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JAY COUNTY HOSPITAL AUXILIARY INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
JAY COUNTY HOSPITAL AUXILIARY INC (EIN 35-2139245)
Tax period
2021-01-01 to 2021-12-31
Filed
2023-11-13
IRS object ID
202343179349310099
Schema version
2021v4.0
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)
Return2023-11-13T17:32:25-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN271323477PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ROSE MORGAN CPABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1202 S MAIN ST PO BOX 253AddressLine1Txt
CityDUNKIRKCityNm
State AbbreviationINStateAbbreviationCd
ZIP47336ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN352139245EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JAY COUNTY HOSPITAL AUXILIARY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlJAYCBusinessNameControlTxt
Phone2607261878PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 W VOTAWAddressLine1Txt
CityPORTLANDCityNm
State AbbreviationINStateAbbreviationCd
ZIP47371ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBETTY HAFFNERPersonNm
Person TitleMEMBER/TREASURERPersonTitleTxt
Phone2607261878PhoneNum
Signature2022-11-13SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstBETTYPersonFirstNm
Person LastHAFFNERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonROSE MORGANPreparerPersonNm
PTINP00548582PTIN
Phone7657686716PhoneNum
Preparation2023-11-10PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerBETTY HAFFNERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 W VOTAW STAddressLine1Txt
Address Line2500 W VOTAW STAddressLine2Txt
CityPORTLANDCityNm
State AbbreviationINStateAbbreviationCd
ZIP47371ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$55,505GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionTHE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF IU HEALTH JAY. FUNCTIONS OF THE ORGANZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE & PROMOTION OF THE HOSPITAL.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers25TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$4,030PYContributionsGrantsAmt
CY Contributions Grants$4,000CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$1,621PYInvestmentIncomeAmt
CY Investment Income$2,140CYInvestmentIncomeAmt
PY Other Revenue-$1,109PYOtherRevenueAmt
CY Other Revenue$10,653CYOtherRevenueAmt
PY Total Revenue$4,542PYTotalRevenueAmt
CY Total Revenue$16,793CYTotalRevenueAmt
PY Grants And Similar Paid$2,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,100CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$21,976PYOtherExpensesAmt
CY Other Expenses$33,193CYOtherExpensesAmt
PY Total Expenses$23,976PYTotalExpensesAmt
CY Total Expenses$35,293CYTotalExpensesAmt
PY Revenues Less Expenses-$19,434PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$18,500CYRevenuesLessExpensesAmt
Total Assets BOY$162,721TotalAssetsBOYAmt
Total Assets EOY$154,920TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$162,721NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$154,920NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF IU HEALTH JAY. FUNCTIONS OF THE ORGANZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE & PROMOTION OF THE HOSPITAL.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$35,293ExpenseAmt
Grant$2,100GrantAmt
DescTHE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF IU HEALTH JAY HOSPITAL. FUNCTIONS OF THE ORGANZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE & PROMOTION OF THE HOSPITAL.Desc
Total Program Service Expenses$35,293TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJAY COUNTY HOSPITAL AUXILIARYPersonNm
Phone2607261878PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 W VOTAW STAddressLine1Txt
Address Line2500 W VOTAW STAddressLine2Txt
CityPORTLANDCityNm
State AbbreviationINStateAbbreviationCd
ZIP47371ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
PAT BROCKMAN
MEMBERYes (X)$0$0$0
GLEN BRYANT
MEMBERYes (X)$0$0$0
JANE CARLIN
MEMBERYes (X)$0$0$0
JOYCE ELDRIDGE
MEMBERYes (X)$0$0$0
SHIRLEY EVANS
MEMBERYes (X)$0$0$0
GLORIA GREEN
VICE PRESIDEYes (X)$0$0$0Yes (X)
SHARON GRIFFITH
TREASURERYes (X)$0$0$0Yes (X)
BETTY HAFFNER
MEMBER/TREASYes (X)$0$0$0
LINDA LEONARD
MEMBERYes (X)$0$0$0
SANDY MCGRAW
PRESIDENTYes (X)$0$0$0Yes (X)
DON SHAUVER
MEMBERYes (X)$0$0$0
ROSE SNOW
MEMBERYes (X)$0$0$0
SUE SOMMERS
MEMBERYes (X)$0$0$0
CAROL STEPHENS
MEMBERYes (X)$0$0$0
ROXIE ZUERCHER
MEMBERYes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
All Other Contributions$4,000AllOtherContributionsAmt
Noncash Contributions$4,000NoncashContributionsAmt
Total Contributions$4,000TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,140TotalRevenueColumnAmt
Exclusion$2,140ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$49,365GrossSalesOfInventoryAmt
Cost Of Goods Sold$38,712CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,653TotalRevenueColumnAmt
Related Or Exempt Func Income$10,653RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,793TotalRevenueColumnAmt
Related Or Exempt Func Income$10,653RelatedOrExemptFuncIncomeAmt
Exclusion$2,140ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$2,100TotalAmt
Program Services$2,100ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$1,055TotalAmt
Program Services$1,055ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$1,218TotalAmt
Program Services$1,218ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$578TotalAmt
Program Services$578ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,860TotalAmt
Program Services$1,860ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,000TotalAmt
Program Services$4,000ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,781TotalAmt
Program Services$1,781ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,804TotalAmt
Program Services$3,804ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
ENBEZZKED FUNDS$15,240$15,240
CREDIT CARD CHARGES$1,937$1,937
CHARITABLE CONTRIBUTION$1,145$1,145
MISCELLANEOUS$520$520

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$55TotalAmt
Program Services$55ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$35,293TotalAmt
Program Services$35,293ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$60,767BOYAmt
EOY$47,264EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$68,417LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$49,001LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$23,220BOYAmt
EOY$19,416EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$78,734BOYAmt
EOY$88,240EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$162,721BOYAmt
EOY$154,920EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$83,987BOYAmt
EOY$66,680EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$78,734BOYAmt
EOY$88,240EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$162,721BOYAmt
EOY$154,920EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$162,721BOYAmt
EOY$154,920EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$18,500ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$10,699NetUnrlzdGainsLossesInvstAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$68,417OtherCostOrOtherBasisAmt
Depreciation$49,001DepreciationAmt
Book Value$19,416BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$19,416TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescPORTLAND FOUNDATION SCHOLARSHIP FUNDDesc
Book Value$88,240BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$88,240TotalBookValueOtherAssetsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990 - ORGANIZATION'S MISSIONTHE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF IU HEALTH JAY. FUNCTIONS OF THE ORGANZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE & PROMOTION OF THE HOSPITAL.
FORM 990, PAGE 6, PART VI, LINE 11BTHE BOARD OF DIRECTORS REVIEWS THE TAX RETURN BEFORE IT IS FILED.
FORM 990, PAGE 6, PART VI, LINE 12CANNUAL CONFLICT OF INTEREST POLICY STATEMENTS ARE SIGNED BY EACH BOARD MEMBER. THESE ARE THEN REVIEWED BY THE BOARD OF DIRECTORS TO ENSURE COMPLIANCE.
FORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST.