WILLAMETTE VALLEY HOSPICE INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- WILLAMETTE VALLEY HOSPICE INC (EIN 93-0738493)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202233189349313653
- 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 | 2022-11-14T15:02:34-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 200 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930738493 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLAMETTE VALLEY HOSPICE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WILL | BusinessNameControlTxt |
| Phone | 5035883600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1015 3RD STREET NW | AddressLine1Txt |
| City | SALEM | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97304 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | IRIA NISHIMURA | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 5035883600 | PhoneNum |
| Signature | 2022-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | IRIA | PersonFirstNm |
| Person Last | NISHIMURA | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2022-11-14 | 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 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | IRIA NISHIMURA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1015 3RD STREET NW | AddressLine1Txt |
| City | SALEM | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97304 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,946,165 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WVH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1978 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | COMPREHENSIVE CARE FOR THE TERMINALLY ILL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 154 | TotalEmployeeCnt |
| Total Volunteers | 118 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $610,463 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,058,457 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,157,495 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,548,004 | CYProgramServiceRevenueAmt |
| PY Investment Income | $165,732 | PYInvestmentIncomeAmt |
| CY Investment Income | $219,397 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$5,831 | PYOtherRevenueAmt |
| CY Other Revenue | -$5,453 | CYOtherRevenueAmt |
| PY Total Revenue | $16,927,859 | PYTotalRevenueAmt |
| CY Total Revenue | $15,820,405 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,079,525 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,965,691 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $162,145 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,824,334 | PYOtherExpensesAmt |
| CY Other Expenses | $3,250,763 | CYOtherExpensesAmt |
| PY Total Expenses | $14,903,859 | PYTotalExpensesAmt |
| CY Total Expenses | $14,216,454 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,024,000 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,603,951 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,666,328 | TotalAssetsBOYAmt |
| Total Assets EOY | $13,915,866 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,904,801 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,028,439 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,761,527 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,887,427 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO CHANGE THE END OF LIFE EXPERIENCE FOR TERMINALLY ILL PERSONS AND THEIR FAMILIES, TO PROVIDE BEREAVEMENT SUPPORT FOR THE CAREGIVERS AND FAMILIES OF OUR PATIENTS AND MEMBERS OF THE COMMUNITY, AND TO EDUCATE THE COMMUNITY ABOUT END OF LIFE PHILOSOPHY AND PROGRAMS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $9,076,705 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $13,548,004 | RevenueAmt |
| Desc | WILLAMETTE VALLEY HOSPICE PROVIDES COMPASSIONATE HOSPICE CARE TO TERMINALLY ILL PATIENTS AND THEIR CAREGIVERS. SERVICES INCLUDE IN-HOME NURSING VISITS, PAIN AND SYMPTOM MANAGEMENT, PERSONAL CARE ASSISTANCE, SOCIAL SERVICE ASSISTANCE, RESPITE, SPIRITUAL COUNSELING, MASSAGE, MUSIC AND PET THERAPY, AND BEREAVEMENTS SUPPORT FOR CAREGIVERS AND THE COMMUNITY. WVH RECEIVES FUNDING FROM MEDICARE AND OTHER INSURANCE PLANS. HOWEVER, THIS DOES NOT COVER VOLUNTEER SERVICES, BEREAVEMENT SERVICES, AND ADDITIONAL THERAPIES SUCH AS MUSIC AND MASSAGE. SERVICES ARE ALSO PROVIDED REGARDLESS OF A PATIENT'S ABILITY TO PAY. WVH PROVIDES A UNIQUE SERVICE AS IT IS THE ONLY FREE-STANDING NONPROFIT HOSPICE CARE ORGANIZATION WITHIN A 35-MILE RADIUS OF SALEM. WVH WORKS AS A PARTNER WITH OTHER HEALTHCARE COMMUNITIES, RESIDENTIAL CARE FACILITIES, ADULT FOSTER HOMES, AND ASSISTED LIVING CENTERS, PROVIDING SUPPORT AND EDUCATION ABOUT END OF LIFE CARE.DURING 2021, WVH PROVIDED COMPREHENSIVE HOSPICE CARE TO 857 TERMINALLY ILL PATIENTS AND THEIR FAMILIES, INCLUDING NURSING CARE AND MEDICAL AND PSYCHOSOCIAL ASSISTANCE. 3,979 VOLUNTEER HOURS WERE UTILIZED IN PERFORMING THE SERVICES OF THE ORGANIZATION. WVH PROVIDED ADULT FOSTER CARE TO 32 HOSPICE PATIENTS WHO COULD NO LONGER RESIDE IN THEIR OWN HOME. WVH PROVIDED PALLIATIVE CARE TO 87 PATIENTS AND FAMILIES. WVH PROVIDED 94 INSTANCES OF INDIVIDUAL AND FAMILY COUNSELING, SERVED 89 INDIVIDUALS IN BEREAVEMENT GROUPS, AND HOSTED 2 COMMUNITY BEREAVEMENT EVENTS. | Desc |
| Total Program Service Expenses | $9,076,705 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 43 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 154 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | OLIVER FRASER | PersonNm |
| Phone | 5035883600 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1015 3RD STREET NW | AddressLine1Txt |
| City | SALEM | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97304 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Key EmployeeKeyEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| CHERYL MACDONALD | ||||||||
| MEDICAL DIRECTOR | 40.00 | Yes (X) | $297,558 | $0 | $7,077 | |||
| NANCY BOUTIN | ||||||||
| HOSPICE PHYSICIAN | 40.00 | $241,727 | $0 | $24,986 | Yes (X) | |||
| IRIA NISHIMURA | ||||||||
| EXECUTIVE DIRECTOR | 40.00 | $188,600 | $0 | $16,344 | Yes (X) | |||
| BARB FARMER | ||||||||
| CLINICAL MANAGER | 40.00 | $159,358 | $0 | $16,996 | Yes (X) | |||
| HILARY LICARDI | ||||||||
| NURSE PRACTITIONER | 40.00 | $127,091 | $0 | $15,573 | Yes (X) | |||
| KATHY BIRD | ||||||||
| SOCIAL SERVICES MANAGER | 40.00 | $121,971 | $0 | $15,336 | Yes (X) | |||
| JENNIFER MCKENZIE | ||||||||
| REGISTERED NURSE | 40.00 | $120,035 | $0 | $11,477 | Yes (X) | |||
| CAROLYN VAN OTTEN | ||||||||
| PRESIDENT & PAST PRESIDENT | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| ANDREW BONE | ||||||||
| SECRETARY & PRESIDENT | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| REV JOHN MOODY | ||||||||
| VICE PRESIDENT | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| BETTY O'BRIEN | ||||||||
| TREASURER | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DR RICK COOK | ||||||||
| DIRECTOR & SECRETARY | 0.50 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| MARK BIDWELL | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| JINX BRANDT | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| CHAD CAMPBELL | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| MYCHAL CHERRY | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| SCOTT GALLANT | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| NAOMI HORMANN | ||||||||
| PAST PRESIDENT & DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| JULIE HUCKESTEIN | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| WAYNE KINKADE | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| SHERRIE LESINGER | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| GAIL STECK | ||||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,256,340 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $107,789 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 16 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INTELLA TRIAGE | |||||
| 8011 BROOKS CHAPEL ROAD | BRENTWOOD | TN | 37027 | AFTER HOURS TRIAGE SERVICES | $147,357 |
| MAXIM STAFFING SOLUTIONS | |||||
| 12558 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | RECRUITING | $109,285 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $5,723 | FundraisingAmt |
| Government Grants | $1,743,377 | GovernmentGrantsAmt |
| All Other Contributions | $309,357 | AllOtherContributionsAmt |
| Noncash Contributions | $35,440 | NoncashContributionsAmt |
| Total Contributions | $2,058,457 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621610 | $13,026,473 | $13,026,473 |
| ADULT FOSTER HOME | 621610 | $521,531 | $521,531 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,548,004 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $78,817 | TotalRevenueColumnAmt |
| Exclusion | $78,817 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $260,887 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $120,307 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $140,580 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $140,580 | TotalRevenueColumnAmt |
| Exclusion | $140,580 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $5,723 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $5,453 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,453 | TotalRevenueColumnAmt |
| Exclusion | -$5,453 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,820,405 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,548,004 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $213,944 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,558 | TotalAmt |
| Program Services | $238,046 | ProgramServicesAmt |
| Management And General | $59,512 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,677,102 | TotalAmt |
| Program Services | $5,672,310 | ProgramServicesAmt |
| Management And General | $2,904,237 | ManagementAndGeneralAmt |
| Fundraising | $100,555 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,982 | TotalAmt |
| Program Services | $106,884 | ProgramServicesAmt |
| Management And General | $55,518 | ManagementAndGeneralAmt |
| Fundraising | $2,580 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,174,315 | TotalAmt |
| Program Services | $755,284 | ProgramServicesAmt |
| Management And General | $400,796 | ManagementAndGeneralAmt |
| Fundraising | $18,235 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $651,734 | TotalAmt |
| Program Services | $422,227 | ProgramServicesAmt |
| Management And General | $219,314 | ManagementAndGeneralAmt |
| Fundraising | $10,193 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,925 | TotalAmt |
| Management And General | $11,925 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,395 | TotalAmt |
| Management And General | $72,395 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,435 | TotalAmt |
| Management And General | $27,435 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $695,869 | TotalAmt |
| Program Services | $217,705 | ProgramServicesAmt |
| Management And General | $478,164 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $246,641 | TotalAmt |
| Management And General | $216,059 | ManagementAndGeneralAmt |
| Fundraising | $30,582 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,456 | TotalAmt |
| Management And General | $248,456 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,053 | TotalAmt |
| Program Services | $2,304 | ProgramServicesAmt |
| Management And General | $95,749 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,188 | TotalAmt |
| Program Services | $257,365 | ProgramServicesAmt |
| Management And General | $10,823 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,647 | TotalAmt |
| Management And General | $9,647 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,867 | TotalAmt |
| Program Services | $16,997 | ProgramServicesAmt |
| Management And General | $112,870 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,704 | TotalAmt |
| Management And General | $54,704 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT COSTS | Desc |
| Total | $1,387,583 | TotalAmt |
| Program Services | $1,387,583 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,216,454 | TotalAmt |
| Program Services | $9,076,705 | ProgramServicesAmt |
| Management And General | $4,977,604 | ManagementAndGeneralAmt |
| Fundraising | $162,145 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,673,409 | BOYAmt |
| EOY | $1,759,973 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $452,705 | BOYAmt |
| EOY | $681,591 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,055,616 | BOYAmt |
| EOY | $3,181,903 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $177,047 | BOYAmt |
| EOY | $153,737 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,511,543 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,257,367 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,316,733 | BOYAmt |
| EOY | $2,254,176 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,959,569 | BOYAmt |
| EOY | $5,843,150 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,249 | BOYAmt |
| EOY | $41,336 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,666,328 | BOYAmt |
| EOY | $13,915,866 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $984,207 | BOYAmt |
| EOY | $1,018,141 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,920,594 | BOYAmt |
| EOY | $10,298 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,904,801 | BOYAmt |
| EOY | $1,028,439 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,428,509 | BOYAmt |
| EOY | $12,422,804 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $333,018 | BOYAmt |
| EOY | $464,623 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,761,527 | BOYAmt |
| EOY | $12,887,427 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,666,328 | BOYAmt |
| EOY | $13,915,866 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,603,951 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $249,095 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $272,854 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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 Minus4 Years | $1,006,334 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $466,800 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $147,830 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $610,463 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,058,457 | CurrentTaxYearAmt |
| Total | $4,289,884 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $10,267,041 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,259,559 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $12,965,142 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,157,495 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,548,004 | CurrentTaxYearAmt |
| Total | $63,197,241 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,273,375 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,726,359 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,112,972 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,767,958 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,606,461 | CurrentTaxYearAmt |
| Total | $67,487,125 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | 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) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $67,487,125 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $110,843 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $98,517 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $75,625 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $59,692 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $78,817 | CurrentTaxYearAmt |
| Total | $423,494 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $110,843 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $98,517 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $75,625 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $59,692 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $78,817 | CurrentTaxYearAmt |
| Total | $423,494 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $55,399 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $91,954 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,345 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $599 | CurrentTaxYearMinus1YearAmt |
| Total | $157,297 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,439,617 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,916,830 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,197,942 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $16,828,249 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $15,685,278 | CurrentTaxYearAmt |
| Total | $68,067,916 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99150 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98910 | PublicSupportPY509Pct |
| Investment Income CY | 0.00620 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00770 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS INCOME FUNDRAISING EVENT REVENUES | ExplanationTxt |
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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,292,797 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $196,332 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $8,688 | AdministrativeExpensesAmt |
| End Year Balance | $1,480,441 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,081,200 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $218,906 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $7,309 | AdministrativeExpensesAmt |
| End Year Balance | $1,292,797 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $883,484 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $204,117 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $6,401 | AdministrativeExpensesAmt |
| End Year Balance | $1,081,200 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $596,790 | BeginningYearBalanceAmt |
| Contributions | $425,000 | ContributionsAmt |
| Investment Earnings Or Losses | -$132,693 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $5,613 | AdministrativeExpensesAmt |
| End Year Balance | $883,484 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $263,964 | BeginningYearBalanceAmt |
| Contributions | $318,176 | ContributionsAmt |
| Investment Earnings Or Losses | $16,733 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,083 | OtherExpendituresAmt |
| End Year Balance | $596,790 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $416,150 | OtherCostOrOtherBasisAmt |
| Book Value | $416,150 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,509,558 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,673,965 | DepreciationAmt |
| Book Value | $1,835,593 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,585,835 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,583,402 | DepreciationAmt |
| Book Value | $2,433 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,254,176 | TotalBookValueLandBuildingsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | BOARD-DESIGNATED ENDOWMENTS PROVIDE FOR UNFUNDED HOSPICE CARE FOR THE COMMUNITY AND PROVIDE FOR UNCOMPENSATED CARE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHERYL MACDONALD | ||||||||||||||
| MEDICAL DIRECTOR | $283,107 | $0 | $14,451 | $0 | $0 | $0 | $0 | $0 | $7,077 | $0 | $304,635 | $0 | $0 | $0 |
| NANCY BOUTIN | ||||||||||||||
| HOSPICE PHYSICIAN | $238,164 | $0 | $3,563 | $0 | $0 | $0 | $24,986 | $0 | $0 | $0 | $266,713 | $0 | $0 | $0 |
| IRIA NISHIMURA | ||||||||||||||
| EXECUTIVE DIRECTOR | $183,100 | $0 | $5,500 | $0 | $0 | $0 | $8,522 | $0 | $7,822 | $0 | $204,944 | $0 | $0 | $0 |
| BARB FARMER | ||||||||||||||
| CLINICAL MANAGER | $147,312 | $0 | $12,046 | $0 | $0 | $0 | $10,061 | $0 | $6,935 | $0 | $176,354 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 46 | ContributionCnt |
| Noncash Contributions Rpt F990 | $10,411 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | ESTIMATED FMV | MethodOfDeterminingRevenuesTxt |
Food Inventory FoodInventoryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 15 | ContributionCnt |
| Noncash Contributions Rpt F990 | $3,600 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | ESTIMATED FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 25 | ContributionCnt |
| Noncash Contributions Rpt F990 | $10,320 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | ESTIMATED FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | SUPPLIES | Desc |
| Contribution | 54 | ContributionCnt |
| Noncash Contributions Rpt F990 | $11,109 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | ESTIMATED FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. THE EXCUTIVE COMMITTEE HAS THE POWER OF THE BOARD TO AUTHORIZE EXPENDITURES AND AMENDMENTS TO BUDGETS, SET POLICIES, AND AUTHORIZE PROGRAMS OR ACTIVITIES. THE EXECUTIVE COMMITTE MAKES REASONABLE EFFORTS TO COMMUNICATE WITH THE FULL BOARD IN ADVANCE REGARDING THE ISSUES AND DECISIONS THAT WILL BE CONSIDERED OR VOTED ON AT EXECUTIVE COMMITTEE MEETINGS. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR FINANCIAL OVERSIGHT OF THE ORGANIZATION'S INCOME AND EXPENSES. THE COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE ORGANIZATION'S FINANCIAL TRANSACTIONS AND THE IMPLEMENTATION OF THE ORGANIZATION'S FINANCIAL POLICIES. THE COMMITTEE REVIEWS ON A MONTHLY BASIS, OR OVERSEE A MONTHLY REVIEW OF, THE ORGANIZATION'S EXPENDITURES, FINANCIAL TRANSACTIONS, BANK STATEMENTS, RETURNED CHECKS, AND CREDIT CARD STATEMENTS. THE COMMITTEE ALSO MAKES THE NECESSARY ARRANGEMENTS FOR AND OVERSEES THE ORGANIZATION'S ANNUAL AUDIT OR ANNUAL FINANCIAL REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS REVIEWED BY THE FINANCE MANAGER, THE EXECUTIVE DIRECTOR AND THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS AND EMPLOYEES. ALL BOARD MEMBERS, VOLUNTEERS AND STAFF SIGN A CONFLICT OF INTEREST STATEMENT UPON JOINING THE ORGANIZATION. BOARD MEMBERS AND EXECUTIVE STAFF ANNUALLY PROVIDE WRITTEN DISCLOSURE OF ALL PROFESSIONAL AND PERSONAL RELATIONSHIPS OR INTERESTS, DIRECT OR INDIRECT, THAT MIGHT PRESENT A CONFLICT OF INTEREST. IF A MATTER ARISES IN WHICH A BOARD MEMBER HAS AN ACTUAL OR POTENTIAL CONFLICT, THAT CONFLICT IS IMMEDIATELY DISCLOSED TO THE BOARD. IF THE MATTER INVOLVES A VOTE, THE CONFLICTED INDIVIDUAL ABSTAINS FROM VOTING. IF A MATTER ARISES IN WHICH A VOLUNTEER OR EMPLOYEE HAS AN ACTUAL OR POTENTIAL CONFLICT, THE CONFLICT IS IMMEDIATELY DISCLOSED TO THE EXECUTIVE DIRECTOR WHO INVESTIGATES IT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND IS SUMMARIZED IN AN EMPLOYMENT CONTRACT. ALL OTHER EMPLOYEES' COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE DIRECTOR. COMPARABLE COMPENSATION WAS DETERMINED BY USING MARKET RESEARCH WITH ASSISTANCE FROM A COMPENSATION CONSULTING FIRM. MARKET SURVEYS ARE DONE ON ALL EMPLOYEES EACH YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XII, LINE 2C | THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |