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FOSS HOME & VILLIAGE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
FOSS HOME & VILLIAGE (EIN 91-0573114)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-10-03
IRS object ID
201102769349300720
Schema version
2010v3.4
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)
Timestamp2011-10-03T15:04:29-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MONSON & BASS INC PSBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13500 188TH SW SUITE 234AddressLine1
CityLYNNWOODCity
StateWAState
ZIP Code980374716ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

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 Signed2011-09-12DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameSTEVEN B BASS CPAName
Phone4257785232Phone
Date Prepared2011-09-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

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 Receipts18496877GrossReceipts
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 Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees376TotalNbrEmployees
Total Nbr Volunteers162TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year131773ContributionsGrantsPriorYear
Contributions Grants Current Year200000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year18705425ProgramServiceRevenuePriorYear
Program Service Revenue CY18198386ProgramServiceRevenueCY
Investment Income Prior Year39024InvestmentIncomePriorYear
Investment Income Current Year41491InvestmentIncomeCurrentYear
Other Revenue Prior Year35860OtherRevenuePriorYear
Other Revenue Current Year9290OtherRevenueCurrentYear
Total Revenue Prior Year18912082TotalRevenuePriorYear
Total Revenue Current Year18449167TotalRevenueCurrentYear
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 Year13460933SalariesEtcPriorYear
Salaries Etc Current Year13744323SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4587061OtherExpensePriorYear
Other Expenses Current Year4401040OtherExpensesCurrentYear
Total Expenses Prior Year18047994TotalExpensesPriorYear
Total Expenses Current Year18145363TotalExpensesCurrentYear
Revenues Less Expenses Prior Year864088RevenuesLessExpensesPriorYear
Revenues Less Expenses CY303804RevenuesLessExpensesCY
Total Assets BOY11401711TotalAssetsBOY
Total Assets EOY11338239TotalAssetsEOY
Total Liabilities BOY7892410TotalLiabilitiesBOY
Total Liabilities EOY7465352TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3509301NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3872887NetAssetsOrFundBalancesEOY
Mission DescriptionNURSING HOME AND ASSISTED LIVING FACILITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16058698Expense
Revenue18198386Revenue
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 Expense16058698TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 With109647NumberFormsTransmittedWith1096
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 Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
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 (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
ART BATT
TRUSTEE2.00X000
ARLENE VANDERKLOMP
CHAIRPERSON2.00X000X
KELLIE HESSLER DE'ARTURET
TRUSTEE2.00X000
MARYANN JOHNSTON
SECRETARY2.00X000X
DAWNELL LAMB
TRUSTEE2.00X000
CARLOS GUANGORENA
TRUSTEE2.00X000
PAUL WOLD
TRUSTEE2.00X000
MARK CHURCHILL
VICE-CHAIRPERSON2.00X000X
NORMA BEERWEILER
TRUSTEE2.00X000
REVEREND MARVIN JONASEN
TRUSTEE2.00X000
JANE JONES
TRUSTEE2.00X000
DAVID CROUCH
PRESIDENT & CEO40.00181674077720X
PATRICIA L UPDEGRAFF
TREASURER, CFO40.00109212043465X
GAIL M BARTHOLD
DIRECTOR OF NURSING40.00101304031585X
JOHN F HENRY JR
PROGRAM DIRECTOR40.00106782022438X
FieldValueIRS element (for citing)
Total Reportable Comp From Org498972TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation175208TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
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
Compensation234345Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Related Organizations200000RelatedOrganizations
Total Contributions200000TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT FEESDescription
Business Code623000BusinessCode
Total Revenue Column18045676TotalRevenueColumn
Related Or Exempt Function Income18045676RelatedOrExemptFunctionIncome

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column152710TotalRevenueColumn
Related Or Exempt Function Income152710RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue18198386TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column41491TotalRevenueColumn
Exclusion$41,491ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real57000Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real47710Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real9290Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column9290TotalRevenueColumn
Exclusion$9,290ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18449167TotalRevenueColumn
Related Or Exempt Function Income18198386RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$50,781ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total412071Total
Management And General412071ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10384947Total
Program Services9394733ProgramServices
Management And General990214ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total314575Total
Program Services281945ProgramServices
Management And General32630ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1522617Total
Program Services1441426ProgramServices
Management And General81191ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1110113Total
Program Services976899ProgramServices
Management And General133214ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total43680Total
Program Services43680ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total19098Total
Management And General19098ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total49855Total
Management And General49855ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total119102Total
Program Services119102ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total83813Total
Program Services73755ProgramServices
Management And General10058ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total755084Total
Program Services664474ProgramServices
Management And General90610ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total36866Total
Program Services36866ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total118175Total
Program Services103994ProgramServices
Management And General14181ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total521307Total
Program Services458750ProgramServices
Management And General62557ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES74813765836189776
FOOD734708734708
PURCHASED SERVICES59727352560071673
PHARMACY333286333286

