2011-02-09T11:30:05-06:00 2010-09-30 ATHERTON & ASSOCIATES LLP PO BOX 4339 MODESTO CA 953524339 990 2009-10-01 770562224 COMMUNITY HOSPICE FOUNDATION OF STANISLAUS COUNTY COMM 2095786300 4368 SPYRES WAY MODESTO CA 95356 rick dahlseid cpa 2095786300 2011-01-26 1 Ronald Ehrke 2095774800 X 2009 2016-02-24 21:20:13Z harold a peterson iii 4368 SPyRES WAY MODESTO CA 95356 1015615 0 X WWW.HOSPICEHEART.ORG X 2002 CA SUPPORT OF COMMUNITY HOSPICE, INC. 21 21 4 70 0 0 1021410 665760 0 59912 31818 -51879 185605 1029443 883183 693831 5332 0 241521 236194 34253 0 130816 256076 215959 1225681 457485 -196238 425698 4450453 4916907 147441 94216 4303012 4822691 the foundation exists to raise funds and awareness of the Community Hospice mission. Community Hospice provides compassionate end-of-life care and bereavement support to patients and their families regardless of ability to pay. The foundation raises funds utilizing a number of fundraising avenues. 0 0 263278 TO RAISE FUNDS TO SUPPORT THE OPERATIONS OF COMMUNITY HOSPICE, INC., A RELATED NOT-FOR-PROFIT CORPORATION. COMMUNITY HOSPICE, INC., USES THESE FUNDS TO PROVIDE SERVICES AND SUPPORT TO THE TERMINALLY ILL AND THEIR FAMILIES. 263278 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 13 0 4 1 0 0 0 0 0 0 0 0 0 0 0 21 21 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X RICK DAHLSEID cpa 2095786300 4368 SPYRES WAY MODESTO CA 95356 X JAMES COGDILL 1.00 X 0 0 0 CATHY TUXSON 1.00 X 0 0 0 CLARENCE ABID 1.00 X 0 0 0 GARY ERVIN 1.00 X 0 0 0 MICHAEL HERRERO 1.00 X 0 0 0 VICKI BAYLEY 1.00 X 0 0 0 SALLY COFER LINDBERG 1.00 X 0 0 0 JOSE DIAZ 1.00 X 0 0 0 RONI EDGMON 1.00 X 0 0 0 VERN FERGEL 1.00 X 0 0 0 DON GAEKLE 1.00 X 0 0 0 MARK KANAI 1.00 X 0 0 0 JANICE LUCERO 1.00 X 0 0 0 STEVE LUNA 1.00 X 0 0 0 GARRAD MARSH 1.00 X 0 0 0 LESLIE KALIM mchugh 1.00 X 0 0 0 NORIK NARAGHI 1.00 X 0 0 0 MERYL SNIDER 1.00 X 0 0 0 JON TREMAYNE 1.00 X 0 0 0 KRISTY WATERMAN 1.00 X 0 0 0 JOLENE A YEE 1.00 X 0 0 0 HAROLD A PETERSON III 5.00 X 0 221441 9508 RICK DAHLSEID 5.00 X 0 117103 1926 CAROLE RICHARD 40.00 X 102350 0 4752 102350 338544 16186 1 0 1 0 0 60406 605354 61264 665760 31818 31818 254775 60406 132432 122343 122343 9836 9836 9836 LOSS FROM LIMITED PART 900099 52985 52985 MISCELLANEOUS INCOME 900099 441 441 53426 883183 10277 0 207146 5332 5332 208559 104279 104280 10093 5046 5047 17542 8771 8771 24880 24880 33169 33169 18066 18066 3452 3452 7247 7247 management service fees 63391 63391 Bank, credit card & pay 18076 18076 POSTAGE 14038 14038 bad debt expense 12309 12309 Computer maintenance 7512 7512 13819 13410 409 457485 263278 63391 130816 85437 562364 219977 187013 20000 2691 3771 1170 16583 6171 8889 32665 15683 24228 16982 984617 1025187 2702000 2726000 403082 371198 4450453 4916907 55934 36610 91507 57606 147441 94216 X 3877743 4402945 19085 0 406184 419746 4303012 4822691 4450453 4916907 X 0 1 1 X 0 X X X 0 0 0 community hospice inc 942638213 9 1 1 1 5332 1 5332 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 417600 1253 21928 440781 189918 216266 11416 417600 0 0 8474 6410 2064 24191 9273 14918 16982 LIMITED PARTNERSHIP 2726000 F 2726000 investment property 7800 endowment investments 255310 pledges receivable restricted for endowment 108088 371198 RELATED PARTY PAYABLE 57606 57606 883183 457485 425698 93981 93981 519679 1109155 93981 132432 226413 882742 441 441 883183 584144 132432 132432 451712 5773 5773 457485 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 X X X X CA Gala 211719 53713 158006 15501 44743 57861 holiday tree 37864 870 36994 100 100 5426 7 65598 5823 59775 346 2715 5640 315181 60406 254775 15947 47558 68927 132432 122343 CA 1 0 0 0 1.00000 rick dahlseid cpa 4368 spyres way modesto CA 95356 0 carole richard 107102 registration and operation of raffles. X 0 1 COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 501(C)(3) 5332 FUNDS RAISED AND REIMBURSED EXPENSES FOR COMMUNITY HOSPICE INC Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: all funds distributed to community hospice, inc. which is a related entity. X X X X X 0 0 0 0 0 0 0 0 0 HAROLD A PETERSON III 0 221441 0 0 0 0 0 9508 0 0 0 230949 0 230042 X Rent 120 based on donors representation X miscellaneous 1520 based on donors representation X Decorations 1092 based on donors representation X Prizes 44237 based on donors representation X advertising 5182 based on donors representation X food 8961 based on donors representation X printing 152 based on donors representation 0 1 0 Form 990, Part VI, Section A, line 3 management duties are performed by chi management, inc. which is a related party exempt organization. Form 990, Part VI, Section A, line 6 THE ORGANIZATION'S ONLY MEMBER IS COMMUNITY HOSPICE, INC. Form 990, Part VI, Section B, line 11 The Chief Financial Officer (CFO) obtains the completed form 990 from the preparer and reviews it for accuracy and completeness. If considered accurate and complete, 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 12c All employees, volunteers, and members of the Board of Directors and advisory committees will sign a conflict of interest document upon employment, appointment, or reappointment, indicating that they have read and understood the relevant policies and that they will observe them. Form 990, Part VI, Section B, line 15 Compensation is approved by the independent Board of Directors where the vote of each member is counted. Compensation analysis of 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 18 The 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 19 The 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. COMMUNITY HOSPICE INC 4368 SPYRES WAY MODESTO CA 95356 942638213 HOSPICE CARE FOR THE TERMINALLY ILL CA 501(C)(3) 509(a)(2) N/A CHI MANAGEMENT INC 4368 SPYRES WAY MODESTO CA 95356 200178425 PROVIDE PROFESSIONAL SERVICES FOR COMMUNITY HOSPICE, INC AND THE HOPE CHEST CA 501(C)(3) 509(a)(2) N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 community hospice inc & chi mangement inc M community hospice inc Q 5332 COMMUNITY HOSPICE INC & CHI MANAGEMENT INC N COMMUNITY hospice inc O