JAY COUNTY HOSPITAL AUXILIARY INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- JAY COUNTY HOSPITAL AUXILIARY INC (EIN 35-2139245)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-05-12
- IRS object ID
- 201131329349301113
- Schema version
- 2010v3.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T10:39:10-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BOLLENBACHER & ASSOCIATES LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 215 E PEARL ST PO BOX 702 | AddressLine1 |
| City | PORTLAND | City |
| State | IN | State |
| ZIP Code | 47371 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 352139245 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY COUNTY HOSPITAL AUXILIARY INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JAYC | NameControl |
| Phone | 2607261878 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 W VOTAW | AddressLine1 |
| City | PORTLAND | City |
| State | IN | State |
| ZIP Code | 47371 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RACHEL STULTZ | Name |
| Title | PRESIDENT | Title |
| Phone | 2607261878 | Phone |
| Date Signed | 2011-05-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT A BOLLENBACHER CPA | Name |
| Phone | 2607264207 | Phone |
| Date Prepared | 2011-05-10 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RACHEL STULTZ | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 W VOTAW | AddressLine1 |
| City | PORTLAND | City |
| State | IN | State |
| ZIP Code | 47371 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 129493 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | THE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF THE JAY COUNTY HOSPITAL. FUNCTIONS OF THE ORGANIZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE, AND PROMOTION OF THE HOSPITAL'S PROGRAMS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 16 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 134 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 4281 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4333 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 73684 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 35562 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -27952 | InvestmentIncomePriorYear |
| Investment Income Current Year | -22711 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 24597 | OtherRevenuePriorYear |
| Other Revenue Current Year | 19166 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 74610 | TotalRevenuePriorYear |
| Total Revenue Current Year | 36350 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 37147 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 6903 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 37577 | OtherExpensePriorYear |
| Other Expenses Current Year | 35958 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 74724 | TotalExpensesPriorYear |
| Total Expenses Current Year | 42861 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -114 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -6511 | RevenuesLessExpensesCY |
| Total Assets BOY | 218621 | TotalAssetsBOY |
| Total Assets EOY | 240066 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 218621 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 240066 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF THE JAY COUNTY HOSPITAL. FUNCTIONS OF THE ORGANIZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE, AND PROMOTION OF THE HOSPITAL'S PROGRAMS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 42861 | Expense |
| Grants | 6903 | Grants |
| Revenue | 24639 | Revenue |
| Description | THE JAY COUNTY HOSPITAL AUXILIARY IS A NOT-FOR-PROFIT ORGANIZATION WHOSE PRIMARY PURPOSE IS TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF THE JAY COUNTY HOSPITAL. FUNCTIONS OF THE ORGANIZATION INCLUDE SPONSORSHIP OF HOSPITAL BUILDINGS, EQUIPMENT, PROJECTS AND PROGRAMS TO IMPROVE PATIENT CARE, AND PROMOTION OF THE HOSPITAL'S PROGRAMS. | Description |
| Total Program Service Expense | 42861 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 16 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY COUNTY HOSPITAL AUXILARY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2607261878 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 W VOTAW ST | AddressLine1 |
| City | PORTLAND | City |
| State | IN | State |
| ZIP Code | 47371 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|
| BETTY KRIEG | ||||
| MEMBERSHIP DIRECTOR | X | 0 | 0 | 0 |
| VELMA ROOK | ||||
| MEMBER | X | 0 | 0 | 0 |
| CINDA MIXON | ||||
| MEMBER | X | 0 | 0 | 0 |
| GLEN COLPAERT | ||||
| MEMBER | X | 0 | 0 | 0 |
| KAREN COLPAERT | ||||
| MEMBER | X | 0 | 0 | 0 |
| MARIA HIATT | ||||
| TREASURER | X | 0 | 0 | 0 |
| ROSEMARY PENSINGER | ||||
| ASSISTANT TREASURER | X | 0 | 0 | 0 |
| ROSE FENNING | ||||
| MEMBER | X | 0 | 0 | 0 |
| GAIL FRANKS | ||||
| MEMBER | X | 0 | 0 | 0 |
| KAREN GORE | ||||
| MEMBER | X | 0 | 0 | 0 |
| VERA HEFFNER | ||||
| MEMBER | X | 0 | 0 | 0 |
| DOLLY SNODGRASS | ||||
| MEMBER | X | 0 | 0 | 0 |
| RACHEL STULTZ | ||||
| PRESIDENT | X | 0 | 0 | 0 |
| CAROLE LEONHARD | ||||
| PRESIDENT ELECT | X | 0 | 0 | 0 |
| EMILY STEVESON | ||||
| RECORDING SECRETARY | X | 0 | 0 | 0 |
| EVA WYRICK | ||||
| CORRESPONDING SECRETARY | X | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Membership Dues | 333 | MembershipDues |
| All Other Contributions | 4000 | AllOtherContributions |
| Noncash Contributions | 4000 | NoncashContributions |
| Total Contributions | 4333 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| LIFELINE PROGRAM FEES | 900000 | 27373 | 27373 |
| MISCELLANEOUS INCOME | 900000 | 8189 | 8189 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 35562 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 362 | TotalRevenueColumn |
| Exclusion | $362 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 16695 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 39768 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -23073 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -23073 | TotalRevenueColumn |
| Related Or Exempt Function Income | -23073 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 13745 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 6729 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7016 | TotalRevenueColumn |
| Exclusion | $7,016 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 58796 | GrossSalesOfInventory |
| Cost Of Goods Sold | 46646 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12150 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12150 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36350 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24639 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $7,378 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6903 | Total |
| Program Services | 6903 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4328 | Total |
| Program Services | 4328 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 689 | Total |
| Program Services | 689 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10146 | Total |
| Program Services | 10146 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MISCELLANEOUS EXPENSES | 6186 | 6186 |
| LIFELINE PROGRAM EXPENS | 5903 | 5903 |
| RENT | 4000 | 4000 |
| MILEAGE | 3243 | 3243 |
| ANNUAL DINNER | 770 | 770 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 693 | Total |
| Program Services | 693 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42861 | Total |
| Program Services | 42861 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67439 | BOY |
| EOY | 77863 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44301 | BOY |
| EOY | 44650 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12812 | BOY |
| EOY | 14060 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 210160 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 159415 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46086 | BOY |
| EOY | 50745 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47983 | BOY |
| EOY | 52748 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 218621 | BOY |
| EOY | 240066 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 174102 | BOY |
| EOY | 187318 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 8229 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44519 | BOY |
| EOY | 44519 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 218621 | BOY |
| EOY | 240066 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 218621 | BOY |
| EOY | 240066 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -6511 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 27956 | ReconcilationOtherChanges |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 210160 | OtherCostOrOtherBasis |
| Depreciation | 159415 | Depreciation |
| Book Value | 50745 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 50745 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PORTLAND FOUNDATION SCHOLARSHIP FUND | Description |
| Book Value | 52748 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 52748 | TotalBookValueOtherAssets |
| Total Revenue | 36350 | TotalRevenue |
| Total Expenses | 42861 | TotalExpenses |
| Excess Or Deficit For Year | -6511 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 27956 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 27956 | TotalAdjustments |
| Excess Or Deficit Per FS | 21445 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 64306 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 27956 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 27956 | RevenueNotRptdF990 |
| Revenue Subtotal | 36350 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 36350 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 42861 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 42861 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 42861 | TotalExpensesPerForm990 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | CELEBRATION OF LIGHTS | NameOfEvent1 |
| Gross Receipts Event1 | 9314 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 9314 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 4218 | OtherDirectExpensesEvent1 |
| Name Of Event2 | BOOK SALE | NameOfEvent2 |
| Gross Receipts Event2 | 2667 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 2667 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 2283 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 1764 | GrossReceiptsOtherEvents |
| Gross Revenue Other Events | 1764 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 228 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 13745 | GrossReceiptsTotal |
| Gross Revenue Total Events | 13745 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 6729 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6729 | DirectExpenseSummaryEvents |
| Net Income Summary | 7016 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAY COUNTY HOSPITAL | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 W VOTAW ST | AddressLine1 |
| City | PORTLAND | City |
| State | IN | State |
| ZIP Code | 47371 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 351143305 | EINOfRecipient |
| Amount Of Cash Grant | 6903 | AmountOfCashGrant |
| Purpose Of Grant | TO ASSIST THE JAY COUNTY HOSPITAL IN ITS MISSION TO SERVE THE RESIDENCE OF JAY COUNTY, INDIANA WITH MEDICAL TREATMENT. | PurposeOfGrant |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD OF DIRECTORS REVIEWS THE TAX RETURN BEFORE IT IS FILED | |
| ANNUAL CONFLICT OF INTEREST POLICY STATEMENTS ARE SIGNED BY EACH BOARD MEMBER. THESE ARE THEN REVIEWED BY THE BOARD OF DIRECTORS TO ENSURE COMPLIANCE. | FORM 990, PART VI, SECTION B, LINE 12C | |
| GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 27,956. | FORM 990, PART XI, LINE 5: |