COMMUNITY HOSPICE FOUNDATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPICE FOUNDATION (EIN 77-0562224)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-02-12
- IRS object ID
- 201640439349301824
- Schema version
- 2014v6.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-02-12T17:27:47-06:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 941239084 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHERTON & ASSOCIATES LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 4339 | AddressLine1Txt |
| City | MODESTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 953524339 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770562224 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 2095786300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1Txt |
| City | MODESTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95356 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICK DAHLSEID CPA | PersonNm |
| Person Title | VP/CFO | PersonTitleTxt |
| Phone | 2095786300 | PhoneNum |
| Signature | 2016-02-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RONALD EHRKE | PreparerPersonNm |
| PTIN | P00141781 | PTIN |
| Phone | 2095774800 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | C DESHA MCLEOD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1Txt |
| City | MODESTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95356 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,642,138 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HOSPICEHEART.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | SUPPORT OF COMMUNITY HOSPICE, INC. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 18 | VotingMembersIndependentCnt |
| Total Employee | 4 | TotalEmployeeCnt |
| Total Volunteers | 61 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $797,965 | PYContributionsGrantsAmt |
| CY Contributions Grants | $901,132 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $245,839 | PYInvestmentIncomeAmt |
| CY Investment Income | $315,156 | CYInvestmentIncomeAmt |
| PY Other Revenue | $263,131 | PYOtherRevenueAmt |
| CY Other Revenue | $237,326 | CYOtherRevenueAmt |
| PY Total Revenue | $1,306,935 | PYTotalRevenueAmt |
| CY Total Revenue | $1,453,614 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $410,698 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $248,418 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $246,511 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $205,109 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $113,381 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $217,064 | PYOtherExpensesAmt |
| CY Other Expenses | $225,824 | CYOtherExpensesAmt |
| PY Total Expenses | $874,273 | PYTotalExpensesAmt |
| CY Total Expenses | $679,351 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $432,662 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $774,263 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,239,108 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,392,558 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $82,444 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $108,440 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,156,664 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,284,118 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE FOUNDATION EXISTS TO RAISE FUNDS AND AWARENESS OF THE COMMUNITY HOSPICE MISSION. COMMUNITY HOSPICE PROVIDES COMPASSIONATE END-OF-LIFE CARE AND BEREAVEMENT SUPPORT TO PATIENTS AND THEIR FAMILIES REGARDLESS OF ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $508,947 | ExpenseAmt |
| Grant | $248,418 | GrantAmt |
| Revenue | $121,814 | RevenueAmt |
| Desc | TO RAISE FUNDS TO SUPPORT THE OPERATIONS OF COMMUNITY HOSPICE, INC., A RELATED NOT-FOR-PROFIT CORPORATION. COMMUNITY HOSPICE, INC., USES THESE FUNDS TO PROVIDE SERVICES AND SUPPORT TO THE TERMINALLY ILL AND THEIR FAMILIES. | Desc |
| Total Program Service Expenses | $508,947 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | Yes (1) | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 4 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | 0 | Form8899Filedind |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 18 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICK DAHLSEID CPA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2095786300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1Txt |
| City | MODESTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95356 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JON TREMAYNE | ||||||||
| CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SUZANNE CANDINI | ||||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SALLY COFER-LINDBERG | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| SUE CIPPONERI | ||||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JANICE LUCERO | ||||||||
| PAST CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ASHLEY BARBOZA | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES RYAN COGDILL | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| PATTY DUVAL | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RONI EDGMON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DEANNA HANSEN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LESLIE KALIM MCHUGH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MICHAEL KRAUSNICK | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JYOTHI PRABHU SEETHARAM | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TICIA SODHI | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GINA MACHADO | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KRISTI AH YOU | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GLENN RICHARDSON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JENNIFER SANGUINETTI | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| LYNIS CHAFFEY | ||||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $89,905 | $0 | $3,266 | |||
