HOSPICE OF DARKE COUNTY INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HOSPICE OF DARKE COUNTY INC (EIN 31-1004692)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-01-07
IRS object ID
201430139349300023
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-01-07T11:21:17-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN310905417EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1VONLEHMAN & COMPANY INCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1250 GRANDVIEW DR SUITE 300AddressLine1
CityFT MITCHELLCity
StateKYState
ZIP Code41017ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311004692EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF DARKE COUNTY INCBusinessNameLine1
Business Name Line2DBA STATE OF THE HEART HOSPICEBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone9375482999Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11350 N BROADWAYAddressLine1
CityGREENVILLECity
StateOHState
ZIP Code45331ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJAMES STAMCOFFName
TitlePRESIDENTTitle
Phone9375486994Phone
Date Signed2013-12-02DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBETH VICEName
PTINP00545816PTIN
Phone8593313300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAMES STAMCOFFNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11350 N BROADWAYAddressLine1
CityGREENVILLECity
StateOHState
ZIP Code45331ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9442550GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.STATEOFTHEHEARTCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1981YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionHOSPICE OF DARKE COUNTY, INC. WORKS TO MAINTAIN THE VALUE AND DIGNITY OF HUMAN LIFE BY PROVIDING A CHOICE FOR HIGH QUALITY, COMPASSIONATE CARE AND SUPPORT SERVICES TO PATIENTS AND FAMILIES WITH LIFE LIMITING ILLNESS, TO PROMOTE THE EMOTIONAL, PSYCHOLOGICAL, SPIRITUAL AND PHYSICAL WELL BEING OF SURVIVORS AFFECTED BY DEATH, DYING AND GRIEF, AND TO SUPPORT ALL MEMBERS OF THE COMMUNITY IN THE KNOWLEDGE AND CARE OF THOSE PERSONS EXPERIENCING END-OF-LIFE ISSUES.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees119TotalNbrEmployees
Total Nbr Volunteers106TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year196369ContributionsGrantsPriorYear
Contributions Grants Current Year203838ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7132535ProgramServiceRevenuePriorYear
Program Service Revenue CY9008544ProgramServiceRevenueCY
Investment Income Prior Year122357InvestmentIncomePriorYear
Investment Income Current Year166058InvestmentIncomeCurrentYear
Other Revenue Prior Year27021OtherRevenuePriorYear
Other Revenue Current Year9671OtherRevenueCurrentYear
Total Revenue Prior Year7478282TotalRevenuePriorYear
Total Revenue Current Year9388111TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3833570SalariesEtcPriorYear
Salaries Etc Current Year4763529SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year82847TotalFundrsngExpCurrentYear
Other Expense Prior Year3494799OtherExpensePriorYear
Other Expenses Current Year4078513OtherExpensesCurrentYear
Total Expenses Prior Year7328369TotalExpensesPriorYear
Total Expenses Current Year8842042TotalExpensesCurrentYear
Revenues Less Expenses Prior Year149913RevenuesLessExpensesPriorYear
Revenues Less Expenses CY546069RevenuesLessExpensesCY
Total Assets BOY8305452TotalAssetsBOY
Total Assets EOY9545562TotalAssetsEOY
Total Liabilities BOY809164TotalLiabilitiesBOY
Total Liabilities EOY1222795TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7496288NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8322767NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionHOSPICE OF DARKE COUNTY, INC. WORKS TO MAINTAIN THE VALUE AND DIGNITY OF HUMAN LIFE BY PROVIDING A CHOICE FOR HIGH QUALITY, COMPASSIONATE CARE AND SUPPORT SERVICES TO PATIENTS AND FAMILIES WITH LIFE LIMITING ILLNESS, TO PROMOTE THE EMOTIONAL, PSYCHOLOGICAL, SPIRITUAL AND PHYSICAL WELL BEING OF SURVIVORS AFFECTED BY DEATH, DYING AND GRIEF, TO SUPPORT ALL MEMBERS OF THE COMMUNITY IN THE KNOWLEDGE AND CARE OF THOSE PERSONS EXPERIENCING END-OF-LIFE ISSUES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7010884Expense
Revenue9009947Revenue
DescriptionHOSPICE OF DARKE COUNTY, INC. WORKS TO MAINTAIN THE VALUE AND DIGNITY OF HUMAN LIFE BY PROVIDING A CHOICE FOR HIGH QUALITY, COMPASSIONATE CARE AND SUPPORT SERVICES TO PATIENTS AND FAMILIES WITH LIFE LIMITING ILLNESS, TO PROMOTE THE EMOTIONAL, PSYCHOLOGICAL, SPIRITUAL AND PHYSICAL WELL BEING OF SURVIVORS AFFECTED BY DEATH, DYING AND GRIEF, TO SUPPORT ALL MEMBERS OF THE COMMUNITY IN THE KNOWLEDGE AND CARE OF THOSE PERSONS EXPERIENCING END-OF-LIFE ISSUES.Description
Total Program Service Expense7010884TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10965NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees119NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KELLY BRUNSWICKBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9375482999TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11350 N BROADWAYAddressLine1
