2025-03-03T08:56:09-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 1188 PADRE DRIVE STE 101 SALINAS CA 93901 990 2024-01-01 863477976 JERRY RUBIN FOUNDATION FOR CANCER CARE JERR 8316424041 5 HARRIS COURT BUILDING T 201 MONTEREY CA 939405750 VALERIA WAREHAM EXECUTIVE DIR. 8316424041 2025-02-28 1 1 KIELY HOLCOMB CPA P01430569 8317596300 2025-02-28 2024 2025-03-06 01:10:19Z VALERIA WAREHAM 5 HARRIS COURT BUILDING T 201 MONTEREY CA 939405750 386762 0 X WWW.JERRYRUBINFOUNDATIONFORCANCERCARE.ORG X 2021 CA TO PROVIDE FINANCIAL AND OTHER ASSISTANCE AND SUPPORT TO CANCER PATIENTS. 3 3 2 4 0 0 210808 386737 0 0 0 0 0 25 210808 386762 0 183049 0 0 32756 62608 0 0 5289 139970 24582 172726 270239 38082 116523 93766 210289 0 0 93766 210289 X THE FOUNDATION IS FORMED (I) TO PROVIDE FINANCIAL AND OTHER ASSISTANCE AND SUPPORT TO CANCER PATIENTS, INCLUDING, WITHOUT LIMITATION, PROGRAMS DESIGNED TO MEET THE PSYCHOLOGICAL AND EMOTIONAL NEEDS OF CANCER PATIENTS; (II) TO PROVIDE EDUCATIONAL PROGRAMS FOR MEDICAL PROFESSIONALS WITH RESPECT TO THE DIAGNOSIS, TREATMENT AND MANAGEMENT OF CANCER; (III) TO ESTABLISH COMMUNITY-BASED EDUCATIONAL INITIATIVES TO PROMOTE THE EARLY DETECTION OF CANCER AND AN INTEGRATED APPROACH TO CANCER TREATMENT; (IV) TO PROVIDE SUPPORT GROUPS FOCUSED ON CANCER PATIENTS, CAREGIVERS AND THE BEREAVED, AND (V) TO PROVIDE SUCH OTHER PROGRAMS AS WILL ASSIST CANCER PATIENTS DURING THEIR BATTLE WITH CANCER AND WITH END OF LIFE. 0 0 190032 183049 0 THE JERRY RUBIN FOUNDATION WAS ESTABLISHED IN DECEMBER 2021 TO ASSIST CANCER PATIENTS THROUGHOUT THEIR CANCER JOURNEY. ADDITIONALLY, IT IS STRUCTURED TO HELP PATIENTS WITH END-OF-LIFE CARE.THE FOUNDATION CONTINUES TO RECEIVE FINANCIAL SUPPORT FROM THE HOSPICE GIVING FOUNDATION. ADDITIONALLY, THE PHYSICIANS OF PACIFIC CANCER CARE DONATED $100,000 TO THE FOUNDATION. THERE ARE MULTIPLE MONTHLY DONATIONS COMING IN FROM THE COMMUNITY AND WE CONTINUE TO APPLY FOR ADDITIONAL GRANTS TO INCREASE OUR FUNDING FOR OUR PROGRAMS.THE HOSPICE FACILITY WE'VE DEVELOPED IS CALLED JERRY'S PLACE. THIS FACILITY OPENED IN DECEMBER 2022.WE'VE HAD 29 TOTAL RESIDENTS TO DATE: SEVENTEEN MALES AND TWELVE FEMALES. THE DIAGNOSES THE RESIDENTS HAVE HAD INCLUDE PARKINSONS, CANCER, HEART DISEASE, LEWY BODY, STROKE AND SEPSIS. REFERRALS HAVE COME FROM THREE LOCAL HOSPITALS AND SEVEN DIFFERENT HOSPICE AGENCIES. THE AGE RANGE OF THE RESIDENTS IS 52-95 YEARS OLD. THE AVERAGE LENGTH OF STAY AT JERRY'S PLACE IS 34.7 DAYS AND THERE HAVE BEEN TWO LIVE DISCHARGES FROM JERRY'S PLACE DUE TO EXTENDED PROGNOSIS. RESIDENTS OF JERRY'S PLACE HAVE ALL BEEN FROM MONTEREY COUNTY INCLUDING CARMEL VALLEY, KING CITY, MARINA, PACIFIC GROVE, SALINAS, SEASIDE AND WATSONVILLE.THE FOUNDATION HAS 2 EMPLOYEES TO OVERSEE THE OPERATIONS OF JERRY'S PLACE. THE EMPLOYEES ARE BOTH PART-TME AND HAVE INCREASED THEIR HOURS FROM 15+ PER WEEK EACH TO 20+ HOURS PER WEEK OVER THE PAST YEAR. WE HAVE A PROGRAM MANAGER WHO MEETS WITH ALL THE HOSPICE AGENCIES AND HOSPITALS REGARDING OUR SERVICES. THIS POSITION OVERSEES ALL INCOMING REFERRALS AND MANAGES ALL RESIDENT ADMISSIONS. THE SECOND POSITION IS A FOUNDATION SERVICES COORDINATOR. THIS POSITION DOES GRANT WRITING, MARKETING, AND HELPS THE PROGRAM MANAGER WITH EVENTS. BOTH POSITIONS ALSO SPEND TIME AT JERRY'S PLACE WITH THE PATIENTS AND THEIR FAMILIES.WE CONTINUE TO ACCEPT FINANCIAL ASSISTANCE APPLICATIONS FROM PATIENTS NEEDING HELP WITH FINANCES DURING ACTIVE TREATMENT. THEY CAN ACCESS UP TO $1,500 PER YEAR FOR BASIC LIVING EXPENSES. THESE FUNDS CANNOT BE USED FOR PAYMENT OF MEDICAL BILLS OR INSURANCE PREMIUMS. THE FOUNDATION AWARDED $6,478 IN FINANCIAL ASSISTANCE DURING 2024 FOR GROCERY AND GAS CARDS, RENT, UTILITIES AND TRANSPORTATION. 