STRATEGY STUDIO / PUBLIC DATA EXPLORER

HOSPICE ALLIANCE FOUNDATION INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
HOSPICE ALLIANCE FOUNDATION INC (EIN 39-1822945)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-09-11
IRS object ID
202022559349300412
Schema version
2019v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-09-11T08:47:46-05:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN391648207PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ANDREA & ORENDORFF LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line16300 76TH ST STE 200AddressLine1Txt
CityKENOSHACityNm
State AbbreviationWIStateAbbreviationCd
ZIP531424018ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391822945EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHOSPBusinessNameControlTxt
Phone2626524400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1Txt
CityPLEASANT PRAIRIECityNm
State AbbreviationWIStateAbbreviationCd
ZIP53158ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJEAN GARRETTOPersonNm
Person TitleSECRETARY/TREASURERPersonTitleTxt
Phone2626524482PhoneNum
Signature2020-09-01SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMIKE HEDDENPreparerPersonNm
PTINP00744376PTIN
Phone2626577716PhoneNum
Preparation2020-09-01PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address74.218.59.85IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-09-11IPDt
IP Tm08:47:46IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdF3543CC7BF6C365C69313107A5F8E030DA8CA74AAtSubmissionCreationDeviceId
At Submission Filing Device Id58564B83F3CE31422438AEB8BF6CA74893FB9944AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJEAN GARRETTOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1Txt
CityPLEASANT PRAIRIECityNm
State AbbreviationWIStateAbbreviationCd
ZIP53158ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,778,714GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HOSPICEALLIANCE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1996FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTHE FOUNDATION SUPPORTS HOSPICE ALLIANCE IN PROVIDING PHYSICAL, EMOTIONAL AND SPIRITUAL CARE, AND EDUCATION FOR PATIENTS FACING LIFE-LIMITING ILLNESSES, THOSE WHO SUPPORT THEM AND THE COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$321,291PYContributionsGrantsAmt
CY Contributions Grants$262,703CYContributionsGrantsAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income-$234,183PYInvestmentIncomeAmt
CY Investment Income$1,336,767CYInvestmentIncomeAmt
PY Other Revenue-$87,847PYOtherRevenueAmt
CY Other Revenue-$105,250CYOtherRevenueAmt
PY Total Revenue-$739PYTotalRevenueAmt
CY Total Revenue$1,494,220CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$122,503PYOtherExpensesAmt
CY Other Expenses$98,202CYOtherExpensesAmt
PY Total Expenses$122,503PYTotalExpensesAmt
CY Total Expenses$98,202CYTotalExpensesAmt
PY Revenues Less Expenses-$123,242PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,396,018CYRevenuesLessExpensesAmt
Total Assets BOY$14,109,403TotalAssetsBOYAmt
Total Assets EOY$15,483,822TotalAssetsEOYAmt
Total Liabilities BOY$558,071TotalLiabilitiesBOYAmt
Total Liabilities EOY$536,472TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$13,551,332NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$14,947,350NetAssetsOrFundBalancesEOYAmt
MissionTHE FOUNDATION SUPPORTS HOSPICE ALLIANCE IN PROVIDING PHYSICAL, EMOTIONAL AND SPIRITUAL CARE, AND EDUCATION FOR PATIENTS FACING LIFE-LIMITING ILLNESSES, THOSE WHO SUPPORT THEM AND THE COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$74,151ExpenseAmt
DescALL REVENUES AND EXPENSES ARE RELATED TO THE PURPOSE OF RAISING MONEY FOR HOSPICE ALLIANCE, INC. THE FOUNDATION WILL BE ABLE TO GRANT MONEY TO HOSPICE ALLIANCE, INC. AS NEEDED DUE TO CHANGES IN ITS BUSINESS ENVIRONMENT.Desc
Total Program Service Expenses$74,151TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BLACKMOR CPABusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8282331180PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11611 ASHEVILLE HIGHWAYAddressLine1Txt
CityHENDERSONVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28791ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
DAVID BERMAN
MEMBER1.00Yes (X)$0$0$0
JEAN GARRETTO
SECRETARY/TR1.00Yes (X)$0$0$0Yes (X)
LEONARD IAQUINTA
MEMBER1.00Yes (X)$0$0$0
DENNIS MATTIOLI
MEMBER1.00Yes (X)$0$0$0
ALIYA PITTS
FORMER MEMBE1.00Yes (X)$0$0$0
JOHN PLOUS
PRESIDENT1.00Yes (X)$0$0$0Yes (X)
RICHARD REGNER
VICE PRESIDE1.00Yes (X)$0$0$0Yes (X)
SANDRA RIESE RN
FORMER MEMBE1.00Yes (X)$0$0$0
TOM TENUTA
MEMBER1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
All Other Contributions$262,703AllOtherContributionsAmt
Total Contributions$262,703TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,336,767TotalRevenueColumnAmt
Exclusion$1,336,767ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$99,996RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$267,997RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real-$168,001RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column-$168,001TotalRevenueColumnAmt
Exclusion-$168,001ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$75,947FundraisingGrossIncomeAmt
Fundraising Direct Expenses$16,497FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$59,450TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescBRICK MEMORIALDesc
Total Revenue Column$3,301TotalRevenueColumnAmt
Related Or Exempt Func Income$3,301RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$3,301OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,494,220TotalRevenueColumnAmt
Related Or Exempt Func Income$3,301RelatedOrExemptFuncIncomeAmt
Exclusion$1,168,766ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$250TotalAmt
Management And General$250ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$6,741TotalAmt
Management And General$6,741ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$58,737TotalAmt
Program Services$52,098ProgramServicesAmt
Management And General$6,639ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$3,258TotalAmt
Program Services$3,258ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
COMMUNITY AWARENESS$16,839$16,839
PROPERTY TAXES$10,421$10,421
DUES$1,801$1,801
LICENSES & PERMITS$155$155

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$98,202TotalAmt
Program Services$74,151ProgramServicesAmt
Management And General$24,051ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$872,160BOYAmt
EOY$492,993EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,766,718BOYAmt
EOY$1,798,811EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$4,068BOYAmt
EOY$4,499EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$6,226,644LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,859,164LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,457,891BOYAmt
EOY$4,367,480EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$7,008,566BOYAmt
EOY$8,820,039EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$14,109,403BOYAmt
EOY$15,483,822EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,910BOYAmt
EOY$8,473EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$550,161BOYAmt
EOY$527,999EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$558,071BOYAmt
EOY$536,472EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$13,551,332BOYAmt
EOY$14,947,350EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$13,551,332BOYAmt
EOY$14,947,350EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$14,109,403BOYAmt
EOY$15,483,822EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,396,018ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE INCBusinessNameLine1Txt
Business Name Line2HOSPICE ALLIANCE INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
EIN391403883EIN
Organization Type10OrganizationTypeCd
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$188,997OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Other Support Sum$188,997OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,135,876OtherCostOrOtherBasisAmt
Book Value$1,135,876BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,167,553OtherCostOrOtherBasisAmt
Depreciation$1,424,225DepreciationAmt
Book Value$2,743,328BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$669,945OtherCostOrOtherBasisAmt
Depreciation$255,077DepreciationAmt
Book Value$414,868BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$253,270OtherCostOrOtherBasisAmt
Depreciation$179,862DepreciationAmt
Book Value$73,408BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,367,480TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$1,494,220TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$1,494,220RevenueSubtotalAmt
Total Revenue Per Form990$1,494,220TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$98,202TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$98,202ExpensesSubtotalAmt
Total Expenses Per Form990$98,202TotalExpensesPerForm990Amt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1ANNUAL GALAEvent1Nm
Gross Receipts Event1$75,947GrossReceiptsEvent1Amt
Gross Revenue Event1$75,947GrossRevenueEvent1Amt
Rent Facility Costs Event1$1,845RentFacilityCostsEvent1Amt
Food And Beverage Event1$9,115FoodAndBeverageEvent1Amt
Entertainment Event1$1,500EntertainmentEvent1Amt
Other Direct Expenses Event1$4,037OtherDirectExpensesEvent1Amt
Gross Receipts Total$75,947GrossReceiptsTotalAmt
Gross Revenue Total Events$75,947GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$1,845RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$9,115FoodAndBeverageTotalEventsAmt
Entertainment Total Events$1,500EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$4,037OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$16,497DirectExpenseSummaryEventsAmt
Net Income Summary$59,450NetIncomeSummaryAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 1, PART I, LINE 6THERE ARE NO VOLUNTEERS FOR FOUNDATION, BUT VOLUNTEERS ARE PART OF HOSPICE ALLIANCE, INC. (OPERATIONS).
FORM 990, PAGE 6, PART VI, LINE 11BTHE 990 WAS REVIEWED IN DETAIL BY THE FINANCE DIRECTOR AND BY THE ORGANIZATIONS FINANCE COMMITTEE AND THEN APPROVED BY THE FINANCE COMMITTEE. ALL FINANCIAL INFORMATION IN THIS RETURN IS BASED OFF OF THE AUDITED FINANCIAL STATEMENTS.
FORM 990, PAGE 6, PART VI, LINE 12CPRIOR TO ELECTION, POTENTIAL BOARD MEMBERS MUST DOCUMENT ANY CONFLICTS OF INTEREST. BOARD MEMBERS MUST REAFFIRM ANNUALLY.
FORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION WILL FURNISH AUDITED FINANCIAL STATEMENTS UPON REQUEST.
FORM 990, PART IX, LINE 11GCONTRACTED SERVICES-OPS 52,098 0 0 CONSULTING 0 6,639 0 TOTAL 52,098 6,639 0

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE ALLIANCE INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line110220 PRAIRIE RIDGE BLVDAddressLine1Txt
CityPLEASANT PRAIRIECityNm
State AbbreviationWIStateAbbreviationCd
ZIP53158ZIPCd
FieldValueIRS element (for citing)
EIN391403883EIN
Primary ActivitiesHOSPICEPrimaryActivitiesTxt
Legal Domicile StateWILegalDomicileStateCd
Exempt Code Section501C3ExemptCodeSectionTxt
Public Charity Status10PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
HOSPICE ALLIANCE INC
B$99,997RENTAL CONTRACT
HOSPICE ALLIANCE INC
P$52,098FOR OFFICE & PERSONNEL