HOSPICE FOUNDATION OF JEFFERSON COUNTY INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
HOSPICE FOUNDATION OF JEFFERSON COUNTY INC (EIN 16-1541636)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-03-26
IRS object ID
201240869349300434
Schema version
2010v3.4
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)
Timestamp2012-03-26T16:21:35-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BONADIO & CO LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1115 SOLAR STREETAddressLine1
CitySYRACUSECity
StateNYState
ZIP Code13204ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN161541636EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE FOUNDATION OF JEFFERSON COUNTY INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOSPNameControl
Phone3157887323Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1425 WASHINGTON STREETAddressLine1
CityWATERTOWNCity
StateNYState
ZIP Code13601ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSTEPHEN P LYMANName
TitleCEOTitle
Phone3157887323Phone
Date Signed2012-03-24DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBETTINA LIPPHARDTName
Phone3152147575Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSTEPHEN P LYMANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1425 WASHINGTON STREETAddressLine1
CityWATERTOWNCity
StateNYState
ZIP Code13601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4731075GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.JEFFHOSPICE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1993YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTO ENSURE THE HOSPICE SERVICES REMAIN STRONG AND FISCALLY VIABLE TO SERVE AS AN INTEGRAL COMPONENT OF OUR COMMUNITY'S HEALTHCARE DELIVERY SYSTEM.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers86TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year523007ContributionsGrantsPriorYear
Contributions Grants Current Year3613265ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year78762InvestmentIncomePriorYear
Investment Income Current Year88052InvestmentIncomeCurrentYear
Other Revenue Prior Year35821OtherRevenuePriorYear
Other Revenue Current Year83147OtherRevenueCurrentYear
Total Revenue Prior Year637590TotalRevenuePriorYear
Total Revenue Current Year3784464TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year97330GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY28333GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year57644SalariesEtcPriorYear
Salaries Etc Current Year58133SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year40678TotalFundrsngExpCurrentYear
Other Expense Prior Year234000OtherExpensePriorYear
Other Expenses Current Year197176OtherExpensesCurrentYear
Total Expenses Prior Year388974TotalExpensesPriorYear
Total Expenses Current Year283642TotalExpensesCurrentYear
Revenues Less Expenses Prior Year248616RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3500822RevenuesLessExpensesCY
Total Assets BOY2969960TotalAssetsBOY
Total Assets EOY6404633TotalAssetsEOY
Total Liabilities BOY7371TotalLiabilitiesBOY
Total Liabilities EOY27310TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2962589NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6377323NetAssetsOrFundBalancesEOY
Mission DescriptionTO ENSURE THAT HOSPICE SERVICES REMAIN STRONG AND FISCALLY VIABLE TO SERVE AS AN INTEGRAL COMPONENT OF OUR COMMUNITY'S HEALTHCARE DELIVERY SYSTEM.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense28333Expense
DescriptionFINANCIAL SUPPORT HOSPICE OF JEFFERSON COUNTY, INC. IN ITS OPERATIONS TO PROVIDE MEDICAL CARE AND TREATMENT TO THE TERMINALLY ILL.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense180Expense
DescriptionPROVIDED SUPPORT FOR MEDICAL CARE TO PATIENTS IN ORDER TO REDUCE THE EFFECTS OF THE SEVERITY OF SYMPTOMS OF A DISEASE. SUCH CARE IS NOT DEPENDENT ON THE PROGNOSIS OF THE PATIENT.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense5600Expense
DescriptionSOLICITING, RECEIVING, AND ACKNOWLEDGING ALL FORMS OF CHARITABLE GIFTS FROM INDIVIDUALS, ORGANIZATIONS AND FOUNDATIONS VIA FUNDRAISING EVENTS AND MAIL SOLICITATIONS.Description
FieldValueIRS element (for citing)
Total Program Service Expense34113TotalProgramServiceExpense
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 Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
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 Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
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 Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SUE WARNERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3157887323TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1425 WASHINGTON STREETAddressLine1
CityWATERTOWNCity
StateNYState
ZIP Code13601ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ROBERT WARDWELL
PRESIDENT1.00XX000
NICKOLAS DARLING
VICE PRESIDENT1.00XX000
JEFFREY BARNARD
TREASURER1.00XX000
MAUREEN O'DONNELL
SECRETARY1.00XX000
GAIL CHRISTENSEN
BOARD MEMBER1.00XX000
ROXANNE BURNS
BOARD MEMBER1.00X000
HOLLY BUSH
BOARD MEMBER1.00X000
STEVE JENNINGS
BOARD MEMBER1.00X000
MARC LADOUCEUR
BOARD MEMBER1.00X000
RACHEL LEWIS
BOARD MEMBER1.00X000
MAUREEN LUNDY-WAY
BOARD MEMBER1.00X000
BARBARA MADDOCKS
BOARD MEMBER1.00X000
MADELINE MOORE
BOARD MEMBER1.00X000
DELTRA WILLIS
BOARD MEMBER1.00X000
JOHN DEANS
BOARD MEMBER1.00X000
LINDA SHARLOW
FOUNDATION DIRECTOR40.00X0498218312
STEPHEN LYMAN
CHIEF EXECUTIVE OFFICER40.00X0650004592
SUSAN WARNER
FINANCE DIRECTOR40.00X0644078899
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs179228TotalReportableCompFrmRltdOrgs
Total Other Compensation21803TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events118671FundraisingEvents
Government Grants3109691GovernmentGrants
All Other Contributions384903AllOtherContributions
Noncash Contributions87178NoncashContributions
Total Contributions3613265TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column40464TotalRevenueColumn
Exclusion$40,464ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real22000Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real22000Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column22000TotalRevenueColumn
Exclusion$22,000ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities921120Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities873532Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities47588Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column47588TotalRevenueColumn
Exclusion$47,588ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events133634GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events118671CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses73079FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column60555TotalRevenueColumn
