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FOSS HOME & VILLIAGE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FOSS HOME & VILLIAGE (EIN 91-0573114)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201233199349305458
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2012-11-14T15:06:06-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 NORTHUP WAY SUITE 200AddressLine1
CityBELLEVUECity
StateWAState
ZIP Code980041446ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN910573114EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FOSS HOME & VILLAGEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFOSSNameControl
Phone2063641300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line113023 GREENWOOD AVE NAddressLine1
CitySEATTLECity
StateWAState
ZIP Code981337397ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID CROUCHName
TitlePRESIDENT & CEOTitle
Phone2063641300Phone
Date Signed2012-10-29DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSTEVE BASSName
PTINP00004800PTIN
Phone4252506100Phone
Date Prepared2012-10-29DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID CROUCHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line113023 GREENWOOD AVE NAddressLine1
CitySEATTLECity
StateWAState
ZIP Code981337397ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18115846GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.FOSSCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1929YearFormation
State Legal DomicileWAStateLegalDomicile
Activity Or Mission DescriptionNURSING HOME & ASSISTED LIVING FACILITYActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees376TotalNbrEmployees
Total Nbr Volunteers162TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year200000ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year18198386ProgramServiceRevenuePriorYear
Program Service Revenue CY18008295ProgramServiceRevenueCY
Investment Income Prior Year41491InvestmentIncomePriorYear
Investment Income Current Year48851InvestmentIncomeCurrentYear
Other Revenue Prior Year9290OtherRevenuePriorYear
Other Revenue Current Year7291OtherRevenueCurrentYear
Total Revenue Prior Year18449167TotalRevenuePriorYear
Total Revenue Current Year18064437TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year13744323SalariesEtcPriorYear
Salaries Etc Current Year13258828SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4401040OtherExpensePriorYear
Other Expenses Current Year4386833OtherExpensesCurrentYear
Total Expenses Prior Year18145363TotalExpensesPriorYear
Total Expenses Current Year17645661TotalExpensesCurrentYear
Revenues Less Expenses Prior Year303804RevenuesLessExpensesPriorYear
Revenues Less Expenses CY418776RevenuesLessExpensesCY
Total Assets BOY11338239TotalAssetsBOY
Total Assets EOY11822134TotalAssetsEOY
Total Liabilities BOY7465352TotalLiabilitiesBOY
Total Liabilities EOY7489943TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3872887NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4332191NetAssetsOrFundBalancesEOY
Mission DescriptionNURSING HOME AND ASSISTED LIVING FACILITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense15872180Expense
Revenue18015586Revenue
DescriptionNURSING HOME AND ASSISTED LIVING CARE, INCLUDING A SUBSTANTIAL NUMBER OF MEDICARE & MEDICAID SUPPORTED RESIDENTS/PATIENTS. 52% OF REVENUE IS FROM MEDICARE/MEDICAID AND THE REMAINDER IS FROM PRIVATE PAY RESIDENTS. RATES ARE SET BASED ON MARKET RATES IN THE SEATTLE AREA, AND ARE NECESSARY TO MAKE THE ORGANIZATION VIABLE.Description
Total Program Service Expense15872180TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109641NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees376NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledWAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PATRICIA UPDEGRAFFBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2063641300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line113023 GREENWOOD AVE NAddressLine1
CitySEATTLECity
StateWAState
ZIP Code981337397ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
ART BATT
TRUSTEE2.00XX000
KELLIE HESSLER DE'ARTURET
TRUSTEE2.00X000
MARYANN JOHNSTON
VICE-CHAIRPERSON2.00XX000
DAWNELL LAMB
TRUSTEE2.00X000
CARLOS GUANGORENA
TRUSTEE2.00X000
PAUL WOLD
TRUSTEE2.00X000
MARK CHURCHILL
CHAIRPERSON2.00XX000
NORMA BEERWEILER
TRUSTEE2.00X000
REVEREND MARVIN JONASEN
TRUSTEE2.00X000
JANE JONES
TRUSTEE2.00X000
DAVID CROUCH
PRESIDENT & CEO40.00X168196072805
PATRICIA L UPDEGRAFF
TREASURER, CFO40.00X101074039593
JOHN F HENRY JR
PROGRAM DIRECTOR40.00100886021404X
FieldValueIRS element (for citing)
Total Reportable Comp From Org370156TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation133802TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonJEM PROFESSIONAL SERVICESNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line117912 25TH DRIVE SEAddressLine1
CityBOTHELLCity
StateWAState
ZIP Code98012ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONTRACT THERAPISTDescriptionOfServices
Compensation186693Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT FEESDescription
Business Code623000BusinessCode
Total Revenue Column17733831TotalRevenueColumn
Related Or Exempt Function Income17733831RelatedOrExemptFunctionIncome

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column274464TotalRevenueColumn
Related Or Exempt Function Income274464RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue18008295TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column48851TotalRevenueColumn
Exclusion$48,851ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real58700Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real51409Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real7291Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column7291TotalRevenueColumn
Exclusion$7,291ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18064437TotalRevenueColumn
Related Or Exempt Function Income18008295RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$56,142ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total381668Total
Management And General381668ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9844229Total
Program Services9210076ProgramServices
Management And General634153ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total290389Total
Program Services258446ProgramServices
Management And General31943ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1650948Total
Program Services1477095ProgramServices
Management And General173853ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1091594Total
Program Services1013674ProgramServices
Management And General77920ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total43960Total
Program Services43960ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total16701Total
Program Services16701ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total49475Total
Program Services49475ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total107605Total
Program Services107605ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total81400Total
Management And General81400ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total708320Total
Program Services672904ProgramServices
Management And General35416ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total17688Total
Program Services17688ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total102269Total
Program Services43771ProgramServices
Management And General58498ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total377792Total
Program Services358902ProgramServices
Management And General18890ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
PURCHASED SERVICES744380597339147041
FOOD733722733722
SUPPLIES71872969825020479
PHARMACY449497449497

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total235295Total
Program Services123075ProgramServices
Management And General112220ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total17645661Total
Program Services15872180ProgramServices
Management And General1773481ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY948698BOY
EOY996627EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1860259BOY
EOY2012592EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY55878BOY
EOY61530EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY290021BOY
EOY266533EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18300292LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11448999LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6630278BOY
EOY6851293EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY428397BOY
EOY467783EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY954695BOY
EOY1018359EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY170013BOY
EOY147417EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11338239BOY
EOY11822134EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2205248BOY
EOY2637965EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5090000BOY
EOY4670000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY170104BOY
EOY181978EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7465352BOY
EOY7489943EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3872887BOY
EOY4332191EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3872887BOY
EOY4332191EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11338239BOY
EOY11822134EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses418776ReconcilationRevenueExpenses
Reconcilation Other Changes40528ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years268971CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years757977CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years131773CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year200000CurrentTaxYearMinus1Year
Total1358721Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18371846CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18235508CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18705425CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18198386CurrentTaxYearMinus1Year
Current Tax Year18015586CurrentTaxYear
Total91526751Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1253CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years-2186CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4193CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year57000CurrentTaxYearMinus1Year
Current Tax Year58700CurrentTaxYear
Total118960Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18642070CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18991299CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18841391CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18455386CurrentTaxYearMinus1Year
Current Tax Year18074286CurrentTaxYear
Total93004432Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50993004432PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years139477CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56248CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39024CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year41491CurrentTaxYearMinus1Year
Current Tax Year48851CurrentTaxYear
Total325091Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years139477CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56248CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39024CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year41491CurrentTaxYearMinus1Year
Current Tax Year48851CurrentTaxYear
Total325091Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years35860CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9290CurrentTaxYearMinus2Years
Total45150Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years18781547CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years19083407CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18889705CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18496877CurrentTaxYearMinus1Year
Current Tax Year18123137CurrentTaxYear
Total93374673Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99600PublicSupportPercentage509
Prior Year Support Percentage0.99470PriorYearSupportPercentage
Investment Income Percentage0.00350InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00480PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis824380InvestmentCostOrOtherBasis
Other Cost Or Other Basis1454155OtherCostOrOtherBasis
Book Value2278535BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1091940InvestmentCostOrOtherBasis
Other Cost Or Other Basis8274224OtherCostOrOtherBasis
Depreciation5660541Depreciation
Book Value3705623BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5568290OtherCostOrOtherBasis
Depreciation4872561Depreciation
Book Value695729BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1087303OtherCostOrOtherBasis
Depreciation915897Depreciation
Book Value171406BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6851293TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
WELLESLEY INCOME FUND503991F
WELLINGTON FUND ADMIRAL514368F
FieldValueIRS element (for citing)
Total Of Book Value Securities1018359TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RESIDENT TRUST ACCTS$15,934
DEPOSITS$166,044
FieldValueIRS element (for citing)
Total Of Amounts181978TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS REPORT THERE ARE NO MATTERS THAT WOULD CREATE UNRELATED BUSINESS INCOME TAX OR CALL INTO QUESTION ITS EXEMPT STATUS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonDAVID CROUCHNamePerson
Base Compensation Filing Org168196BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org49841DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org22964NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org241001TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationDAVID CROUCH 49,841Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11DRAFT TAX RETURN DISTRIBUTED AT BOARD MEETING FOR REVIEW AND APPROVAL.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY 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 15BOARD OF DIRECTORS REVIEWS DATA ON SALARY FROM SALARY SURVEY COMPILED BY HOPSITAL ASSOCIATION, REVIEWS FROM 990'S OF COMPARABLE ORGANIZAITONS.
FORM 990, PART VI, SECTION C, LINE 19DOCUMENTS AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 40,528.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2CTHE AUDIT COMMITTEE HAS OVERSIGHT RESPONSIBILITY FOR THE FINANCIAL STATEMENTS, AND THE SELECTION OF THE INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.AUDIT COMMITTEE RESPONSIBILITY

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1FOSS FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line113023 GREENWOOD AVE NAddressLine1
CitySEATTLECity
StateWAState
ZIP Code981337397ZIPCode
FieldValueIRS element (for citing)
EIN911640102EIN
Primary ActivitiesFUNDRAISING ACTIVITIES TO RAISE FUNDS TO PROVIDE GRANTS TO FOSS HOME & VILLAPrimaryActivities
Legal Domicile StateWALegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusSEC 170(B)(1)(A)(I)PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg