FOSS HOME & VILLIAGE: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- FOSS HOME & VILLIAGE (EIN 91-0573114)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-10-08
- IRS object ID
- 202102819349301320
- Schema version
- 2020v4.1
- 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 | 2021-10-08T12:04:23-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | 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 | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910573114 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FOSS HOME & VILLAGE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FOSS | BusinessNameControlTxt |
| Phone | 2063641300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13023 GREENWOOD AVENUE NORTH | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 981337397 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN HENRY JR | PersonNm |
| Person Title | PRESIDENT & CEO | PersonTitleTxt |
| Phone | 2063641300 | PhoneNum |
| Signature | 2021-10-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOHN | PersonFirstNm |
| Person Last | HENRY JR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2021-10-06 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN HENRY JR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13023 GREENWOOD AVENUE NORTH | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 981337397 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,842,622 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FOSSCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1929 | FormationYr |
| Legal Domicile State | WA | LegalDomicileStateCd |
| Activity Or Mission | NURSING HOME AND ASSISTED LIVING FACILITY | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 367 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $366,590 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,660,130 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $20,638,829 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $16,588,783 | CYProgramServiceRevenueAmt |
| PY Investment Income | $90,179 | PYInvestmentIncomeAmt |
| CY Investment Income | $125,465 | CYInvestmentIncomeAmt |
| PY Other Revenue | $298,928 | PYOtherRevenueAmt |
| CY Other Revenue | $283,022 | CYOtherRevenueAmt |
| PY Total Revenue | $21,394,526 | PYTotalRevenueAmt |
| CY Total Revenue | $18,657,400 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $600 | 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 | $15,486,719 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,241,591 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $99,967 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,971,932 | PYOtherExpensesAmt |
| CY Other Expenses | $5,077,958 | CYOtherExpensesAmt |
| PY Total Expenses | $21,459,251 | PYTotalExpensesAmt |
| CY Total Expenses | $20,319,549 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$64,725 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,662,149 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,994,538 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,533,947 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,712,057 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,829,981 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,282,481 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,703,966 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | NURSING HOME AND ASSISTED LIVING FACILITY | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,817,496 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $16,588,783 | RevenueAmt |
| Desc | NURSING HOME AND ASSISTED LIVING CARE, INCLUDING A SUBSTANTIAL NUMBER OF MEDICAID AND MEDICARE SUPPORTED RESIDENTS/PATIENTS. 70% OF SERVICE REVENUE IS FROM MEDICARE/MEDICAID AND THE REMAINDER IS FROM PRIVATE PAY RESIDENTS. WE SERVED 299 NURSING HOME CLIENTS AND 59 ASSISTED LIVING CLIENTS. THE AVERAGE LENGTH OF STAY FOR SHORT-STAY RESIDENTS, DEFINED BY THOSE WHO STAYED 100 DAYS OR LESS, WAS 20.9 DAYS. RATES ARE SET BASED ON MARKET RATES IN THE SEATTLE AREA, AND ARE NECESSARY TO MAKE THE ORGANIZATION VIABLE. FOSS PARTNERS WITH COMMUNITY COLLEGES, COLLEGES AND UNIVERSITIES, TO PROVIDE A LEARNING ENVIRONMENT, FOR INTERN PROGRAMS IN THE AREAS OF DENTISTRY, PHARMACY, RESTORATIVE THERAPY, NURSING, AND NURSING ASSISTANT TRAINING. FOSS ALSO HAS AN ACTIVE VOLUNTEER PROGRAM THAT ENCOURAGES HIGH SCHOOL AND COLLEGE STUDENTS. | Desc |
| Total Program Service Expenses | $15,817,496 | 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 | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | 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 | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | 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 | 0 | 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 | 38 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 367 | 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 | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN RICK HENRY JR | PersonNm |
| Phone | 2063641300 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13023 GREENWOOD AVENUE NORTH | AddressLine1Txt |
| City | SEATTLE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 981337397 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| PATRICIA UPDEGRAFF | |||||||
| CFO & TREASURER (THROUGH MARCH 2020) | 40.00 | Yes (X) | $337,920 | $0 | $6,614 | ||
| JOHN RICK HENRY JR | |||||||
| PRESIDENT & CEO | 40.00 | Yes (X) | $234,250 | $0 | $20,491 | ||
| BANAFSHEH BAHARLOO RN | |||||||
| NURSE | 40.00 | $203,822 | $0 | $18,481 | Yes (X) | ||
| RACHAEL GERDIS NHS | |||||||
| VICE PRESIDENT & COO | 40.00 | $143,314 | $0 | $42,199 | Yes (X) | ||
| LORINDA HOOPER | |||||||
| DIRECTOR OF NURSING | 40.00 | $139,370 | $0 | $17,714 | Yes (X) | ||
| SOLOMON G-KIDANE LPN | |||||||
| NURSE | 40.00 | $144,674 | $0 | $12,306 | Yes (X) | ||
| KIFLE SHEWANGIZAW LPN | |||||||
| NURSE | 40.00 | $138,156 | $0 | $13,610 | Yes (X) | ||
| ELLIOTT WESTERMAN | |||||||
| CONTRACT CFO (MARCH-NOV 2020) | 8.00 | Yes (X) | $0 | $0 | $0 | ||
| JULIE YARI | |||||||
| CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JEFF WEST RN | |||||||
| VICE CHAIR | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LARRAINE KING | |||||||
| SECRETARY | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KRIS CHICK | |||||||
| TREASURER | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| MARTA ACEDO | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| LYNNE DASHER | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| JOHN GIENAPP | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| BEV ROACH | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| JUDY WILDES | |||||||
| TRUSTEE | 0.50 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,341,506 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $131,415 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CONSONUS REHAB | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4560 SE INTERNATIONAL WAY SUITE 10 | AddressLine1Txt |
| City | MILWAUKIE | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97222 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | THERAPY | ServicesDesc |
| Compensation | $559,442 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,358,087 | GovernmentGrantsAmt |
| All Other Contributions | $302,043 | AllOtherContributionsAmt |
| Total Contributions | $1,660,130 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RESIDENT FEES | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $16,588,783 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,588,783 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $16,588,783 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $125,465 | TotalRevenueColumnAmt |
| Exclusion | $125,465 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $237,960 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $178,788 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $59,172 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,172 | TotalRevenueColumnAmt |
| Exclusion | $59,172 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $19,089 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $6,434 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,655 | TotalRevenueColumnAmt |
| Exclusion | $12,655 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS INCOME | 900099 | $210,695 | $210,695 |
| GUEST MEAL INCOME | 900099 | $500 | $500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $211,195 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,657,400 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,588,783 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $408,487 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $593,922 | TotalAmt |
| Management And General | $593,922 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,788,169 | TotalAmt |
| Program Services | $9,652,286 | ProgramServicesAmt |
| Management And General | $2,071,998 | ManagementAndGeneralAmt |
| Fundraising | $63,885 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $322,865 | TotalAmt |
| Program Services | $256,308 | ProgramServicesAmt |
| Management And General | $64,861 | ManagementAndGeneralAmt |
| Fundraising | $1,696 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,423,868 | TotalAmt |
| Program Services | $1,124,716 | ProgramServicesAmt |
| Management And General | $291,708 | ManagementAndGeneralAmt |
| Fundraising | $7,444 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,112,767 | TotalAmt |
| Program Services | $868,969 | ProgramServicesAmt |
| Management And General | $238,047 | ManagementAndGeneralAmt |
| Fundraising | $5,751 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,007 | TotalAmt |
| Management And General | $19,007 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,104 | TotalAmt |
| Management And General | $53,104 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,122,725 | TotalAmt |
| Program Services | $786,821 | ProgramServicesAmt |
| Management And General | $335,394 | ManagementAndGeneralAmt |
| Fundraising | $510 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,718 | TotalAmt |
| Program Services | $43 | ProgramServicesAmt |
| Management And General | $30,338 | ManagementAndGeneralAmt |
| Fundraising | $2,337 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,402 | TotalAmt |
| Program Services | $25,926 | ProgramServicesAmt |
| Management And General | $27,015 | ManagementAndGeneralAmt |
| Fundraising | $14,461 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $882,753 | TotalAmt |
| Program Services | $592,969 | ProgramServicesAmt |
| Management And General | $289,784 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,585 | TotalAmt |
| Management And General | $7,585 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,318 | TotalAmt |
| Management And General | $130,318 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $554,654 | TotalAmt |
| Program Services | $527,224 | ProgramServicesAmt |
| Management And General | $27,430 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,096,252 | $1,096,252 | |
| FOOD | $640,392 | $640,392 | |
| BAD DEBT EXPENSE | $171,585 | $171,585 | |
| REPAIRS & MAINTENANCE | $122,745 | $69,325 | $53,420 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,718 | TotalAmt |
| Program Services | $4,680 | ProgramServicesAmt |
| Management And General | $168,155 | ManagementAndGeneralAmt |
| Fundraising | $3,883 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,319,549 | TotalAmt |
| Program Services | $15,817,496 | ProgramServicesAmt |
| Management And General | $4,402,086 | ManagementAndGeneralAmt |