190032 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X X VALERIA WAREHAM 8316424041 5 HARRIS COURT BUILDING T SUITE 201 MONTEREY CA 939405750 X JOHN HAUSDORFF MD PRESIDENT 2.00 X X 0 0 0 ROGER SHIFFMAN MD VICE PRESIDENT 0.50 X X 0 0 0 M ZACH KOONTZ MD TREAS/SECRETARY 2.00 X X 0 0 0 VALERIA WAREHAM EXECUTIVE DIR. 15.00 X 0 0 0 0 0 0 0 0 0 0 0 386737 386737 MISCELLANEOUS REVENUE 900099 25 25 25 386762 0 0 25 7500 7500 175549 175549 57211 57211 530 530 4867 4867 2468 2468 279 279 1200 1200 17030 6788 4953 5289 195 195 698 698 BUSINESS REGISTRATION F 325 325 2387 2387 270239 190032 74918 5289 93766 210289 93766 210289 0 0 X 93766 210289 93766 210289 93766 210289 116523 0 X 0 0 0 X 750 72050 210808 386712 670320 750 72050 210808 386712 670320 28425 641895 25 25 670345 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2024 AMOUNT: $ 25. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 HOSPICE GIVING FOUNDATION 80 GARDEN COURT SUITE 201 MONTEREY CA 93940 942404634 501(C)(3) 7500 0 N/A N/A GENERAL SUPPORT 1 0 RENT ASSISTANCE TO PATIENTS 19 169500 0 N/A N/A GIFT CARDS AND UTILITIES PAID FOR PATIENTS 20 6049 0 N/A N/A PART I, LINE 2: WE GIVE OUT GRANTS IN THE FORM OF GIFT CARDS FOR GAS OR GROCERIES; WE PAY RENTS, UTILITY BILLS OR OTHER LIVING EXPENSES DIRECTLY. NO CASH IS GIVEN TO ANY OF THE RECIPIENTS AND NO MEDICAL BILLS ARE COVERED BY OUR GRANTS. WE CONFIRM WITH THEM AT TIME OF AWARD WHICH FORM OF ASSISTANCE WOULD BE MOST HELPFUL AND THEN WE SEND THE CARDS TO THEM OR PAYMENTS DIRECTLY TO THE UTILITY COMPANIES OR LANDLORDS. FORM 990, PART VI, SECTION A, LINE 8B THERE WERE NO COMMITTEES IN EXISTENCE WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD FORM 990, PART VI, SECTION B, LINE 11B THE PRESIDENT AND TREASURER ARE HEREBY APPOINTED AS A COMMITTEE OF THE BOARD WITH AUTHORITY OF THE BOARD TO REVIEW THE IRS FORM 990, FTB FORM 199, AG FORM RRF-1 AND ANY OTHER REQUIRED FILINGS TO BE FILED BY THE CORPORATION ON AN ANNUAL BASIS, AND SUCH COMMITTEE IS AUTHORIZED AND DIRECTED TO REVIEW SUCH FORMS (AS MAY BE PREPARED BY THE CERTIFIED PUBLIC ACCOUNTANTS ENGAGED BY THE CORPORATION) ON AN ANNUAL BASIS PRIOR TO THE FILING OF SUCH FORMS. ALL BOARD MEMBERS RECEIVE A COPY OF THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C INTERESTED PERSON - AN "INTERESTED PERSON" SHALL MEAN ANY DIRECTOR, OFFICER, KEY EMPLOYEE OR ANY COMMITTEE MEMBER REGARDLESS OF WHETHER SUCH PERSON IS A DIRECTOR, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST IN A CONTEMPLATED TRANSACTION OR ARRANGEMENT. EACH DIRECTOR, OFFICER, KEY EMPLOYEE AND MEMBER OF ANY COMMITTEE SHALL ANNUALLY SIGN A STATEMENT THAT AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THIS CONFLICT OF INTEREST POLICY, HAS AGREED TO COMPLY WITH THIS CONFLICT OF INTEREST POLICY, AND AGREED TO PROMPTLY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST. CONFLICT OF INTEREST. A CONFLICT OF INTEREST MAY EXIST WHEN AN INTERESTED PERSON HAS, DIRECTLY OR INDIRECTLY, A FINANCIAL INTEREST IN ANY TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION BY ANY OFFICER, THE BOARD OR ANY COMMITTEE. DUTY TO DISCLOSE. A. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST FULLY DISCLOSE ALL MATERIAL FACTS RELATED TO THE RELATIONSHIPS AND/OR FINANCIAL OR OTHER INTERESTS THAT GIVE RISE TO THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE MADE TO THE BOARD OR ANY OFFICER(S) CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. B. IF A DIRECTOR, OFFICER, KEY EMPLOYEE OR COMMITTEE MEMBER BECOMES AWARE OF ANY POTENTIAL CONFLICT OF INTEREST RELATED TO ANOTHER DIRECTOR, OFFICER, KEY EMPLOYEE OR COMMITTEE MEMBER, HE OR SHE SHALL BRING IT TO THE ATTENTION OF THE PRESIDENT, TREASURER/CHIEF FINANCIAL OFFICER OR THE SECRETARY IMMEDIATELY. DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS. THE BOARD MAY DETERMINE THAT THE FINANCIAL OR OTHER INTEREST IS NOT MATERIAL AND THAT, THEREFORE, THERE IS NO ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IF THE BOARD DETERMINES THAT THERE IS NO ACTUAL OR POTENTIAL CONFLICT OF INTEREST, NO VOTE OF THE BOARD SHALL BE REQUIRED TO PROCEED WITH THE TRANSACTION OR ARRANGEMENT. IF THE BOARD DETERMINES THAT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE BOARD MAY AUTHORIZE OR APPROVE THE TRANSACTION OR ARRANGEMENT PURSUANT TO THE PROCEDURES SET FORTH IN THE NEXT SECTION. PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST. IF THE BOARD DETERMINES THAT THERE IS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE BOARD SHALL PROCEED AS FOLLOWS: A. THE INTERESTED PERSON(S) SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND VOTE ON, THE TRANSACTION OR ARRANGEMENT, PROVIDED THAT SUCH INTERESTED PERSON(S) SHALL BE GIVEN THE OPPORTUNITY TO ADDRESS THE MEETING WITH RESPECT TO THE TRANSACTION OR ARRANGEMENT BEFORE LEAVING THE MEETING. B. THE BOARD MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT BEFORE VOTING ON SUCH TRANSACTION OR ARRANGEMENT. C. THE BOARD, ACTING IN GOOD FAITH, MAY AUTHORIZE OR APPROVE THE TRANSACTION OR ARRANGEMENT BY VOTE OF A MAJORITY OF THE DIRECTORS THEN IN OFFICE WITHOUT COUNTING THE VOTE OF ANY DIRECTOR WHO HAS A MATERIAL FINANCIAL INTEREST IN THE TRANSACTION OR ARRANGEMENT (ALTHOUGH SUCH DIRECTOR(S) MAY BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM) AFTER DETERMINING THE FOLLOWING: I. THAT THE BOARD HAS KNOWLEDGE OF ALL MATERIAL FACTS CONCERNING THE TRANSACTION OR ARRANGEMENT AND THE FINANCIAL INTEREST OF ANY INTERESTED PERSON IN SUCH TRANSACTION OR ARRANGEMENT; II. THAT THE BOARD IS ACTING IN GOOD FAITH; III. THAT THE CORPORATION IS ENTERING INTO THE TRANSACTION FOR ITS OWN BENEFIT; IV. THAT THE TRANSACTION IS (OR WAS) FAIR AND REASONABLE TO THE CORPORATION AT THE TIME THE CORPORATION WILL (OR DID) ENTER INTO IT; AND, V. THAT, AFTER REASONABLE INVESTIGATION UNDER THE CIRCUMSTANCES, THE CORPORATION CANNOT OBTAIN A MORE ADVANTAGEOUS ARRANGEMENT WITH REASONABLE EFFORT UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS AND ITS IRS FORM 990 ARE AVAILABLE ON THE WEBSITE OF THE OFFICE OF THE CALIFORNIA ATTORNEY GENERAL.