| RICK DAHLSEID CPA | ||||||||
| VICE PRESIDENT, CFO | 40.00 | Yes (X) | $0 | $132,764 | $7,136 | |||
| CHARLOTTE D MCLEOD | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $0 | $219,690 | $4,492 | |||
| MONICA OJCIUS | ||||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $0 | $0 | $0 | |||
| SHAILESH KANTILAL | ||||||||
| VP CHIEF INFORMATION OFFICER | 40.00 | $0 | $151,849 | $7,230 | Yes (X) | |||
| CHERYL KIRK | ||||||||
| RN CASE MANAGER | 40.00 | $0 | $153,172 | $7,931 | Yes (X) | |||
| JOHN RENNER | ||||||||
| DIRECTOR OF RETAIL OPS | 40.00 | $0 | $116,087 | $5,152 | Yes (X) | |||
| LAURA MILLER | ||||||||
| VP CHIEF CLINICAL OFFICER | 40.00 | $0 | $134,439 | $6,800 | Yes (X) | |||
| TERESA ANNE HARRINGTON | ||||||||
| DIRECTOR OF INTEGRATED QUALITY AND HEALTH INFORMAT | 40.00 | $0 | $117,424 | $6,097 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $89,905 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,025,425 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $48,104 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $43,752 | FundraisingAmt |
| All Other Contributions | $857,380 | AllOtherContributionsAmt |
| Noncash Contributions | $43,752 | NoncashContributionsAmt |
| Total Contributions | $901,132 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $193,342 | TotalRevenueColumnAmt |
| Exclusion | $193,342 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $121,814 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $121,814 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $121,814 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $121,814 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $402,359 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $43,752 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $188,524 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $213,835 | TotalRevenueColumnAmt |
| Exclusion | $213,835 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $23,491 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,491 | TotalRevenueColumnAmt |
| Exclusion | $23,491 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,453,614 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $121,814 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $430,668 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,418 | TotalAmt |
| Program Services | $248,418 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,675 | TotalAmt |
| Program Services | $37,838 | ProgramServicesAmt |
| Fundraising | $37,837 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,734 | TotalAmt |
| Program Services | $54,367 | ProgramServicesAmt |
| Fundraising | $54,367 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,024 | TotalAmt |
| Program Services | $3,012 | ProgramServicesAmt |
| Fundraising | $3,012 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,676 | TotalAmt |
| Program Services | $7,338 | ProgramServicesAmt |
| Fundraising | $7,338 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,327 | TotalAmt |
| Program Services | $35,327 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25 | TotalAmt |
| Program Services | $25 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,938 | TotalAmt |
| Program Services | $26,938 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,000 | TotalAmt |
| Program Services | $18,000 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,999 | TotalAmt |
| Fundraising | $3,999 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,986 | TotalAmt |
| Program Services | $7,986 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| MANAGEMENT SERVICE FEES | $57,023 | $57,023 | |
| BANK, CREDIT CARD & PAY | $26,815 | $26,815 | |
| COMPUTER MAINTENANCE | $12,974 | $12,974 | |
| POSTAGE | $9,323 | $9,323 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,414 | TotalAmt |
| Program Services | $20,586 | ProgramServicesAmt |
| Fundraising | $6,828 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $679,351 | TotalAmt |
| Program Services | $508,947 | ProgramServicesAmt |
| Management And General | $57,023 | ManagementAndGeneralAmt |
| Fundraising | $113,381 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $175,800 | BOYAmt |
| EOY | $827,102 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,700 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,425 | BOYAmt |
| EOY | $11,150 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,627 | BOYAmt |
| EOY | $10,830 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $53,685 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $52,838 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,833 | BOYAmt |
| EOY | $847 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,386,101 | BOYAmt |
| EOY | $5,029,884 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $628,622 | BOYAmt |
| EOY | $512,745 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,239,108 | BOYAmt |
| EOY | $6,392,558 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,200 | BOYAmt |
| EOY | $71,624 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,244 | BOYAmt |
| EOY | $36,816 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,444 | BOYAmt |
| EOY | $108,440 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,661,639 | BOYAmt |
| EOY | $5,722,290 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,833 | BOYAmt |
| EOY | $138,584 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $423,192 | BOYAmt |
| EOY | $423,244 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,156,664 | BOYAmt |
| EOY | $6,284,118 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,239,108 | BOYAmt |
| EOY | $6,392,558 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $774,263 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$646,809 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 942638213 | EIN |
| Organization Type | 9 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $248,418 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $248,418 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $552,733 | BeginningYearBalanceAmt |
| Contributions | $2,752 | ContributionsAmt |
| Investment Earnings Or Losses | -$40,565 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $514,920 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $510,920 | BeginningYearBalanceAmt |
| Contributions | $3,213 | ContributionsAmt |
| Investment Earnings Or Losses | $38,600 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $552,733 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $470,320 | BeginningYearBalanceAmt |
| Contributions | $8,577 | ContributionsAmt |
| Investment Earnings Or Losses | $32,023 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $510,920 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $422,502 | BeginningYearBalanceAmt |
| Contributions | $3,426 | ContributionsAmt |
| Investment Earnings Or Losses | $44,392 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $470,320 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $440,781 | BeginningYearBalanceAmt |
| Contributions | -$11,770 | ContributionsAmt |
| Investment Earnings Or Losses | -$6,509 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $422,502 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,104 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,604 | DepreciationAmt |
| Book Value | $500 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,581 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,234 | DepreciationAmt |
| Book Value | $347 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $847 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| LIMITED PARTNERSHIP | $2,826,000 | F |
| PUBLICLY TRADED SECURITIES | $2,203,884 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $5,029,884 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INVESTMENT PROPERTY | $4,000 |
| ENDOWMENT INVESTMENTS | $508,745 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $512,745 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED REVENUE | $1,817 |
| RELATED PARTY PAYABLE | $34,999 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $36,816 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $992,629 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$646,809 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $188,524 | OtherRevenueAmt |
| Revenue Not Reported | -$458,285 | RevenueNotReportedAmt |
| Revenue Subtotal | $1,450,914 | RevenueSubtotalAmt |
| Other Revenues Not Included | $2,700 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $2,700 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,453,614 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $616,757 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $188,524 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $188,524 | ExpensesNotReportedAmt |
| Expenses Subtotal | $428,233 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $251,118 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $251,118 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $679,351 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE INTENDED USE OF THE ENDOWMENT FUNDS ARE TO FUND FUTURE OPERATING EXPENSES. |
| PART X, LINE 2: | MANAGEMENT HAS EVALUATED THE FOUNDATION'S TAX POSITIONS AND CONCLUDED THAT THE FOUNDATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | EVENT REVENUE |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | EVENT EXPENSES INCLUDED PART VIII LINE 8B |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | SUPPORT TRANSFERRED TO OTHER PARTIES NOT INCLUDED IN EXPENSES ON F/S BAD DEBT |
| PART XIII, LINE 2D AND 4B | LINE 2D OTHER REVENUE - COST OF GOOD SOLD FOR FUNDRAISING EVENTS LINE 2D OTHER EXPENSES - COST OF GOODS SOLD FOR FUNDRAISING EVENTS LINE 4B OTHER EXPENSES - TRANSFERS MADE TO RELATED PARTIES |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GALA | Event1Nm |
| Gross Receipts Event1 | $274,615 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $39,105 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $235,510 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $23,730 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $24,954 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $63,533 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF FORE HOSPICE | Event2Nm |
| Gross Receipts Event2 | $76,699 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $2,615 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $74,084 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $808 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $20,125 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $12,804 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 8 | OtherEventsTotalCnt |
| Gross Receipts Other Events | $94,797 | GrossReceiptsOtherEventsAmt |
| Charitable Contri Other Events | $2,032 | CharitableContriOtherEventsAmt |
| Gross Revenue Other Events | $92,765 | GrossRevenueOtherEventsAmt |
| Rent Fclty Costs Other Events | $9,759 | RentFcltyCostsOtherEventsAmt |
| Food And Beverage Other Events | $10,693 | FoodAndBeverageOtherEventsAmt |
| Oth Direct Expnss Other Events | $22,118 | OthDirectExpnssOtherEventsAmt |
| Gross Receipts Total | $446,111 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $43,752 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $402,359 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $34,297 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $55,772 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $98,455 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $188,524 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $213,835 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $23,491 | GrossRevenueOtherGamingAmt |
| Volunteer Labor Other Gaming | Yes (1) | VolunteerLaborOtherGamingInd |
| Volunteer Labor Other Gaming | 0.95000 | VolunteerLaborOtherGamingPct |
| Gross Revenue Total Gaming | $23,491 | GrossRevenueTotalGamingAmt |
| Net Gaming Income Summary | $23,491 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | CA | StatesWhereGamingConductedCd |
| Licensed | Yes (1) | LicensedInd |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | 0 | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Other Facility | 1.00000 | GamingOtherFacilityPct |
| Individual With Books | RICK DAHLSEID CPA | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1Txt |
| City | MODESTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95356 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
| Gaming Manager Person | LYNIS CHAFFEY | GamingManagerPersonNm |
| Gaming Manager Compensation | $89,905 | GamingManagerCompensationAmt |
| Gaming Manager Services Prov | REGISTRATION AND OPERATION OF RAFFLES. | GamingManagerServicesProvTxt |
| Gaming Manager Is Director Ofcr | Yes (X) | GamingManagerIsDirectorOfcrInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1Txt |
| City | MODESTO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95356 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 942638213 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $248,418 | CashGrantAmt |
| Purpose Of Grant | FUNDS RAISED AND REIMBURSED EXPENSES FOR COMMUNITY HOSPICE INC | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | ALL FUNDS ARE DISTRIBUTED TO COMMUNITY HOSPICE, INC. WHICH IS A RELATED ENTITY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHARLOTTE D MCLEOD | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $0 | $219,690 | $0 | $0 | $0 | $0 | $0 | $4,492 | $0 | $0 | $0 | $224,182 | $0 | $0 |
| SHAILESH KANTILAL | ||||||||||||||
| VP CHIEF INFORMATION OFFICER | $0 | $151,849 | $0 | $0 | $0 | $0 | $0 | $7,230 | $0 | $0 | $0 | $159,079 | $0 | $0 |
| CHERYL KIRK | ||||||||||||||
| RN CASE MANAGER | $0 | $153,172 | $0 | $0 | $0 | $0 | $0 | $7,931 | $0 | $0 | $0 | $161,103 | $0 | $0 |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | PRIZES | Desc |
| Contribution | 0 | ContributionCnt |
| Noncash Contributions Rpt F990 | $43,752 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | BASED ON DONORS REPR | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT DUTIES ARE PERFORMED BY CHI MANAGEMENT, INC. WHICH IS A RELATED PARTY EXEMPT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | COMMUNITY HOSPICE INC. IS THE MEMBER OF COMMUNITY HOSPICE FOUNDATION AND IS A RELATED ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION HAS ONE MEMBER WITH THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY. THE MEMBER IS COMMUNITY HOSPICE, A RELATED ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNANCE DECISIONS BY THE ORGANIZATION MAY BE SUBJECT TO APPROVAL BY THE MEMBER. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CHIEF FINANCIAL OFFICER (CFO) OBTAINS THE COMPLETED FORM 990 FROM THE PREPARER AND REVIEWS IT FOR ACCURACY AND COMPLETENESS. ONCE CONSIDERED ACCURATE AND COMPLETE, THE FORM 990 IS CONVERTED TO A PDF FILE FOR ELECTRONIC STORAGE AND VIEWING. A PDF COPY IS FORWARDED TO EACH MEMBER OF THE AUDIT COMMITTEE FOR THEIR REVIEW. THE AUDIT COMMITTEE IS COMPRISED OF 1 INDIVIDUAL FROM EACH RELATED ENTITY (COMMUNITY HOSPICE, CHI MANAGEMENT, AND COMMUNITY HOSPICE FOUNDATION.) AFTER THE AUDIT COMMITTEE REVIEWS THE FORM 990, THE PREPARER WILL ADDRESS ANY QUESTIONS OR CONCERNS THEY MAY HAVE. ABSENT ANY QUESTIONS OR CONCERNS OF THE AUDIT COMMITTEE, THE FORM 990 WILL BE ELECTRONICALLY SENT TO EACH BOARD MEMBER WITH A RECOMMENDATION OF THE AUDIT COMMITTEE AND A REQUEST FOR COMMENT. AFTER 72 HOURS THE FORM 990 WILL BE CONSIDERED READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL EMPLOYEES, VOLUNTEERS, AND MEMBERS OF THE BOARD OF DIRECTORS AND ADVISORY COMMITTEES WILL SIGN A CONFLICT OF INTEREST DOCUMENT UPON EMPLOYMENT, APPOINTMENT, OR REAPPOINTMENT AT LEAST ANNUALLY AND MONITORED BY THE CORPORATE COMPLIANCE OFFICER, INDICATING THAT THEY HAVE READ AND UNDERSTOOD THE RELEVANT POLICIES AND THAT THEY WILL OBSERVE THEM. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS APPROVED BY THE INDEPENDENT BOARD OF DIRECTORS WHERE THE VOTE OF EACH MEMBER IS COUNTED. COMPENSATION ANALYSIS OF SIMILARLY SITUATED ORGANIZATIONS (TAXABLE AND TAX-EXEMPT) WITH RESPECT TO SIZE AND RESPONSIBILITIES OF EACH POSITION ARE COMPARED. THIS ANALYSIS IS PREPARED ANNUALLY. THE PROCESS OF ARRIVING AT EACH INDIVIDUAL'S COMPENSATION ARRANGEMENT IS DOCUMENTED IN BOARD MINUTES, PERSONAL ACTION FORMS, AND THE EMPLOYEE'S PERSONNEL FILE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ANNUAL REPORT TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | MEMBERS OF THE BOARD OF DIRECTORS FROM COMMUNITY HOSPICE, INC., CHI MANAGEMENT, INC. AND COMMUNITY HOSPICE FOUNDATION MAKE UP THE AUDIT COMMITTEE CHARGED WITH RESPONSIBILITY OF OVERSIGHT IN CONNECTION TO THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT AUDITORS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HOSPICE INC | ||||||||||
| 4368 SPYRES WAY | MODESTO | CA | 95356 | 942638213 | HOSPICE CARE FOR THE TERMINALLY ILL | CA | 501(C)(3) | 509(A)(2) | N/A | 0 |
| CHI MANAGEMENT INC | ||||||||||
| 4368 SPYRES WAY | MODESTO | CA | 95356 | 200178425 | PROVIDE PROFESSIONAL SERVICES FOR CHI INC., CHI FOUNDATION AND HOPE CHEST | CA | 501(C)(3) | 509(A)(2) | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| COMMUNITY HOSPICE INC | ||
| R | $248,418 | FAIR MARKET VALUE |
| COMMUNITY HOSPICE MANAGEMENT INC | ||
| O | $57,023 | FAIR MARKET VALUE |
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