MAYERS HEALTHCARE FOUNDATION INC: Form 990EZ, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MAYERS HEALTHCARE FOUNDATION INC (EIN 91-1839151)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201243209349201929
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T09:59:29-08:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Debra J Crone CPA | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 143 | AddressLine1 |
| City | Burney | City |
| State | CA | State |
| ZIP Code | 96013 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911839151 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Intermountain Healthcare Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | INTE | NameControl |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 77 | AddressLine1 |
| City | Fall River Mills | City |
| State | CA | State |
| ZIP Code | 96028 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Keith Earnest | Name |
| Title | President | Title |
| Phone | 5303365512 | Phone |
| Date Signed | 2011-11-14 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Debra J Crone | Name |
| Phone | 5309491272 | Phone |
| Date Prepared | 2012-11-15 | DatePrepared |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Schedule B Not Required | X | ScheduleBNotRequired |
| Web Site | NA | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 156706 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 29462 | ContributionsGiftsGrantsEtc |
| Investment Income | 1540 | InvestmentIncome |
| Fundraising Gross Income | 63285 | FundraisingGrossIncome |
| Special Events Direct Expenses | 22878 | SpecialEventsDirectExpenses |
| Special Events Net Income Loss | 40407 | SpecialEventsNetIncomeLoss |
| Gross Sales Of Inventory | 62419 | GrossSalesOfInventory |
| Cost Of Goods Sold | 25730 | CostOfGoodsSold |
| Gro Profit Loss Sales Of Inventory | 36689 | GroProfitLossSalesOfInventory |
| Total Revenue | 108098 | TotalRevenue |
| Grants And Similar Amounts Paid | 75021 | GrantsAndSimilarAmountsPaid |
| Fees And Oth Pymt To Ind Contractors | 600 | FeesAndOthPymtToIndContractors |
| Printing Publications Postage | 1381 | PrintingPublicationsPostage |
| Other Expenses Total | 571 | OtherExpensesTotal |
| Total Expenses | 77573 | TotalExpenses |
| Excess Or Deficit For Year | 30525 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 214679 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | -4376 | OtherChangesInNetAssets |
| Net Assets Or Fund Balances EOY | 240828 | NetAssetsOrFundBalancesEOY |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 214679 | BOY |
| EOY | 240828 | EOY |
Land And Buildings LandAndBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 214679 | BOY |
| EOY | 240828 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 214679 | BOY |
| EOY | 240828 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | Non-profit funding for healthcare org | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment (2 entries)
| Description Program Service AccomDescriptionProgramServiceAccom | Grants And AllocationsGrantsAndAllocations | Program Service ExpensesProgramServiceExpenses |
|---|---|---|
| Provide digital Xray package IV pumps medical equipment and rural heath care support to Mayers Memorial Hospital | 58741 | 58471 |
| Provided support to Mayers Memorial Hospital Hospice program including payment for medications volunteer training and other services for hospice patients | 16550 | 16550 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 75021 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|---|---|---|---|
| Keith Earnest | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | President | 4 | 0 | 0 | 0 |
| Gail McClung | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Secretary | 1 | 0 | 0 | 0 |
| Pam Giacomini | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Treasurer | 1 | 0 | 0 | 0 |
| Michael Kerns | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Ex-Offico | 1 | 0 | 0 | 0 |
| Matthew Rees | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Ex-Officio | 1 | 0 | 0 | 0 |
| Renee Coe | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Director | 1 | 0 | 0 | 0 |
| Dewey Matthews | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Director | 1 | 0 | 0 | 0 |
| Elsie Matthews | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Director | 1 | 0 | 0 | 0 |
| Mona Carr | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Director | 1 | 0 | 0 | 0 |
| Steven B Raffin MD | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Director | 1 | 0 | 0 | 0 |
| Randall L Harr | ||||||||
| PO Box 77 | Fall River Mills | CA | 96028 | Director | 1 | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | true | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | false | OrganizationHadUBI |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Organization Dissolved Etc | false | OrganizationDissolvedEtc |
| Did Org File Form1120 POL This Year | false | DidOrgFileForm1120POLThisYear |
| Made Loans To From Officers | false | MadeLoansToFromOfficers |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTrans |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Linda Eastman | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 77 | AddressLine1 |
| City | Fall River Mills | City |
| State | CA | State |
| ZIP Code | 96028 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5303365512 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccount |
| Foreign Office | false | ForeignOffice |
| Maintain Any Donor Advised Funds | false | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | false | DoesOrgHaveHospital |
| Tanning Services Provided | false | TanningServicesProvided |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction With Control Entity | false | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | false | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | false | EngageInLobbyingActivities |
| Operating School | false | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | false | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | true | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | true | ContribByControllingIndividual |
| Contribution By Related Party | true | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mayers Memorial Hospital Dist | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 911839151 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Supported Organization Notified | true | SupportedOrganizationNotified |
| Organized In US | true | OrganizedInUS |
| Amount | $75,021 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sum Of Amounts | 75021 | SumOfAmounts |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | false | AgreementRefFundraising |
| Licensed States | CA | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournam | NameOfEvent1 |
| Gross Receipts Event1 | 30183 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 180 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 30003 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 2444 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 7242 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 2925 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 1394 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Health Fair | NameOfEvent2 |
| Gross Receipts Event2 | 12065 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 125 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 11940 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 350 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 237 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 5 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 27300 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 5958 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 21342 | GrossRevenueOtherEvents |
| Non Cash Prizes Other Events | 485 | NonCashPrizesOtherEvents |
| Food And Beverage Other Events | 3025 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 700 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 4076 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 69548 | GrossReceiptsTotal |
| Charitable Contributions Total | 6263 | CharitableContributionsTotal |
| Gross Revenue Total Events | 63285 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2929 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 7592 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 5950 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 700 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 5707 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 22878 | DirectExpenseSummaryEvents |
| Net Income Summary | 40407 | NetIncomeSummary |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| 01. List of grants and similar amounts paid (Part I, line 10) | Activity Hospice Program Relationship NA Amount 16550 Activity Digital Xray Package Relationship NA Amount 40000 Activity IV Pumps Relationship NA Amount 12568 Activity Medical Equipment Relationship NA Amount 3365 Activity Rural Health Care Support Relationship NA Amount 2538 |
| 02. Description of other expenses (Part I, line 16) | Description Amount Supplies 471 Taxes & Fees 100 |
| 03. Other changes in net assets or fund balances (Part I, line 20) | Description Amount Investment Value Loss 4376 |
| 04. Changes to governing documents (Part V, line 34) | By-laws amended to include non-voting Honorary Advisory Members to provide expert advice to Foundation or assist in other ways Elected by the full board and serve at the discretion of the Board of Directors |
Comments