Exclusion$60,555ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column592TotalRevenueColumn
Exclusion$592ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue592TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3784464TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$171,199ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total28333Total
Program Services28333ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total58133Total
Management And General58133ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total84030Total
Management And General84030ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1912Total
Management And General1912ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total4975Total
Management And General4975ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total14288Total
Management And General14288ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total24245Total
Program Services600ProgramServices
Fundraising23645Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total20246Total
Management And General20246ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total7406Total
Management And General7406ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total348Total
Management And General348ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1398Total
Management And General1398ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11598Total
Management And General11598ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2927Total
Management And General2927ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalFundraisingFundraisingProgram ServicesProgramServices
FUNDRAISING1703317033
BAD DEBT50005000
PALLIATIVE CARE180180

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1590Total
Management And General1590ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total283642Total
Program Services34113ProgramServices
Management And General208851ManagementAndGeneral
Fundraising40678Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY476642BOY
EOY1021231EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY280049BOY
EOY267558EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
EOY600552EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1776BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3905BOY
EOY4004EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3631220LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec172089LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY499540BOY
EOY3459131EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1708048BOY
EOY1052157EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2969960BOY
EOY6404633EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6621BOY
EOY27310EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY750BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7371BOY
EOY27310EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2248273BOY
EOY5244142EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY714316BOY
EOY1133181EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2962589BOY
EOY6377323EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2969960BOY
EOY6404633EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3500822ReconcilationRevenueExpenses
Reconcilation Other Changes-86088ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
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 Years79440CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years408286CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years406893CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year523007CurrentTaxYearMinus1Year
Current Tax Year3547555CurrentTaxYear
Total4965181Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years79440CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years408286CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years406893CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year523007CurrentTaxYearMinus1Year
Current Tax Year3547555CurrentTaxYear
Total4965181Total
FieldValueIRS element (for citing)
Public Support Total1704965181PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years74500CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years78127CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years65841CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year68552CurrentTaxYearMinus1Year
Current Tax Year62464CurrentTaxYear
Total349484Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years15805CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years606CurrentTaxYearMinus2Years
Current Tax Year592CurrentTaxYear
Total17003Total
FieldValueIRS element (for citing)
Total Support5331668TotalSupport
Public Support Pertcentage1700.93130PublicSupportPertcentage170
Public Support Pertcent Prior Year0.78770PublicSupportPertcentPriorYear
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 Basis64500OtherCostOrOtherBasis
Book Value64500BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis330260OtherCostOrOtherBasis
Depreciation108824Depreciation
Book Value221436BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis66227OtherCostOrOtherBasis
Depreciation63265Depreciation
Book Value2962BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3170233OtherCostOrOtherBasis
Book Value3170233BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3459131TotalOfBookValueLandBuildings
Total Revenue3784464TotalRevenue
Total Expenses283642TotalExpenses
Excess Or Deficit For Year3500822ExcessOrDeficitForYear
Net Unrealized GL On Investments-86088NetUnrealizedGLOnInvestments
Total Adjustments-86088TotalAdjustments
Excess Or Deficit Per FS3414734ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3771455TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-86088NetUnrealizedGainsInvestments
Other Revenues73079OtherRevenues
Revenue Not Rptd F990-13009RevenueNotRptdF990
Revenue Subtotal3784464RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9903784464TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt356721TotExpensesEtcAuditedFinclStmt
Other Expenses Included73079OtherExpensesIncluded
Expenses Not Rptd F99073079ExpensesNotRptdF990
Expenses Subtotal283642ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990283642TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:FOR TAX-EXEMPT ENTITIES, THEIR TAX-EXEMPT STATUS ITSELF IS DEEMED TO BE AN UNCERTAINTY, SINCE EVENTS COULD POTENTIALLY OCCUR TO JEOPARDIZE THEIR TAX-EXEMPT STATUS. AS OF SEPTEMBER 30, 2011 AND 2010, THE ORGANIZATIONS DO NOT HAVE A LIABILITY FOR UNRECOGNIZED TAX BENEFITS. THE ORGANIZATIONS FILE INCOME TAX RETURNS IN THE U.S. FEDERAL JURISDICTION AND NEW YORK STATE. THE ORGANIZATIONS ARE GENERALLY NO LONGER SUBJECT TO U.S. FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008.
PART XII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS EXPENSE 73,079.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:SPECIAL EVENTS 73,079.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event1111550GrossReceiptsEvent1
Charitable Contributions Event165710CharitableContributionsEvent1
Gross Revenue Event145840GrossRevenueEvent1
Cash Prizes Event111196CashPrizesEvent1
Rent Facility Costs Event17216RentFacilityCostsEvent1
Other Direct Expenses Event127400OtherDirectExpensesEvent1
Name Of Event2AUCTIONNameOfEvent2
Gross Receipts Event2116691GrossReceiptsEvent2
Charitable Contributions Event252961CharitableContributionsEvent2
Gross Revenue Event263730GrossRevenueEvent2
Other Direct Expenses Event223148OtherDirectExpensesEvent2
Total Number Of Other Events3TotalNumberOfOtherEvents
Gross Receipts Other Events24064GrossReceiptsOtherEvents
Gross Revenue Other Events24064GrossRevenueOtherEvents
Other Direct Expenses Other Events4119OtherDirectExpensesOtherEvents
Gross Receipts Total252305GrossReceiptsTotal
Charitable Contributions Total118671CharitableContributionsTotal
Gross Revenue Total Events133634GrossRevenueTotalEvents
Cash Prizes Total Events11196CashPrizesTotalEvents
Rent Facility Costs Total Events7216RentFacilityCostsTotalEvents
Other Direct Expenses Total Events54667OtherDirectExpensesTotalEvents
Direct Expense Summary Events73079DirectExpenseSummaryEvents
Net Income Summary60555NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF JEFFERSON COUNTY INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1425 WASHINGTON STREETAddressLine1
CityWATERTOWNCity
StateNYState
ZIP Code13601ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient161266041EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant28333AmountOfCashGrant
Purpose Of GrantTO SUPPORT THE OPERATIONS OF THE HOSPICE OF JEFFERSON COUNTY, INC. IN ACCORDANCE WITH THE FOUNDATION'S MISSIONPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionMISCELLANEOUSDescription
Number Of Contributions113NumberOfContributions
Noncash Contribs Rptd F99087178NoncashContribsRptdF990
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierMETHOD FOR DETERMINING NUMBER OF CONTRIBUTORS:Identifier
Return ReferencePART I, COLUMN (B):ReturnReference
ExplanationNUMEROUS SMALL CONTRIBUTIONS FOR SPECIAL EVENTS AND OTHER EVENTS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 7ASOLE CORPORATE MEMBER, HOSPICE OF JEFFERSON COUNTY, INC. ELECTS BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7BJEFFERSON COUNTY HOSPICE HAS THE EXCLUSIVE POWER AND AUTHORITY TO AMEND, REPEAL, OR ADOPT BY-LAWS OF THE FOUNDATION. IN ADDITION THE JEFFERSON COUNTY HOSPICE HAS ALL RIGHTS AND POWERS RELATED TO ELECTION OF FOUNDATION DIRECTORS, AMENDING THE CERTIFICATE OF INCORPORATION OF THE FOUNDATION, APPROVE ANY MERGER OR CONSOLIDATION OF THE FOUNDATION, APPROVE THE DISSOLUTION OF THE FOUNDATION, AND APPROVE THE SALE OR ENCUMBRANCE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE FOUNDATION.
FORM 990, PART VI, SECTION B, LINE 11THE FOUNDATION PROVIDES DRAFT COPIES OF THE IRS FORM 990 TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO COMPLETION AND FILING WITH THE INTERNAL REVENUE SERVICE AT THEIR REGULARLY SCHEDULED MEETINGS.
CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY. THE EXECUTIVE DIRECTOR AND BOARD PRESIDENT REVIEW AND FOLLOW UP ON DISCLOSURES OF CONFLICTS.FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE EXECUTIVE DIRECTOR. ALL OTHER EMPLOYEES ARE EVALUATED ANNUALLY BY MANAGEMENT. AN ANNUAL SURVEY OF LOCAL HEALTHCARE AGENCIES AND CENTRAL NEW YORK HOSPICES IS PERFORMED FOR PAY SCALES AT ALL STAFFING LEVELS.FORM 990, PART VI, SECTION B, LINE 15
A HIGH LEVEL FINANCIAL PICTURE IS PROVIDED IN THE ANNUAL REPORT, WHICH IS AVAILABLE TO THE PUBLIC. OTHER FINANCIAL DATA AND POLICY INFORMATION IS AVAILABLE UPON REQUEST AND ON A NEED TO KNOW BASIS.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -86,088.FORM 990, PART XI, LINE 5:
SELECTION AND OVERSIGHT OF INDEPENDENT AUDITORSTHE BOARD OF DIRECTORS SELECTS AND MEETS WITH THE INDEPENDENT AUDITORS TO DISCUSS THE RESULTS OF THE AUDIT.FORM 990, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF JEFFERSON COUNTYBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1425 WASHINGTON STREETAddressLine1
CityWATERTOWNCity
StateNYState
ZIP Code13601ZIPCode
FieldValueIRS element (for citing)
EIN161266041EIN
Primary ActivitiesHOSPICE CAREPrimaryActivities
Legal Domicile StateNYLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF JEFFERSON COUNTY INCBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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