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total240656Total
Program Services211119ProgramServices
Management And General29537ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total18145363Total
Program Services16058698ProgramServices
Management And General2086665ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY801190BOY
EOY948698EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1896381BOY
EOY1860259EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY60168BOY
EOY55878EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY269099BOY
EOY290021EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis17919062LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11288784LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6891874BOY
EOY6630278EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1282493BOY
EOY428397EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY954695EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY200506BOY
EOY170013EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11401711BOY
EOY11338239EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2252566BOY
EOY2205248EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5480000BOY
EOY5090000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY159844BOY
EOY170104EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7892410BOY
EOY7465352EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3509301BOY
EOY3872887EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3509301BOY
EOY3872887EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11401711BOY
EOY11338239EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses303804ReconcilationRevenueExpenses
Reconcilation Other Changes59782ReconcilationOtherChanges
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 Years287348CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years268971CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years757977CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year131773CurrentTaxYearMinus1Year
Current Tax Year200000CurrentTaxYear
Total1646069Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17466249CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18371846CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18235508CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18705425CurrentTaxYearMinus1Year
Current Tax Year18198386CurrentTaxYear
Total90977414Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years-7972CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1253CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years-2186CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4193CurrentTaxYearMinus1Year
Current Tax Year57000CurrentTaxYear
Total52288Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17745625CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18642070CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18991299CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18841391CurrentTaxYearMinus1Year
Current Tax Year18455386CurrentTaxYear
Total92675771Total

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 Total50992675771PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years168027CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years139477CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years56248CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39024CurrentTaxYearMinus1Year
Current Tax Year41491CurrentTaxYear
Total444267Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years168027CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years139477CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years56248CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39024CurrentTaxYearMinus1Year
Current Tax Year41491CurrentTaxYear
Total444267Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years35860CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9290CurrentTaxYearMinus1Year
Total45150Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17913652CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18781547CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years19083407CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18889705CurrentTaxYearMinus1Year
Current Tax Year18496877CurrentTaxYear
Total93165188Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99470PublicSupportPercentage509
Prior Year Support Percentage0.99440PriorYearSupportPercentage
Investment Income Percentage0.00480InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00560PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis676973InvestmentCostOrOtherBasis
Other Cost Or Other Basis1454155OtherCostOrOtherBasis
Book Value2131128BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis938516InvestmentCostOrOtherBasis
Other Cost Or Other Basis8110332OtherCostOrOtherBasis
Depreciation5473933Depreciation
Book Value3574915BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5651783OtherCostOrOtherBasis
Depreciation4918722Depreciation
Book Value733061BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1087303OtherCostOrOtherBasis
Depreciation896129Depreciation
Book Value191174BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6630278TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
WELLESLEY INCOME FUND448215F
WELLINGTON FUND ADMIRAL506480F
FieldValueIRS element (for citing)
Total Of Book Value Securities954695TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RESIDENT TRUST ACCTS$14,346
DEPOSITS$155,758
FieldValueIRS element (for citing)
Total Of Amounts170104TotalOfAmounts

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 (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID CROUCH
18167400000526450250750259394000
PATRICIA L UPDEGRAFF
10921200000281630153020152677000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 4BReturnReference
ExplanationDAVID CROUCH 49,012Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11DRAFT TAX RETURN DISTRIBUTED AT BOARD MEETING FOR REVIEW AND APPROVAL.
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 12C
BOARD 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 B, LINE 15
DOCUMENTS AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 59,782.FORM 990, PART XI, LINE 5:
AUDIT COMMITTEE RESPONSIBILITYTHE 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.FORM 990, PART XII, LINE 2C

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 Org1GiftGrantOrCapContrFrOtherOrg
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

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1FOSS FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved200000AmountInvolved
Method Of Amt DeterminationCASHMethodOfAmtDetermination