COMMUNITY HOSPICE FOUNDATION: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HOSPICE FOUNDATION (EIN 77-0562224)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-02-09
IRS object ID
201110409349300816
Schema version
2009v1.7
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)
Timestamp2011-02-09T11:30:05-06:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ATHERTON & ASSOCIATES LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 4339AddressLine1
CityMODESTOCity
StateCAState
ZIP Code953524339ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN770562224EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPICE FOUNDATION OF STANISLAUS COUNTYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone2095786300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14368 SPYRES WAYAddressLine1
CityMODESTOCity
StateCAState
ZIP Code95356ZIPCode

Officer Officer

FieldValueIRS element (for citing)
Namerick dahlseid cpaName
Titlechief financial officerTitle
Phone2095786300Phone
Date Signed2011-01-26DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRonald EhrkeName
Phone2095774800Phone
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer Personharold a peterson iiiNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14368 SPyRES WAYAddressLine1
CityMODESTOCity
StateCAState
ZIP Code95356ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1015615GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.HOSPICEHEART.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionSUPPORT OF COMMUNITY HOSPICE, INC.ActivityOrMissionDescription
Nbr Voting Members Governing Body21NbrVotingMembersGoverningBody
Nbr Independent Voting Members21NbrIndependentVotingMembers
Total Nbr Employees4TotalNbrEmployees
Total Nbr Volunteers70TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1021410ContributionsGrantsPriorYear
Contributions Grants Current Year665760ContributionsGrantsCurrentYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year59912InvestmentIncomePriorYear
Investment Income Current Year31818InvestmentIncomeCurrentYear
Other Revenue Prior Year-51879OtherRevenuePriorYear
Other Revenue Current Year185605OtherRevenueCurrentYear
Total Revenue Prior Year1029443TotalRevenuePriorYear
Total Revenue Current Year883183TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year693831GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY5332GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year241521SalariesEtcPriorYear
Salaries Etc Current Year236194SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year34253TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year130816TotalFundrsngExpCurrentYear
Other Expense Prior Year256076OtherExpensePriorYear
Other Expenses Current Year215959OtherExpensesCurrentYear
Total Expenses Prior Year1225681TotalExpensesPriorYear
Total Expenses Current Year457485TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-196238RevenuesLessExpensesPriorYear
Revenues Less Expenses CY425698RevenuesLessExpensesCY
Total Assets BOY4450453TotalAssetsBOY
Total Assets EOY4916907TotalAssetsEOY
Total Liabilities BOY147441TotalLiabilitiesBOY
Total Liabilities EOY94216TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4303012NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4822691NetAssetsOrFundBalancesEOY
Mission Descriptionthe 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 Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense263278Expense
DescriptionTO 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 Expense263278TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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 Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees4NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Nbr Voting Governing Body Members21NbrVotingGoverningBodyMembers
Number Independent Voting Members21NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RICK DAHLSEID cpaBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2095786300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14368 SPYRES WAYAddressLine1
CityMODESTOCity
StateCAState
ZIP Code95356ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JAMES COGDILL
chairman1.00X000
CATHY TUXSON
VICE CHAIRMAN1.00X000
CLARENCE ABID
SECRETARY1.00X000
GARY ERVIN
TREASURER1.00X000
MICHAEL HERRERO
PAST CHAIRMAN1.00X000
VICKI BAYLEY
DIRECTOR1.00X000
SALLY COFER LINDBERG
DIRECTOR1.00X000
JOSE DIAZ
DIRECTOR1.00X000
RONI EDGMON
DIRECTOR1.00X000
VERN FERGEL
DIRECTOR1.00X000
DON GAEKLE
DIRECTOR1.00X000
MARK KANAI
DIRECTOR1.00X000
JANICE LUCERO
DIRECTOR1.00X000
STEVE LUNA
DIRECTOR1.00X000
GARRAD MARSH
DIRECTOR1.00X000
LESLIE KALIM mchugh
DIRECTOR1.00X000
NORIK NARAGHI
DIRECTOR1.00X000
MERYL SNIDER
DIRECTOR1.00X000
JON TREMAYNE
DIRECTOR1.00X000
KRISTY WATERMAN
DIRECTOR1.00X000
JOLENE A YEE
DIRECTOR1.00X000
HAROLD A PETERSON III
CHIEF EXECUTIVE OFFICER5.0002214419508X
RICK DAHLSEID
CHIEF FINANCIAL OFFICER5.0001171031926X
CAROLE RICHARD
director of fund develop40.0010235004752X
FieldValueIRS element (for citing)
Total Reportable Comp From Org102350TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs338544TotalReportableCompFrmRltdOrgs
Total Other Compensation16186TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events60406FundraisingEvents
All Other Contributions605354AllOtherContributions
Noncash Contributions61264NoncashContributions
Total Contributions665760TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column31818TotalRevenueColumn
Exclusion$31,818ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events254775GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events60406CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses132432FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column122343TotalRevenueColumn
Exclusion$122,343ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming9836GrossIncomeGaming

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column9836TotalRevenueColumn
Related Or Exempt Function Income9836RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
LOSS FROM LIMITED PART90009952985$52,985
MISCELLANEOUS INCOME900099441441
FieldValueIRS element (for citing)
Total Other Revenue53426TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column883183TotalRevenueColumn
Related Or Exempt Function Income10277RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$207,146ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total5332Total
Program Services5332ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total208559Total
Program Services104279ProgramServices
Fundraising104280Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total10093Total
Program Services5046ProgramServices
Fundraising5047Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total17542Total
Program Services8771ProgramServices
Fundraising8771Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total24880Total
Program Services24880ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total33169Total
Program Services33169ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total18066Total
Program Services18066ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3452Total
Program Services3452ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7247Total
Program Services7247ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServicesFundraisingFundraising
management service fees6339163391
Bank, credit card & pay1807618076
POSTAGE1403814038
bad debt expense1230912309
Computer maintenance75127512

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13819Total
Program Services13410ProgramServices
Fundraising409Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total457485Total
Program Services263278ProgramServices
Management And General63391ManagementAndGeneral
Fundraising130816Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY85437BOY
EOY562364EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY219977BOY
EOY187013EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY20000BOY
EOY2691EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3771BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1170BOY
EOY16583EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6171BOY
EOY8889EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis32665LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15683LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24228BOY
EOY16982EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY984617BOY
EOY1025187EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2702000BOY
EOY2726000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY403082BOY
EOY371198EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4450453BOY
EOY4916907EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY55934BOY
EOY36610EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY91507BOY
EOY57606EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY147441BOY
EOY94216EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3877743BOY
EOY4402945EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY19085BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY406184BOY
EOY419746EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4303012BOY
EOY4822691EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4450453BOY
EOY4916907EOY
FieldValueIRS element (for citing)
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)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1community hospice incBusinessNameLine1
FieldValueIRS element (for citing)
EIN942638213EIN
Type Of Organization9TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$5,332Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts5332SumOfAmounts

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

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance417600BeginningOfYearBalance
Contributions1253Contributions
Investment Earnings Or Losses21928InvestmentEarningsOrLosses
End Of Year Balance440781EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance189918BeginningOfYearBalance
Contributions216266Contributions
Investment Earnings Or Losses11416InvestmentEarningsOrLosses
End Of Year Balance417600EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis8474OtherCostOrOtherBasis
Depreciation6410Depreciation
Book Value2064BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis24191OtherCostOrOtherBasis
Depreciation9273Depreciation
Book Value14918BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings16982TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionLIMITED PARTNERSHIPDescription
Book Value2726000BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities2726000TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
investment property7800
endowment investments255310
pledges receivable restricted for endowment108088
FieldValueIRS element (for citing)
Total Book Value Other Assets371198TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionRELATED PARTY PAYABLEDescription
Amount$57,606Amount
FieldValueIRS element (for citing)
Total Of Amounts57606TotalOfAmounts
Total Revenue883183TotalRevenue
Total Expenses457485TotalExpenses
Excess Or Deficit For Year425698ExcessOrDeficitForYear
Net Unrealized GL On Investments93981NetUnrealizedGLOnInvestments
Total Adjustments93981TotalAdjustments
Excess Or Deficit Per FS519679ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt1109155TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments93981NetUnrealizedGainsInvestments
Other Revenues132432OtherRevenues
Revenue Not Rptd F990226413RevenueNotRptdF990
Revenue Subtotal882742RevenueSubtotal
Other Revenues Not Included441OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt441RevenueNotRptdOnFinStmt
Total Revenue Per Form990883183TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt584144TotExpensesEtcAuditedFinclStmt
Other Expenses Included132432OtherExpensesIncluded
Expenses Not Rptd F990132432ExpensesNotRptdF990
Expenses Subtotal451712ExpensesSubtotal
Other Expenses Not Included5773OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt5773ExpensesNotRptdOnFinStmt
Total Expenses Per Form990457485TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:the intended use of the endowment funds are to fund future operating expenses.
line 2d - cost of goods sold for fundraising events line 4b - TRANSFERS MADE TO RELATED PARTIES

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Licensed StatesCALicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GalaNameOfEvent1
Gross Receipts Event1211719GrossReceiptsEvent1
Charitable Contributions Event153713CharitableContributionsEvent1
Gross Revenue Event1158006GrossRevenueEvent1
Rent Facility Costs Event115501RentFacilityCostsEvent1
Food And Beverage Event144743FoodAndBeverageEvent1
Other Direct Expenses Event157861OtherDirectExpensesEvent1
Name Of Event2holiday treeNameOfEvent2
Gross Receipts Event237864GrossReceiptsEvent2
Charitable Contributions Event2870CharitableContributionsEvent2
Gross Revenue Event236994GrossRevenueEvent2
Rent Facility Costs Event2100RentFacilityCostsEvent2
Food And Beverage Event2100FoodAndBeverageEvent2
Other Direct Expenses Event25426OtherDirectExpensesEvent2
Total Number Of Other Events7TotalNumberOfOtherEvents
Gross Receipts Other Events65598GrossReceiptsOtherEvents
Charitable Contrib Other Events5823CharitableContribOtherEvents
Gross Revenue Other Events59775GrossRevenueOtherEvents
Rent Facility Costs Other Events346RentFacilityCostsOtherEvents
Food And Beverage Other Events2715FoodAndBeverageOtherEvents
Other Direct Expenses Other Events5640OtherDirectExpensesOtherEvents
Gross Receipts Total315181GrossReceiptsTotal
Charitable Contributions Total60406CharitableContributionsTotal
Gross Revenue Total Events254775GrossRevenueTotalEvents
Rent Facility Costs Total Events15947RentFacilityCostsTotalEvents
Food And Beverage Total Events47558FoodAndBeverageTotalEvents
Other Direct Expenses Total Events68927OtherDirectExpensesTotalEvents
Direct Expense Summary Events132432DirectExpenseSummaryEvents
Net Income Summary122343NetIncomeSummary
FieldValueIRS element (for citing)
States Where Gaming ConductedCAStatesWhereGamingConducted
Licensed1Licensed
License Suspended Etc0LicenseSuspendedEtc
Gaming With Nonmembers0GamingWithNonmembers
Member Of Other Entity0MemberOfOtherEntity
Percentage Of Gaming Othr Facility1.00000PercentageOfGamingOthrFacility
Name Of Gaming Rec Keeper Personrick dahlseid cpaNameOfGamingRecKeeperPerson

Address Of Gaming Rec Keeper US AddressOfGamingRecKeeperUS

FieldValueIRS element (for citing)
Address Line14368 spyres wayAddressLine1
CitymodestoCity
StateCAState
ZIP Code95356ZIPCode
FieldValueIRS element (for citing)
Contract With3rd Party For Gam Rev0ContractWith3rdPartyForGamRev
Gaming Manager Name Personcarole richardGamingManagerNamePerson
Gaming Manager Compensation107102GamingManagerCompensation
Gaming Manager Services Providedregistration and operation of raffles.GamingManagerServicesProvided
Gaming Manager Is Director OfficerXGamingManagerIsDirectorOfficer
Charitable Distrib Required0CharitableDistribRequired

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPICE INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14368 SPYRES WAYAddressLine1
CityMODESTOCity
StateCAState
ZIP Code95356ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient942638213EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant5332AmountOfCashGrant
Purpose Of GrantFUNDS RAISED AND REIMBURSED EXPENSES FOR COMMUNITY HOSPICE INCPurposeOfGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: all funds distributed to community hospice, inc. which is a related entity.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1HAROLD A PETERSON IIIBusinessNameLine1
FieldValueIRS element (for citing)
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs221441CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs9508DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs230949TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs230042CompReportPrior990RelatedOrgs

Schedule M IRS990ScheduleM

Other Non Cash Contributions Table OtherNonCashContributionsTable (7 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XRent120based on donors representation
Xmiscellaneous1520based on donors representation
XDecorations1092based on donors representation
XPrizes44237based on donors representation
Xadvertising5182based on donors representation
Xfood8961based on donors representation
Xprinting152based on donors representation
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts1ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 3management duties are performed by chi management, inc. which is a related party exempt organization.
Form 990, Part VI, Section A, line 6THE ORGANIZATION'S ONLY MEMBER IS COMMUNITY HOSPICE, INC.
Form 990, Part VI, Section B, line 11The Chief Financial Officer (CFO) obtains the completed form 990 from the preparer and reviews it for accuracy and completeness. If considered accurate and complete, a meeting is scheduled with the CHI Foundation Board. The complete 990 is converted to a PDF file for electronic storage and viewing. At the meeting of the CHI foundation board, the form 990 is provided to each board member. The CFO then goes through each page of the form 990 explaining the main portion of the return as well as the schedules that are required. Meeting notes are kept of the meeting throughout the review to capture any comments or questions that arise from the board members that cannot be answered by the CFO. 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 CHI foundation Board 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 Board 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 12cAll 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 15Compensation is approved by the independent Board of Directors where the vote of each member is counted. Compensation analysis of similar 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 18The organization makes available its governing documents, conflict of interest policy and annual report to the public upon request.
Form 990, Part VI, Section C, line 19The organization makes available its governing documents, conflict of interest policy and annual report to the public upon request.
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 the independent auditors.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
COMMUNITY HOSPICE INC
4368 SPYRES WAYMODESTOCA95356942638213HOSPICE CARE FOR THE TERMINALLY ILLCA501(C)(3)509(a)(2)N/A
CHI MANAGEMENT INC
4368 SPYRES WAYMODESTOCA95356200178425PROVIDE PROFESSIONAL SERVICES FOR COMMUNITY HOSPICE, INC AND THE HOPE CHESTCA501(C)(3)509(a)(2)N/A
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 Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
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 Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
community hospice inc & chi mangement inc
M
community hospice inc
Q5332
COMMUNITY HOSPICE INC & CHI MANAGEMENT INC
N
COMMUNITY hospice inc
O

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.