HOSPICE OF THE HIGHLAND RIM FOUNDATION INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HOSPICE OF THE HIGHLAND RIM FOUNDATION INC (EIN 62-1874162)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-09-30
IRS object ID
201332739349300618
Schema version
2012v2.2
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)
Timestamp2013-09-30T10:16:54-00:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Ray & Gregory PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1925 N Washington StreetAddressLine1
CityTullahomaCity
StateTNState
ZIP Code37388ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN621874162EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Hospice of the Highland Rim Foundation IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone9314559118Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1110 East Lauderdale StreetAddressLine1
CityTullahomaCity
StateTNState
ZIP Code37388ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMerry WeisName
TitlePresidentTitle
Date Signed2013-09-30DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCameron L Ray CPAName
Phone9314551380Phone
Date Prepared2013-09-30DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMerry WeisNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1110 East Lauderdale StreetAddressLine1
CityTullahomaCity
StateTNState
ZIP Code37388ZIPCode
FieldValueIRS element (for citing)
Gross Receipts103157GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2006YearFormation
State Legal DomicileTNStateLegalDomicile
Activity Or Mission DescriptionThe Hospice Foundation provides for medical expenses for individuals who are in the last stages of terminal illnesses.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees1TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year20280ContributionsGrantsCurrentYear
Program Service Revenue Prior Year23336ProgramServiceRevenuePriorYear
Program Service Revenue CY3504ProgramServiceRevenueCY
Investment Income Prior Year80605InvestmentIncomePriorYear
Investment Income Current Year75938InvestmentIncomeCurrentYear
Other Revenue Prior Year11630OtherRevenuePriorYear
Other Revenue Current Year2650OtherRevenueCurrentYear
Total Revenue Prior Year115571TotalRevenuePriorYear
Total Revenue Current Year102372TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year26439GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY29571GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year29371SalariesEtcPriorYear
Salaries Etc Current Year24960SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12567OtherExpensePriorYear
Other Expenses Current Year14645OtherExpensesCurrentYear
Total Expenses Prior Year68377TotalExpensesPriorYear
Total Expenses Current Year69176TotalExpensesCurrentYear
Revenues Less Expenses Prior Year47194RevenuesLessExpensesPriorYear
Revenues Less Expenses CY33196RevenuesLessExpensesCY
Total Assets BOY1111336TotalAssetsBOY
Total Assets EOY1144532TotalAssetsEOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1111336NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1144532NetAssetsOrFundBalancesEOY
Mission DescriptionTo assist families who are dealing with terminal illnesses by providing in home medical support.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense54531Expense
DescriptionThe Hospice Foundation assisted 51 terminally ill patients in the final stages of lifeDescription
Total Program Service Expense54531TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingtrueProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included1NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddresstrueOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledTNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMerry WeisNamePerson
Telephone Number9314559118TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1110 East Lauderdale StreetAddressLine1
CityTullahomaCity
StateTNState
ZIP Code37388ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployee
Merry Weis
President010.00XX000
Fran Gray
Secretary010.00XX000
Joan Gladney
Treasurer010.00XX000
Jennifer Lazenby
Office040.002496000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org24960TotalReportableCompFromOrg
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Government Grants20280GovernmentGrants
Total Contributions20280TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionMedical paymentsDescription
Business Code621610BusinessCode
Total Revenue Column3504TotalRevenueColumn
Related Or Exempt Function Income3504RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue3504TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column75938TotalRevenueColumn
Related Or Exempt Function Income75938RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Gross Income Fundraising Events3435GrossIncomeFundraisingEvents
Fundraising Direct Expenses785FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column2650TotalRevenueColumn

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column102372TotalRevenueColumn
Related Or Exempt Function Income79442RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total29571Total
Program Services29571ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total24960Total
Program Services24960ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total0Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total0Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total175Total
Management And General175ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total872Total
Management And General872ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Fees For Services Prof FundraisingFeesForServicesProfFundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4370Total
Management And General4370ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6186Total
Management And General6186ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total137Total
Management And General137ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
Supplies135135
Non-Profit Registration Fee8484
Insurance26862686

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total69176Total
Program Services54531ProgramServices
Management And General14645ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY12346BOY
EOY83208EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1098990BOY
EOY1061324EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1111336BOY
EOY1144532EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1111336BOY
EOY1144532EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1111336BOY
EOY1144532EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1111336BOY
EOY1144532EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses33196ReconcilationRevenueExpenses
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewtrueAccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
FS AuditedfalseFSAudited
Audit CommitteefalseAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years37812CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24615CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year34966CurrentTaxYearMinus1Year
Current Tax Year20280CurrentTaxYear
Total117673Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years37812CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years24615CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year34966CurrentTaxYearMinus1Year
Current Tax Year20280CurrentTaxYear
Total117673Total
FieldValueIRS element (for citing)
Public Support Total170117673PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years30312CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years687CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year80605CurrentTaxYearMinus1Year
Current Tax Year75938CurrentTaxYear
Total187542Total
FieldValueIRS element (for citing)
Total Support305215TotalSupport
Public Support Pertcentage1700.38550PublicSupportPertcentage170
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
Public Support Percentage5090.00000PublicSupportPercentage509
Investment Income Percentage0.00000InvestmentIncomePercentage

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Agreement Ref FundraisingfalseAgreementRefFundraising
Licensed StatesTNLicensedStates

Schedule I IRS990ScheduleI

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

ExplanationExplanation
Form 990 Part I Line 9 Revenue consists of income from investments and donations
Form 990 Part VI Section B Line 11b

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