HOSPICE FOUNDATION OF JEFFERSON COUNTY INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
HOSPICE FOUNDATION OF JEFFERSON COUNTY INC (EIN 16-1541636)
Tax period
2015-10-01 to 2016-09-30
Filed
2017-04-18
IRS object ID
201701099349300810
Schema version
2015v3.0
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)
Return2017-04-18T00:00:00-05:00ReturnTs
Tax Period End2016-09-30TaxPeriodEndDt

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 Begin2015-10-01TaxPeriodBeginDt

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
Signature2017-04-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBETTINA LIPPHARDTPreparerPersonNm
PTINP00956232PTIN
Phone3154764004PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
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$887,661GrossReceiptsAmt
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$245,692PYContributionsGrantsAmt
CY Contributions Grants$301,159CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$89,365PYInvestmentIncomeAmt
CY Investment Income$212,718CYInvestmentIncomeAmt
PY Other Revenue$25,201PYOtherRevenueAmt
CY Other Revenue$16,526CYOtherRevenueAmt
PY Total Revenue$360,258PYTotalRevenueAmt
CY Total Revenue$530,403CYTotalRevenueAmt
PY Grants And Similar Paid$253,667PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$124,500CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$165,040PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$133,950CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$18,447CYTotalFundraisingExpenseAmt
PY Other Expenses$328,746PYOtherExpensesAmt
CY Other Expenses$353,662CYOtherExpensesAmt
PY Total Expenses$747,453PYTotalExpensesAmt
CY Total Expenses$612,112CYTotalExpensesAmt
PY Revenues Less Expenses-$387,195PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$81,709CYRevenuesLessExpensesAmt
Total Assets BOY$7,319,912TotalAssetsBOYAmt
Total Assets EOY$7,467,450TotalAssetsEOYAmt
Total Liabilities BOY$20,382TotalLiabilitiesBOYAmt
Total Liabilities EOY$51,801TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,299,530NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$7,415,649NetAssetsOrFundBalancesEOYAmt
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$124,500ExpenseAmt
Grant$124,500GrantAmt
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$54,804ExpenseAmt
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$179,304TotalProgramServiceExpensesAmt
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 Stmt0IndependentAuditFinclStmtInd
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 Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
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
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 Line1425 WASHINGTON 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
AMY DEMAR
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
CAROLYN OSBORNE
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
DR JAN TURCOTTE
SECRETARY/TREASURER1.00Yes (X)Yes (X)$0$0$0
MICHAEL BUFALINI
BOARD MEMBER1.00Yes (X)$0$0$0
HOLLY BUSH
BOARD MEMBER1.00Yes (X)$0$0$0
JEFF COLE
BOARD MEMBER1.00Yes (X)$0$0$0
ERIC DELAGARZA
BOARD MEMBER1.00Yes (X)$0$0$0
TODD DEMAR
BOARD MEMBER1.00Yes (X)$0$0$0
LORI GERVERA
BOARD MEMBER1.00Yes (X)$0$0$0
AMY GRUNER
BOARD MEMBER1.00Yes (X)$0$0$0
THEODORE MISIEWICZ
BOARD MEMBER1.00Yes (X)$0$0$0
JAMES PETERS
BOARD MEMBER1.00Yes (X)$0$0$0
JULIA STORMS
BOARD MEMBER1.00Yes (X)$0$0$0
STEPHEN SWAIN
BOARD MEMBER1.00Yes (X)$0$0$0
MERLE TOUSANT
PRESIDENT HOSPICE BOARD1.00Yes (X)$0$0$0
DIANA WOODHOUSE
CHIEF EXECUTIVE OFFICER20.00Yes (X)$0$109,561$8,63020.00
JORDAN JONES
FINANCE DIRECTOR30.00Yes (X)$0$54,091$7,77710.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$163,652TotReportableCompRltdOrgAmt
Total Other Compensation$16,407TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$43,685FundraisingAmt
All Other Contributions$257,474AllOtherContributionsAmt
Total Contributions$301,159TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$84,678TotalRevenueColumnAmt
Exclusion$84,678ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$467,740SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$339,700SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$128,040SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$128,040TotalRevenueColumnAmt
Exclusion$128,040ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$34,084FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$43,685ContriRptFundraisingEventAmt
Fundraising Direct Expenses$17,558FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,526TotalRevenueColumnAmt
Exclusion$16,526ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$530,403TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$229,244ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$124,500TotalAmt
Program Services$124,500ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$73,674TotalAmt
Management And General$73,674ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$57,980TotalAmt
Management And General$57,980ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,296TotalAmt
Management And General$2,296ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,284TotalAmt
Management And General$7,284ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$28,685TotalAmt
Management And General$28,685ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$49,575TotalAmt
Program Services$47,658ProgramServicesAmt
Management And General$1,917ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,951TotalAmt
Management And General$4,951ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$5,060TotalAmt
Management And General$5,060ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$24,914TotalAmt
Management And General$24,914ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,157TotalAmt
Management And General$2,157ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,987TotalAmt
Management And General$3,987ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$194,278TotalAmt
Management And General$194,278ManagementAndGeneralAmt

Insurance InsuranceGrp

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

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtFundraisingFundraisingAmtProgram ServicesProgramServicesAmt
FUNDRAISING$18,447$18,447
BAD DEBTS$7,146$7,146

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,336TotalAmt
Management And General$2,336ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$612,112TotalAmt
Program Services$179,304ProgramServicesAmt
Management And General$414,361ManagementAndGeneralAmt
Fundraising$18,447FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$6,354BOYAmt
EOY$67,849EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$27,146BOYAmt
EOY$10,000EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
EOY$350EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,494,021LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$880,540LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,789,754BOYAmt
EOY$3,613,481EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,418,552BOYAmt
EOY$2,574,389EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,078,106BOYAmt
EOY$1,201,381EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,319,912BOYAmt
EOY$7,467,450EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$20,382BOYAmt
EOY$51,801EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,382BOYAmt
EOY$51,801EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,127,499BOYAmt
EOY$7,245,417EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$122,031BOYAmt
EOY$120,232EOYAmt

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$7,299,530BOYAmt
EOY$7,415,649EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,319,912BOYAmt
EOY$7,467,450EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$81,709ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$197,828NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
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$498,485CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,226,214CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$728,023CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$264,501CurrentTaxYearMinus1YearAmt
Current Tax Year$301,159CurrentTaxYearAmt
Total$3,018,382TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$498,485CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,226,214CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$728,023CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$264,501CurrentTaxYearMinus1YearAmt
Current Tax Year$301,159CurrentTaxYearAmt
Total$3,018,382TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$3,018,382PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$28,875CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$46,665CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$61,008CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$69,885CurrentTaxYearMinus1YearAmt
Current Tax Year$84,678CurrentTaxYearAmt
Total$291,111TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$600CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$150CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$320CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15CurrentTaxYearMinus1YearAmt
Total$1,085TotalAmt
FieldValueIRS element (for citing)
Total Support$3,310,578TotalSupportAmt
Public Support CY1700.91170PublicSupportCY170Pct
Public Support PY1700.95860PublicSupportPY170Pct
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$94,360BeginningYearBalanceAmt
Contributions$11,500ContributionsAmt
Investment Earnings Or Losses$9,991InvestmentEarningsOrLossesAmt
End Year Balance$115,851EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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 EOY0.44450BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.43160PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.12390TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
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$4,266,838OtherCostOrOtherBasisAmt
Depreciation$768,196DepreciationAmt
Book Value$3,498,642BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$187,683OtherCostOrOtherBasisAmt
Depreciation$112,344DepreciationAmt
Book Value$75,339BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$3,613,481TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescINVESTMENT IN THE COMMUNITY FOUNDATIONDesc
Book Value$1,201,381BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$1,201,381TotalBookValueSecuritiesAmt
Total Rev Etc Audited Fincl Stmt$745,789TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$197,828NetUnrealizedGainsInvstAmt
Other Revenue$17,558OtherRevenueAmt
Revenue Not Reported$215,386RevenueNotReportedAmt
Revenue Subtotal$530,403RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$530,403TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$629,670TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$17,558OtherExpensesIncludedAmt
Expenses Not Reported$17,558ExpensesNotReportedAmt
Expenses Subtotal$612,112ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$612,112TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART XI, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSE 17,558.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENT EXPENSES 17,558.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1REGATTAEvent1Nm
Gross Receipts Event1$28,101GrossReceiptsEvent1Amt
Charitable Contri Event1$18,874CharitableContriEvent1Amt
Gross Revenue Event1$9,227GrossRevenueEvent1Amt
Non Cash Prizes Event1$213NonCashPrizesEvent1Amt
Food And Beverage Event1$2,637FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$1,920OtherDirectExpensesEvent1Amt
Event2BALLEvent2Nm
Gross Receipts Event2$24,610GrossReceiptsEvent2Amt
Charitable Contri Event2$15,810CharitableContriEvent2Amt
Gross Revenue Event2$8,800GrossRevenueEvent2Amt
Rent Facility Costs Event2$5,670RentFacilityCostsEvent2Amt
Other Direct Expenses Event2$3,130OtherDirectExpensesEvent2Amt
Other Events Total2OtherEventsTotalCnt
Gross Receipts Other Events$25,058GrossReceiptsOtherEventsAmt
Charitable Contri Other Events$9,001CharitableContriOtherEventsAmt
Gross Revenue Other Events$16,057GrossRevenueOtherEventsAmt
Oth Direct Expnss Other Events$3,988OthDirectExpnssOtherEventsAmt
Gross Receipts Total$77,769GrossReceiptsTotalAmt
Charitable Contributions Tot$43,685CharitableContributionsTotAmt
Gross Revenue Total Events$34,084GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$213NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$5,670RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$2,637FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$9,038OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$17,558DirectExpenseSummaryEventsAmt
Net Income Summary$16,526NetIncomeSummaryAmt

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$124,500CashGrantAmt
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 (8 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 11THE 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.
FORM 990, PART XII, LINE 2CTHE BOARD OF DIRECTORS SELECTS AND MEETS WITH THE INDEPENDENT AUDITORS TO DISCUSS THE RESULTS OF THE AUDIT.

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 Line1425 WASHINGTON STREETAddressLine1Txt
CityWATERTOWNCityNm
State AbbreviationNYStateAbbreviationCd
ZIP13601ZIPCd
FieldValueIRS element (for citing)
EIN161266041EIN
Primary ActivitiesHOSPICE CAREPrimaryActivitiesTxt
Legal Domicile StateNYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity Status9PublicCharityStatusTxt

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$133,950COST INCURRED
HOSPICE OF JEFFERSON COUNTY INC
B$124,500COST INCURRED

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