CityGREENVILLECity
StateOHState
ZIP Code45331ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
LISA GASPER
PAST PRESIDENT2.00X000
PAULA COX
TRUSTEE2.00X000
GAIL DUES
TRUSTEE2.00X000
JAMES STAMCOFF
PRESIDENT2.00X000X
RANDY ELAM
TRUSTEE2.00X000X
TRACY HAINES
TREASURER2.00X000X
ILZE KOCH
TRUSTEE2.00X000
CINDY MCCALLISTER
TRUSTEE2.00X000
GINGER GODFREY
TRUSTEE2.00X000
DIANE SWALLOW
SECRETARY2.00X000
MICHAEL RIEMAN
VICE PRESIDENT2.00X000
WENDY STUKEY
TRUSTEE2.00X000
THEODORE BAUER
EXECUTIVE DIRECTOR40.009762400X
KELLY BRUNSWICK
DIRECTOR OF FINANCE40.004267900X
FieldValueIRS element (for citing)
Total Reportable Comp From Org140303TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUALIS MANAGEMENT
PO BOX 7458ROCKY MOUNTNC27804DURABLE MEDICAL EQUIPMENT436810
PROCARE PBM
1267 PROFESSIONAL PARKWAYGAINSVILLEGA30507PHARMACEUTICAL COMPANY316034
BRETHREN RETIREMENT COMMUNITY
750 CHESTNUT STGREENVILLEOH45331PATIENT ROOM AND BOARD243082
RESTHAVEN
1096 N OHIO STGREENVILLEOH45331PATIENT ROOM AND BOARD212246
CELINA MANOR
1001 MYERS ROADCELINAOH45822PATIENT ROOM AND BOARD198648
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
All Other Contributions203838AllOtherContributions
Total Contributions203838TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT CARE REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column9008544TotalRevenueColumn
Related Or Exempt Function Income9008544RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9008544TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column166058TotalRevenueColumn
Exclusion$166,058ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events62707GrossIncomeFundraisingEvents
Fundraising Direct Expenses54439FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column8268TotalRevenueColumn
Exclusion$8,268ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column1403TotalRevenueColumn
Related Or Exempt Function Income1403RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1403TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9388111TotalRevenueColumn
Related Or Exempt Function Income9009947RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$174,326ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total140303Total
Program Services109436ProgramServices
Management And General28061ManagementAndGeneral
Fundraising2806Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3813877Total
Program Services3172915ProgramServices
Management And General574953ManagementAndGeneral
Fundraising66009Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total52853Total
Program Services31139ProgramServices
Management And General21714ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total458685Total
Program Services13028ProgramServices
Management And General445657ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total297811Total
Program Services224971ProgramServices
Management And General72840ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5000Total
Program Services5000ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total38874Total
Management And General38874ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5769Total
Management And General5769ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total94533Total
Program Services46758ProgramServices
Management And General43048ManagementAndGeneral
Fundraising4727Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total107773Total
Program Services12507ProgramServices
Management And General92167ManagementAndGeneral
Fundraising3099Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total299053Total
Program Services266364ProgramServices
Management And General26483ManagementAndGeneral
Fundraising6206Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total145459Total
Program Services50911ProgramServices
Management And General94548ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total23077Total
Program Services6923ProgramServices
Management And General16154ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
ROOM AND BOARD EXPENSE17721311772131
MEDICAL SUPPLIES & DRUG840042840042
UTILITIES, TELEPHONE, A24293333670209263
SOFTWARE LICENSE EXPENS9990899908

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total403961Total
Program Services325181ProgramServices
Management And General78780ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8842042Total
Program Services7010884ProgramServices
Management And General1748311ManagementAndGeneral
Fundraising82847Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY175BOY
EOY299EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1356580BOY
EOY1329534EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY809963BOY
EOY1070397EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY30025BOY
EOY71166EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3393261LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1400550LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2004134BOY
EOY1992711EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4104575BOY
EOY5081455EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8305452BOY
EOY9545562EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY809164BOY
EOY1222795EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY809164BOY
EOY1222795EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6949344BOY
EOY7730506EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY546944BOY
EOY592261EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7496288BOY
EOY8322767EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8305452BOY
EOY9545562EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses546069ReconcilationRevenueExpenses
Reconciliation Unrealized Invest280410ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years178449CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years162287CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years172204CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year196369CurrentTaxYearMinus1Year
Current Tax Year203838CurrentTaxYear
Total913147Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years178449CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years162287CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years172204CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year196369CurrentTaxYearMinus1Year
Current Tax Year203838CurrentTaxYear
Total913147Total
FieldValueIRS element (for citing)
Public Support Total170913147PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years101140CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years95912CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years83006CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year126420CurrentTaxYearMinus1Year
Current Tax Year166058CurrentTaxYear
Total572536Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years31788CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22534CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years34605CurrentTaxYearMinus2Years
Current Tax Year9671CurrentTaxYear
Total98598Total
FieldValueIRS element (for citing)
Total Support1584281TotalSupport
Public Support Pertcentage1700.57640PublicSupportPertcentage170
Public Support Pertcent Prior Year0.54240PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis242530OtherCostOrOtherBasis
Book Value242530BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2006316OtherCostOrOtherBasis
Depreciation565015Depreciation
Book Value1441301BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1049210OtherCostOrOtherBasis
Depreciation835535Depreciation
Book Value213675BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis95205OtherCostOrOtherBasis
Book Value95205BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1992711TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionMUTUAL FUNDSDescription
Book Value5081455BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities5081455TotalOfBookValueSecurities
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt9803420TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments280410NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities80460DonatedSrvcAndUseOfFacilities
Other Revenues54439OtherRevenues
Revenue Not Rptd F990415309RevenueNotRptdF990
Revenue Subtotal9388111RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9909388111TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8976941TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities80460DonatedServicesUseOfFacilities
Other Expenses Included54439OtherExpensesIncluded
Expenses Not Rptd F990134899ExpensesNotRptdF990
Expenses Subtotal8842042ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9908842042TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. IN ADDITION, THE ORGANIZATION IS NOT A PRIVATE FOUNDATION AS DEFINED IN SECTION 509(A)(1) OF THE U.S. INTERNAL REVENUE CODE. THE ORGANIZATION HAS ADOPTED THE PROVISIONS OF THE ACCOUNTING PRONOUNCEMENT RELATED TO ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE ORGANIZATION RECOGNIZED NO INTEREST OR PENALTIES IN THE STATEMENTS OF ACTIVITIES FOR BOTH YEARS ENDED JUNE 30, 2013 AND 2012. IF THE SITUATION AROSE IN WHICH THE ORGANIZATION WOULD HAVE INTEREST TO RECOGNIZE, IT WOULD RECOGNIZE THIS AS INTEREST EXPENSE AND PENALTIES WOULD BE RECOGNIZED IN OTHER EXPENSES. TAX YEARS STILL OPEN UNDER FEDERAL AND STATE STATUTE OF LIMITATIONS REMAIN SUBJECT TO REVIEW AND CHANGE. BASED ON THE EVALUATION OF THE ORGANIZATION'S TAX POSITIONS, MANAGEMENT BELIEVES ALL POSITIONS TAKEN WOULD BE UPHELD UNDER AN EXAMINATION. THEREFORE, NO PROVISION FOR THE EFFECTS OF UNCERTAIN TAX POSITIONS HAS BEEN RECORDED FOR BOTH YEARS ENDED JUNE 30, 2013 AND 2012.
PART XI, LINE 2D - OTHER ADJUSTMENTS:FUNDRAISING EXPENSES 54,439.
PART XII, LINE 2D - OTHER ADJUSTMENTS:FUNDRAISING EXPENSES 54,439.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF OUTINGNameOfEvent1
Gross Receipts Event139680GrossReceiptsEvent1
Gross Revenue Event139680GrossRevenueEvent1
Other Direct Expenses Event115968OtherDirectExpensesEvent1
Gross Receipts Total39680GrossReceiptsTotal
Gross Revenue Total Events39680GrossRevenueTotalEvents
Other Direct Expenses Total Events15968OtherDirectExpensesTotalEvents
Direct Expense Summary Events15968DirectExpenseSummaryEvents
Net Income Summary23712NetIncomeSummary

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonLORRI KAUPNamePerson
FieldValueIRS element (for citing)
RelationshipFORMER BOARD MEMBERRelationship
Amount Of Transaction746AmountOfTransaction
Description Of TransactionPURCHASE OF DURABLE MEDICAL EQUIPMENTDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11A COPY OF THE FORM 990 IS PRESENTED TO THE FINANCE COMMITTEE AND THEN RECOMMENDED FOR PRESENTATION TO THE BOARD OF DIRECTORS. THE BOARD THEN REVIEWS AND APPROVES THE FORM 990 AT ITS REGULAR MEETING.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY THE BOARD OF TRUSTEES REVIEW A VENDOR AND FINANCIAL INSTITUTION LIST. THE BOARD OF TRUSTEES REVIEW THIS LIST IDENTIFYING ANY POTENTIAL VIOLATIONS OF THE CONFLICT OF INTEREST POLICY. EACH BOARD MEMBER IS GIVEN THE CONFLICT OF INTEREST POLICY TO READ AND CERTIFICATION SHEET TO SIGN ANNUALLY. ALL AFFILIATIONS ARE REQUIRED TO BE DISCLOSED AND DESCRIBED ON THE AGENCY'S CONFLICT OF INTEREST DISCLOSURE DOCUMENT. THE BOARD OF TRUSTEES ANNUALLY REVIEW AND DOCUMENT ANY DISCLOSED AFFILIATIONS TO DETERMINE IF A POSSIBLE CONFLICT OF INTEREST EXISTS.
FORM 990, PART VI, SECTION B, LINE 15ATHE PROCESS FOR DETERMINING COMPENSATION FOR THE EXECUTIVE DIRECTOR INCLUDES THE REVIEW AND APPROVAL BY THE GOVERNING BODY. INFORMATION CONSIDERED DURING THIS PROCESS INCLUDES COMPARATIVE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN COMPARATIVE POSITIONS AT SIMILAR ORGANIZATIONS. DOCUMENTATION AND RECORD KEEPING WITH RESPECT TO THIS REVIEW PROCESS ARE MAINTAINED THROUGHOUT THE PROCESS.
FORM 990, PART VI, SECTION C, LINE 19THE AGENCY'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT OUR FRONT DESK IN WHICH THE INFORMATION WILL BE MAILED TO THE ADDRESS PROVIDED.
PART XII, LINE 2CTHERE HAVE BEEN NO CHANGES IN THE METHOD OF CHOOSING AN INDIVIDUAL AUDITOR OR METHOD OF OVERSIGHT.AUDIT COMMITTE

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