| Fundraising | $99,967 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,389,720 | BOYAmt |
| EOY | $3,576,068 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,651,379 | BOYAmt |
| EOY | $1,108,484 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,243 | BOYAmt |
| EOY | $124,040 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $198,212 | BOYAmt |
| EOY | $219,915 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,868,827 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,631,955 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,644,519 | BOYAmt |
| EOY | $9,236,872 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,049,084 | BOYAmt |
| EOY | $2,253,631 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,381 | BOYAmt |
| EOY | $14,937 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,994,538 | BOYAmt |
| EOY | $16,533,947 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,891,912 | BOYAmt |
| EOY | $1,275,771 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $201,692 | BOYAmt |
| EOY | $2,430,738 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,381 | BOYAmt |
| EOY | $14,937 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,424,429 | BOYAmt |
| EOY | $3,223,408 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,189,643 | BOYAmt |
| EOY | $885,127 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,712,057 | BOYAmt |
| EOY | $7,829,981 | 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 | $9,685,437 | BOYAmt |
| EOY | $8,146,808 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $597,044 | BOYAmt |
| EOY | $557,158 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,282,481 | BOYAmt |
| EOY | $8,703,966 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,994,538 | BOYAmt |
| EOY | $16,533,947 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,662,149 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $83,634 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| 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 | $477,060 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $399,150 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $332,935 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $351,078 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,660,130 | CurrentTaxYearAmt |
| Total | $3,220,353 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $18,840,234 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,009,743 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19,877,132 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $20,638,829 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $16,588,783 | CurrentTaxYearAmt |
| Total | $94,954,721 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $34,160 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $52,968 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $58,764 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $59,524 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,589 | CurrentTaxYearAmt |
| Total | $225,005 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,351,454 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,461,861 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,268,831 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,049,431 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,268,502 | CurrentTaxYearAmt |
| Total | $98,400,079 | 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 | $98,400,079 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $216,601 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $200,940 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $288,001 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $280,969 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $363,425 | CurrentTaxYearAmt |
| Total | $1,349,936 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $216,601 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $200,940 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $288,001 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $280,969 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $363,425 | CurrentTaxYearAmt |
| Total | $1,349,936 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $40,502 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $45,972 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $140,331 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $230,959 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $210,695 | CurrentTaxYearAmt |
| Total | $668,459 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,608,557 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,708,773 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,697,163 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,561,359 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $18,842,622 | CurrentTaxYearAmt |
| Total | $100,418,474 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.97990 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98270 | PublicSupportPY509Pct |
| Investment Income CY | 0.01340 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01150 | 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 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,528,000 | OtherCostOrOtherBasisAmt |
| Book Value | $3,528,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,962,021 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,441,246 | DepreciationAmt |
| Book Value | $4,520,775 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,306,393 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,115,519 | DepreciationAmt |
| Book Value | $190,874 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,072,413 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,075,190 | DepreciationAmt |
| Book Value | $997,223 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,236,872 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFFERRED COMPENSATION | Desc |
| Amt | $885,127 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $885,127 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $18,651,158 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $83,634 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $83,634 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,567,524 | RevenueSubtotalAmt |
| Other Revenues Not Included | $89,876 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $89,876 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,657,400 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,238,218 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,238,218 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $81,331 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $81,331 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $20,319,549 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | THE ORGANIZATION HOLDS TRUST ACCOUNTS FOR RESIDENTS WHO REQUEST THAT WE DO SO AND FOR ANY RESIDENTS OF WHICH THE ORGANIZATION IS REPRESENTATIVE PAYEE FOR SOCIAL SECURITY PURPOSES. THE MONEY IS HELD IN AN INTEREST-BEARING CHECKING ACCOUNT. RESIDENTS CAN OBTAIN THEIR MONEY UPON REQUEST. |
| PART X, LINE 2: | FOSS IS A NONPROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND FILES AN ANNUAL FEDERAL INFORMATION RETURN FORM 990. FOSS IS EXEMPT FROM INCOME TAXES EXCEPT FOR INCOME, IF ANY, DERIVED FROM UNRELATED BUSINESS ACTIVITIES. THERE WAS NO NET UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ISSUED ACCOUNTING STANDARDS CODIFICATION (ASC) TOPIC 740, INCOME TAXES (TOPIC 740) ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. FOSS ADOPTED THIS GUIDANCE FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. MANAGEMENT EVALUATED FOSS' TAX POSITIONS AND CONCLUDED THAT FOSS HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THIS GUIDANCE. FOSS IS NO LONGER SUBJECT TO U.S. FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2017. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CONTRIBUTIONS RESTRICTED FOR CAPITAL USE 8,545. EXPENSES NETTED AGAINST REVENUES IN THE FINANCIAL STATEMENTS 34,383. BAD DEBT EXPENSE 46,948. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES NETTED AGAINST REVENUES IN THE FINANCIAL STATEMENTS 34,383. BAD DEBT EXPENSE 46,948. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 | Yes (1) | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PATRICIA UPDEGRAFF | ||||||||||||||
| CFO & TREASURER (THROUGH MARCH 2020) | $337,920 | $0 | $0 | $0 | $0 | $0 | $1,336 | $0 | $5,278 | $0 | $344,534 | $0 | $0 | $0 |
| JOHN RICK HENRY JR | ||||||||||||||
| PRESIDENT & CEO | $234,250 | $0 | $0 | $0 | $0 | $0 | $9,370 | $0 | $11,121 | $0 | $254,741 | $0 | $0 | $0 |
| BANAFSHEH BAHARLOO RN | ||||||||||||||
| NURSE | $203,822 | $0 | $0 | $0 | $0 | $0 | $8,252 | $0 | $10,229 | $0 | $222,303 | $0 | $0 | $0 |
| RACHAEL GERDIS NHS | ||||||||||||||
| VICE PRESIDENT & COO | $143,314 | $0 | $0 | $0 | $0 | $0 | $5,761 | $0 | $36,438 | $0 | $185,513 | $0 | $0 | $0 |
| LORINDA HOOPER | ||||||||||||||
| DIRECTOR OF NURSING | $139,370 | $0 | $0 | $0 | $0 | $0 | $5,747 | $0 | $11,967 | $0 | $157,084 | $0 | $0 | $0 |
| SOLOMON G-KIDANE LPN | ||||||||||||||
| NURSE | $144,674 | $0 | $0 | $0 | $0 | $0 | $4,195 | $0 | $8,111 | $0 | $156,980 | $0 | $0 | $0 |
| KIFLE SHEWANGIZAW LPN | ||||||||||||||
| NURSE | $138,156 | $0 | $0 | $0 | $0 | $0 | $5,545 | $0 | $8,065 | $0 | $151,766 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | JOHN (RICK) HENRY, JR. AND PAT UPDEGRAFF PARTICIPATE IN A 457(F) SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THERE WERE NO CONTRIBUTIONS INTO, ACCRUALS WITHIN, OR PAYMENTS OUT OF THE PLAN IN 2020. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD, THE CHAIRPERSON OF THE FINANCE COMMITTEE, THE CHAIRPERSON OF THE STRATEGIC PLANNING COMMITTEE, AND THE CHAIRPERSON OF THE GOVERNANCE COMMITTEE. THE DUTIES OF THE EXECUTIVE COMMITTEE ARE TO (A) APPROVE THE AGENDA FOR EACH BOARD MEETING; (B) APPROVE ACTIONS ON BEHALF OF THE BOARD IN THE EVENT OF EMERGENCIES REQUIRING RESOLUTION BEFORE THE FULL BOARD CAN BE CONVENED OR BEFORE THE BOARD CAN APPROVE A UNANIMOUS WRITTEN CONSENT WITHOUT A MEETING; (C) SERVE AS THE SEARCH COMMITTEE FOR PRESIDENTIAL CANDIDATES; (D) ADOPT, SUBJECT TO RATIFICATION OR AMENDMENT BY THE BOARD, THE POSITION DESCRIPTION FOR THE PRESIDENT; (F) CONDUCT THE ANNUAL PERFORMANCE REVIEW WITH THE PRESIDENT; (F) PROVIDE FOR BOARD EDUCATION; (G) MAINTAIN INVOLVEMENT WITH THE OTHER STANDING COMMITTEES OF THE BOARD; AND (H) MAKE RECOMMENDATIONS TO THE BOARD FOR PERSONS TO FILL THE OFFICER POSITIONS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 3 | BETWEEN MARCH AND NOVEMBER 2020, CONTRACT CFO SERVICES WERE PROVIDED BY THE HEARTHSTONE, ANOTHER SENIOR LIVING ORGANIZATION IN SEATTLE, WASHINGTON. |
| FORM 990, PART VI, SECTION B, LINE 11B | PRIOR TO FILING, A DRAFT OF THE FORM 990 WAS REVIEWED BY THE CEO AND CFO, THEN SUBMITTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR THEIR APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED AT THE BOARD MEETING, AND MEMBERS ARE REQUIRED TO COMPLETE AND SIGN THE FORM FOR PROPER DISCLOSURE. MEMBERS ARE DIRECTED TO NOTIFY THE BOARD DURING THE YEAR IF A CONFLICT OF INTEREST DEVELOPS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS REVIEWS SALARY DATA FROM A SALARY SURVEY COMPILED BY LEADINGAGE WASHINGTON AND FROM REVIEWING THE FORMS 990 OF COMPARABLE ORGANIZATIONS. THE CEO REVIEWS SALARY DATA IN A SIMILAR MANNER FOR THE OTHER OFFICERS. THE REVIEW PROCESS WAS LAST CONDUCTED IN 2019 FOR THE CEO AND IN 2018 FOR THE CFO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |