COMMUNITY HOSPICE FOUNDATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPICE FOUNDATION (EIN 77-0562224)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-02-14
- IRS object ID
- 201330459349302733
- Schema version
- 2011v1.5
- 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) |
|---|---|---|
| Timestamp | 2013-02-14T19:06:31-06:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941239084 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHERTON & ASSOCIATES LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 4339 | AddressLine1 |
| City | MODESTO | City |
| State | CA | State |
| ZIP Code | 953524339 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 770562224 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE FOUNDATION OF STANISLAUS COUNTY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 2095786300 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1 |
| City | MODESTO | City |
| State | CA | State |
| ZIP Code | 95356 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RICK DAHLSEID CPA | Name |
| Title | VP/CFO | Title |
| Phone | 2095786300 | Phone |
| Date Signed | 2013-02-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RONALD EHRKE | Name |
| PTIN | P00141781 | PTIN |
| Phone | 2095774800 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | HAROLD A PETERSON III | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1 |
| City | MODESTO | City |
| State | CA | State |
| ZIP Code | 95356 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1372521 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HOSPICEHEART.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | SUPPORT OF COMMUNITY HOSPICE, INC. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 21 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 21 | NbrIndependentVotingMembers |
| Total Nbr Employees | 6 | TotalNbrEmployees |
| Total Nbr Volunteers | 86 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 780785 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 875868 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 53593 | InvestmentIncomePriorYear |
| Investment Income Current Year | 57862 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 245222 | OtherRevenuePriorYear |
| Other Revenue Current Year | 262255 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1079600 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1195985 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 371635 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 622902 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 203885 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 255075 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 136909 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 233244 | OtherExpensePriorYear |
| Other Expenses Current Year | 226375 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 808764 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1104352 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 270836 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 91633 | RevenuesLessExpensesCY |
| Total Assets BOY | 5229864 | TotalAssetsBOY |
| Total Assets EOY | 5623091 | TotalAssetsEOY |
| Total Liabilities BOY | 273454 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 392177 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4956410 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5230914 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. THE FOUNDATION RAISES FUNDS UTILIZING A NUMBER OF FUNDRAISING AVENUES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 904608 | Expense |
| Description | 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. | Description |
| Total Program Service Expense | 904608 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 1 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 6 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 21 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 21 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICK DAHLSEID CPA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2095786300 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1 |
| City | MODESTO | City |
| State | CA | State |
| ZIP Code | 95356 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| CATHY TUXSON | ||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | |
| JANICE LUCERO | ||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | |
| LESLIE KALIM MCHUGH | ||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | |
| GARY ERVIN | ||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | |
| JAMES COGDILL | ||||||
| PAST CHAIR | 1.00 | X | 0 | 0 | 0 | |
| DR ASHLEY BARBOZA | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SALLY COFER-LINDBERG | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PATTY DUVAL | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| RONI EDGMON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SUZANNE CANDINI | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DON GAEKLE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MICHAEL C HERRERO | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JYOTHI PRABHU SEETHARAM | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| KIM JOHNSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| GARRAD MARSH | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| GINA MACHADO | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PETER RODRIGUEZ | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MERYL SNIDER | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JON TREMAYNE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| TICIA SODHI | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| EMILY WIROWEK | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| HAROLD A PETERSON III | ||||||
| CHIEF EXECUTIVE OFFICER | 5.00 | 0 | 212762 | 10220 | X | |
| RICK DAHLSEID CPA | ||||||
| VICE PRESIDENT, CFO | 5.00 | 0 | 119084 | 6208 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 331846 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 16428 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 45418 | FundraisingEvents |
| All Other Contributions | 830450 | AllOtherContributions |
| Noncash Contributions | 45418 | NoncashContributions |
| Total Contributions | 875868 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 57862 | TotalRevenueColumn |
| Exclusion | $57,862 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 370670 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 45418 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 176536 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 194134 | TotalRevenueColumn |
| Exclusion | $194,134 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 16409 | GrossIncomeGaming |
| Gaming Direct Expenses | 0 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16409 | TotalRevenueColumn |
| Exclusion | $16,409 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| GAIN FROM LIMITED PART | 900099 | 50393 | 50393 |
| MISCELLANEOUS INCOME | 900099 | 1319 | 1319 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 51712 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1195985 | TotalRevenueColumn |
| Related Or Exempt Function Income | 51712 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $268,405 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 622902 | Total |
| Program Services | 622902 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75726 | Total |
| Program Services | 37863 | ProgramServices |
| Fundraising | 37863 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156627 | Total |
| Program Services | 78314 | ProgramServices |
| Fundraising | 78313 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7093 | Total |
| Program Services | 3547 | ProgramServices |
| Fundraising | 3546 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15629 | Total |
| Program Services | 7815 | ProgramServices |
| Fundraising | 7814 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20109 | Total |
| Program Services | 20109 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120 | Total |
| Program Services | 120 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27399 | Total |
| Program Services | 27399 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18000 | Total |
| Program Services | 18000 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1823 | Total |
| Program Services | 1823 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5995 | Total |
| Program Services | 5995 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5578 | Total |
| Program Services | 5578 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| MANAGEMENT SERVICE FEES | 62835 | 62835 | |
| BANK, CREDIT CARD & PAY | 22908 | 22908 | |
| POSTAGE | 19034 | 19034 | |
| COMPUTER MAINTENANCE | 14909 | 14909 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27665 | Total |
| Program Services | 18292 | ProgramServices |
| Fundraising | 9373 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1104352 | Total |
| Program Services | 904608 | ProgramServices |
| Management And General | 62835 | ManagementAndGeneral |
| Fundraising | 136909 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 735104 | BOY |
| EOY | 391046 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7227 | BOY |
| EOY | 10351 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7116 | BOY |
| EOY | 3636 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 7500 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3552 | BOY |
| EOY | 3373 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9202 | BOY |
| EOY | 4136 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 44265 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 27035 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11207 | BOY |
| EOY | 17230 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4085584 | BOY |
| EOY | 4756237 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 370872 | BOY |
| EOY | 429582 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5229864 | BOY |
| EOY | 5623091 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53698 | BOY |
| EOY | 55089 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 219756 | BOY |
| EOY | 337088 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 273454 | BOY |
| EOY | 392177 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4536664 | BOY |
| EOY | 4781602 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 37910 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 419746 | BOY |
| EOY | 411402 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4956410 | BOY |
| EOY | 5230914 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5229864 | BOY |
| EOY | 5623091 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 91633 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 182871 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 942638213 | EIN |
| Type Of Organization | 9 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $622,902 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 622902 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 422502 | BeginningOfYearBalance |
| Contributions | 3426 | Contributions |
| Investment Earnings Or Losses | 44392 | InvestmentEarningsOrLosses |
| End Of Year Balance | 470320 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 440781 | BeginningOfYearBalance |
| Contributions | -11770 | Contributions |
| Investment Earnings Or Losses | -6509 | InvestmentEarningsOrLosses |
| End Of Year Balance | 422502 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 417600 | BeginningOfYearBalance |
| Contributions | 1253 | Contributions |
| Investment Earnings Or Losses | 21928 | InvestmentEarningsOrLosses |
| End Of Year Balance | 440781 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 189918 | BeginningOfYearBalance |
| Contributions | 216266 | Contributions |
| Investment Earnings Or Losses | 11416 | InvestmentEarningsOrLosses |
| End Of Year Balance | 417600 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19074 | OtherCostOrOtherBasis |
| Depreciation | 8085 | Depreciation |
| Book Value | 10989 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25191 | OtherCostOrOtherBasis |
| Depreciation | 18950 | Depreciation |
| Book Value | 6241 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 17230 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| LIMITED PARTNERSHIP | 2720000 | F |
| PUBLICLY TRADED SECURITIES | 2036237 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 4756237 | TotalOfBookValueSecurities |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INVESTMENT PROPERTY | 7800 |
| ENDOWMENT INVESTMENTS | 393782 |
| PLEDGES RECEIVABLE RESTRICTED FOR ENDOWMENT | 28000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 429582 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | RELATED PARTY PAYABLE | Description |
| Amount | $337,088 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 337088 | TotalOfAmounts |
| Total Revenue | 1195985 | TotalRevenue |
| Total Expenses | 1104352 | TotalExpenses |
| Excess Or Deficit For Year | 91633 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 182871 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 182871 | TotalAdjustments |
| Excess Or Deficit Per FS | 274504 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 1548992 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 182156 | NetUnrealizedGainsInvestments |
| Other Revenues | 176536 | OtherRevenues |
| Revenue Not Rptd F990 | 358692 | RevenueNotRptdF990 |
| Revenue Subtotal | 1190300 | RevenueSubtotal |
| Other Revenues Not Included | 5685 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 5685 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1195985 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 651586 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 176536 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 176536 | ExpensesNotRptdF990 |
| Expenses Subtotal | 475050 | ExpensesSubtotal |
| Other Expenses Not Included | 629302 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 629302 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1104352 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INTENDED USE OF THE ENDOWMENT FUNDS ARE TO FUND FUTURE OPERATING EXPENSES. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | MANAGEMENT EVALUATED THE FOUNDATIONS 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. |
| LINE 2D - OTHER REVENUE - COST OF GOOD SOLD FOR FUNDRAISING EVENTS LINE 4B - OTHER REVENUE - MISCELLANEOUS REVENUE LINE 2D OTHER EXPENSES - COST OF GOODS SOLD FOR FUNDRAISING EVENTS LINE 4B OTHER EXPENSES - TRANSFERS MADE TO RELATED PARTIES |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GALA | NameOfEvent1 |
| Gross Receipts Event1 | 210384 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 34314 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 176070 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 25800 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 36990 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 43919 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF FORE HOSPICE | NameOfEvent2 |
| Gross Receipts Event2 | 61892 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 4887 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 57005 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 18125 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 1768 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 12802 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 5 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 143812 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 6217 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 137595 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 2179 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 11902 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 23051 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 416088 | GrossReceiptsTotal |
| Charitable Contributions Total | 45418 | CharitableContributionsTotal |
| Gross Revenue Total Events | 370670 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 46104 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 50660 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 79772 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 176536 | DirectExpenseSummaryEvents |
| Net Income Summary | 194134 | NetIncomeSummary |
Gaming Information GamingInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | 16409 | GrossRevenueOtherGaming |
| Volunteer Labor Other Gaming | 1 | VolunteerLaborOtherGaming |
| Volunteer Labor Prcnt Other Gaming | 0.95000 | VolunteerLaborPrcntOtherGaming |
| Gross Revenue Total Gaming | 16409 | GrossRevenueTotalGaming |
| Net Gaming Income Summary | 16409 | NetGamingIncomeSummary |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | CA | StatesWhereGamingConducted |
| Licensed | 1 | Licensed |
| License Suspended Etc | 0 | LicenseSuspendedEtc |
| Gaming With Nonmembers | 0 | GamingWithNonmembers |
| Member Of Other Entity | 0 | MemberOfOtherEntity |
| Percentage Of Gaming Othr Facility | 1.00000 | PercentageOfGamingOthrFacility |
| Name Of Gaming Rec Keeper Person | RICK DAHLSEID CPA | NameOfGamingRecKeeperPerson |
Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1 |
| City | MODESTO | City |
| State | CA | State |
| ZIP Code | 95356 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contract With3rd Party For Gam Rev | 0 | ContractWith3rdPartyForGamRev |
| Gaming Manager Name Person | LYNIS CHAFFEY | GamingManagerNamePerson |
| Gaming Manager Compensation | 75726 | GamingManagerCompensation |
| Gaming Manager Services Provided | REGISTRATION AND OPERATION OF RAFFLES. | GamingManagerServicesProvided |
| Gaming Manager Is Director Officer | X | GamingManagerIsDirectorOfficer |
| Charitable Distrib Required | 0 | CharitableDistribRequired |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPICE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4368 SPYRES WAY | AddressLine1 |
| City | MODESTO | City |
| State | CA | State |
| ZIP Code | 95356 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 942638213 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 622902 | AmountOfCashGrant |
| Purpose Of Grant | FUNDS RAISED AND REIMBURSED EXPENSES FOR COMMUNITY HOSPICE INC | PurposeOfGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: ALL FUNDS ARE DISTRIBUTED TO COMMUNITY HOSPICE, INC. WHICH IS A RELATED ENTITY. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | HAROLD A PETERSON III | NamePerson |
| Base Compensation Filing Org | 0 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 212762 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 10220 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 0 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 0 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 222982 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 223232 | CompReportPrior990RelatedOrgs |
Schedule M IRS990ScheduleM
Other Non Cash Contributions Table OtherNonCashContributionsTable (5 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|
| X | MISCELLANEOUS | 400 | BASED ON DONORS REPRESENTATION |
| X | PRIZES | 42085 | BASED ON DONORS REPRESENTATION |
| X | FOOD | 618 | BASED ON DONORS REPRESENTATION |
| X | NON-EE GIFT AWARDS | 200 | BASED ON DONORS REPRESENTATION |
| X | ADVERTISING | 3012 | BASED ON DONORS REPRESENTATION |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 1 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 B, LINE 11 | THE CHIEF FINANCIAL OFFICER (CFO) OBTAINS THE COMPLETED FORM 990 FROM THE PREPARER AND REVIEWS IT FOR ACCURACY AND COMPLETENESS. IF CONSIDERED ACCURATE AND COMPLETE, THE COMPLETE 990 IS CONVERTED TO A PDF FILE FOR ELECTRONIC STORAGE AND VIEWING AND A PDF COPY OF THE 990 IS FORWARDED TO EACH MEMBER OF THE CHI FOUNDATION AUDIT COMMITTEE FOR THEIR REVIEW. AFTER THE CHI FOUNDATION AUDIT COMMITTEE REVIEWS THE 990, THE CFO WILL GO OVER THE 990 WITH THEM FOR A FINAL REVIEW AND THEIR APPROVAL FOR FILING. AT THE CONCLUSION OF THE REVIEW, ANY UNANSWERED QUESTIONS WILL BE FORWARDED TO THE PREPARER FOR REPLY. THOSE REPLIES WILL BE ELECTRONICALLY FORWARDED TO THE MEMBERS OF THE CHI FOUNDATION AUDIT COMMITTEE FOR COMMENT. ABSENT ANY ADDITIONAL QUESTIONS OF THE PREPARER, THE FORM 990 WILL BE CONSIDERED TO BE COMPLETE AND READY TO FILE WITH THE INTERNAL REVENUE SERVICE. THE CHI FOUNDATION AUDIT COMMITTEE WILL MOVE TO APPROVE THE FORM 990. THE FORM 990 WILL BE SIGNED BY THE CFO AND 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, 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 XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 182,871. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| MEMBERS OF THE BOARD OF DIRECTORS FROM COMMUNITY HOSPICE, INC., CHI MANAGEMENT, INC. AND COMMUNITY HOSPICE FOUNDATION OF STANISLAUS COUNTY 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
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| COMMUNITY HOSPICE INC | ||
| Q | 372902 | FAIR MARKET VALUE |
| COMMUNITY HOSPICE INC | ||
| O | 250000 | FAIR MARKET VALUE |
| COMMUNITY HOSPICE MANAGEMENT INC | ||
| N | 62835 | FAIR MARKET VALUE |
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