying Distributions$112,500QualifyingDistributionsAmt
Applied To Year1$4,335AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$108,165AppliedToCurrentYearAmt
Remaining Distri From Corpus$0RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$0TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$31,855UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$0ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$0ExcessDistriCyovToNextYrAmt

Supplementary Information SupplementaryInformationGrp

FieldValueIRS element (for citing)
Only Contri To PreselectedYes (X)OnlyContriToPreselectedInd

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (5 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
CENTRAL CALIFORNIA NIKKEI FOUNDATION DBA VINTAGE GARDENS ASSISTED LIVING CO
540 S PEACH AVEFRESNOCA93727501(C)(3)COMMUNITY OUTREACH$39,000
EAST SAN GABRIEL VALLEY JAPANESE COMMUNITY CENTER
1203 W PUENTE AVEWEST COVINACA91790501(C)(3)COMMUNITY OUTREACH$25,000
J-SEI INC
1285 66TH STREETEMERYVILLECA94608501(C)(3)COMMUNITY OUTREACH$25,000
LTSC COMMUNITY DEVELOPMENT CORP
231 E 3RD ST STE G106LOS ANGELESCA90013501(C)(3)COMMUNITY OUTREACH$18,500
GRATEFUL CRANE ENSEMBLE
1130 TROPICAL AVEPASADENACA91107501(C)(3)COMMUNITY OUTREACH$5,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$112,500TotalGrantOrContriPdDurYrAmt

Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp (2 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
EAST SAN GABRIEL VALLEY JAPANESE COMMUNITY CENTER
1203 W PUENTE AVEWEST COVINACA91790501(C)(3)COMMUNITY OUTREACH$25,000
J-SEI INC
1285 66TH STREETEMERYVILLECA94608501(C)(3)COMMUNITY OUTREACH$25,000
FieldValueIRS element (for citing)
Total Grant Or Contri Apprv Fut$50,000TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$45,156ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$46,865ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$92,021ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$92,021TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
General RuleYes (X)GeneralRuleInd

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
Contributor1ContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1JA HEALTH BENEFITS TRUSTBusinessNameLine1Txt

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1180 GRAND AVENUE NO 1530AddressLine1Txt
CityOAKLANDCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94612ZIPCd
FieldValueIRS element (for citing)
Total Contributions$2,699,518TotalContributionsAmt
Person ContributionYes (X)PersonContributionInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$2,725Amt
Net Investment Income$1,363NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp

FieldValueIRS element (for citing)
BondCORPORATE BONDSBondNm
EOY Book Value$1,415,422EOYBookValueAmt
EOYFMV$1,395,840EOYFMVAmt

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp

FieldValueIRS element (for citing)
StockMARKETABLE SECURITIESStockNm
EOY Book Value$1,907,198EOYBookValueAmt
EOYFMV$1,994,752EOYFMVAmt

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFeesGrp

FieldValueIRS element (for citing)
CategoryLEGAL FEESCategoryTxt
Legal Fees$1,946LegalFeesAmt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
ADVISOR FEES$12,913$12,913$0
BUSINESS EXPENSES$1,024$0$0
ADMINISTRATIVE FEES PAID TO JA HEALTH BENEFITS FPC$125,000$0$0
OTHER EXPENSES$97$0$0
OPERATION SUPPLIES$285$0$0

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryCONTRACT SERVICESCategoryTxt
Amt$2,934Amt
Net Investment Income$0NetInvestmentIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail

FieldValueIRS element (for citing)
PersonJA HEALTH BENEFITS TRUSTPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1180 GRAND AVENUE NO 1530AddressLine1Txt
CityOAKLANDCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94612ZIPCd

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