MITCHELL HOSPICE HOUSE: Form 990EZ, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MITCHELL HOSPICE HOUSE (EIN 83-0685644)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-08-16
- IRS object ID
- 202242289349200709
- Schema version
- 2021v4.2
- 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) |
|---|---|---|
| Return | 2022-08-16T08:47:51-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 481292483 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENJES CONNER & WILLIAMS PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1937 | AddressLine1Txt |
| City | DAKOTA DUNES | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57049 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830685644 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MITCHELL HOSPICE HOUSE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MITC | BusinessNameControlTxt |
| Phone | 7123016050 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 WYNSTONE DR | AddressLine1Txt |
| City | JEFFERSON | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57038 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAN DYKSTRA | PersonNm |
| Person Title | BOARD SECRETARY | PersonTitleTxt |
| Phone | 7123016050 | PhoneNum |
| Signature | 2022-08-03 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DAN | PersonFirstNm |
| Person Last | DYKSTRA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ANNETTE GOETSCH | PreparerPersonNm |
| PTIN | P01303472 | PTIN |
| Phone | 6052423900 | PhoneNum |
| Preparation | 2022-08-03 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
| Website Address | WWW.MITCHELLHOSPICEHOUSE.ORG | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $59,647 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $59,641 | ContributionsGiftsGrantsEtcAmt |
| Investment Income | $6 | InvestmentIncomeAmt |
| Total Revenue | $59,647 | TotalRevenueAmt |
| Other Expenses Total | $2,206 | OtherExpensesTotalAmt |
| Total Expenses | $2,206 | TotalExpensesAmt |
| Excess Or Deficit For Year | $57,441 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $121,003 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $178,444 | NetAssetsOrFundBalancesEOYAmt |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,902 | BOYAmt |
| EOY | $126,343 | EOYAmt |
Land And Buildings LandAndBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,101 | BOYAmt |
| EOY | $52,101 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,003 | BOYAmt |
| EOY | $178,444 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,003 | BOYAmt |
| EOY | $178,444 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | TO ESTABLISH A HOSPICE HOUSE TO SERVE SIOUXLAND. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | TO PROVIDE A HOSPICE HOUSE TO SERVE SIOUXLAND - NOT YET OPENED. | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $0 | GrantsAndAllocationsAmt |
| Program Service Expenses | $0 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $0 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (8 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| SUSAN MACFARLANE | ||||
| PRESIDENT | 1.00 | $0 | $0 | $0 |
| DANIEL D DYKSTRA | ||||
| SECRETARY | 1.00 | $0 | $0 | $0 |
| ANNETTE GOETSCH | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| DALE R HOLDIMAN | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| RICHARD M KUNZ | ||||
| TREASURER | 1.00 | $0 | $0 | $0 |
| KAREN MATTHEY | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| MARGARET F MITCHELL-WILCOX | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| ANN T MYERS | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN MACFARLANE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 WYNSTONE DR | AddressLine1Txt |
| City | JEFFERSON | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57038 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7123016050 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $5,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $90,646 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $38,938 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $59,641 | CurrentTaxYearAmt |
| Total | $194,225 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $5,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $90,646 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $38,938 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $59,641 | CurrentTaxYearAmt |
| Total | $194,225 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $5,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $65,100 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $900 | CurrentTaxYearAmt |
| Total | $71,000 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $5,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $65,100 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $900 | CurrentTaxYearAmt |
| Total | $71,000 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $123,225 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $101 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $77 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6 | CurrentTaxYearAmt |
| Total | $184 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $101 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $77 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6 | CurrentTaxYearAmt |
| Total | $184 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $5,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $90,747 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $39,015 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $59,647 | CurrentTaxYearAmt |
| Total | $194,409 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | Yes (X) | First5Years509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME | DESCRIPTION: DIVIDEND AND INTEREST INCOME. AMOUNT: 6. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: INSURANCE. AMOUNT: 500. DESCRIPTION: DUES & SUBSCRIPTIONS. AMOUNT: 506. DESCRIPTION: REAL ESTATE TAXES. AMOUNT: 848. DESCRIPTION: BANK CHARGES. AMOUNT: 352. TOTAL TO FORM 990-EZ, LINE 16: 2,206. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. | DeclarationDesc |