Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 819,851 | 744,616 | 673,576 | 674,555 | 1,088,271 | 4,000,869 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 10,935,149 | 11,767,052 | 12,917,444 | 11,910,089 | 13,715,282 | 61,245,016 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 11,755,000 | 12,511,668 | 13,591,020 | 12,584,644 | 14,803,553 | 65,245,885 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 7,880 | 17,565 | 11,210 | 22,375 | 10,175 | 69,205 |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 7,880 | 17,565 | 11,210 | 22,375 | 10,175 | 69,205 |
| 8 | Public support. (Subtract line 7c from line 6.) | 65,176,680 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 11,755,000 | 12,511,668 | 13,591,020 | 12,584,644 | 14,803,553 | 65,245,885 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 179,069 | 174,878 | 192,680 | 182,851 | 184,384 | 913,862 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 179,069 | 174,878 | 192,680 | 182,851 | 184,384 | 913,862 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 7,071 | 6,857 | 2,418 | 4,994 | 2,568 | 23,908 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 11,941,140 | 12,693,403 | 13,786,118 | 12,772,489 | 14,990,505 | 66,183,655 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2016 AMOUNT: $ 7,071. 2017 AMOUNT: $ 6,857. 2018 AMOUNT: $ 2,418. 2019 AMOUNT: $ 4,994. 2020 AMOUNT: $ 2,568. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION UPDATED THE BYLAWS WITH THE FOLLOWING CHANGES: ARTICLE III-BOARD OF DIRECTORS: - PAST CHAIRS OF THE BOARD OF DIRECTORS (INCLUDING THOSE WHO SERVED AS PRESIDENT OF THE BOARD OF DIRECTORS WHEN THE TOP EMPLOYEE WAS EXECUTIVE DIRECTOR) ARE ALSO EXEMPT FROM THESE TERM LIMITS AND MAY CONTINUE TO SERVE ON THE BOARD OF DIRECTORS, WHETHER OR NOT THEY REMAIN ON THE EXECUTIVE COMMITTEE. ARTICLE III-BOARD OF DIRECTORS: SECTION 6. REGULAR MEETING OF THE BOARD - THE BOARD SHALL HOLD NOT LESS THAN ELEVEN REGULAR MEETINGS RATHER THAN SIX AS PREVIOUSLY REQUIRED. ARTICLE IV-OFFICERS: SECTION 1. DESIGNATION AND ELECTION OF OFFICERS - THE BOARD INCREASED THE MAXIMUM NUMBER OF OFFICERS FROM ELEVEN TO TWELVE OFFICERS. ARTICLE IV-OFFICERS: SECTION 3. VICE-CHAIRPERSON OF THE BOARD- IN THE ABSENCE OF BOTH THE CHAIRPERSON AND THE VICE-CHAIRPERSON OF THE BOARD, THE BOARD, ON MOTION OF ANY DIRECTOR AND PROPERLY APPROVED, SHALL DESIGNATE AN ACTING CHAIR FOR THAT MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | HOSPICE OF ORANGE AND SULLIVAN COUNTIES, INC. HAS ITS FORM 990 PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND HAS ESTABLISHED THE FOLLOWING REVIEW PROCESS TO ENSURE THAT THE INFORMATION REPORTED IS COMPLETE AND ACCURATE. WHEN THE FORM 990 HAS BEEN PREPARED, REVIEWED BY THE OUTSIDE ACCOUNTANTS AND IS READY TO BE FILED WITH THE INTERNAL REVENUE SERVICE, IT IS ELECTRONICALLY SENT TO THE VP OF FINANCE OF THE ORGANIZATION. ANY QUESTIONS OR CHANGES ARE PROVIDED TO THE OUTSIDE ACCOUNTANTS. A REVISED COPY OF THE FORM 990 IS THEN ELECTRONICALLY SENT TO THE TREASURER AND CHAIRMAN OF THE BOARD FOR REVIEW. AFTER THEIR REVIEW IS COMPLETE, A COPY IS PROVIDED ELECTRONICALLY OR BY MAIL TO THE BOARD MEMBERS, AND THE RETURN IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS APPLICABLE TO ALL HOSPICE PERSONNEL, AS WELL AS MEMBERS OF THE GOVERNING BODY. EACH MEMBER OF THE GOVERNING BODY IS REQUIRED TO SIGN AN ANNUAL DISCLOSURE STATEMENT WHICH STATES IF THEY BELIEVE THAT THEY HAVE AN ACTUAL OR POTENTIAL CONFLICT. IF A CONFLICT WERE TO ARISE DURING THE YEAR, THE STAFF MEMBER MUST MAKE THE PRESIDENT/CEO OF THE ORGANIZATION AWARE OF THE CONFLICT IN WRITING. THE PRESIDENT/CEO MAKES A DECISION ON HOW TO PROCEED WITH THE MATTER. IF A CONFLICT ARISES WITH A MEMBER OF THE GOVERNING BODY, HE/SHE IS OBLIGATED TO REPORT THE POTENTIAL CONFLICT TO THE GOVERNING BODY. THE GOVERNING BODY WILL RENDER A DECISION OF THAT MEMBER'S ELIGIBILITY TO BE PART OF THE VOTING, IF APPLICABLE. DISCLOSURES OF AN ACTUAL OR POTENTIAL CONFLICT AND THE GOVERNING BODY'S DECISION REGARDING VOTING WILL BE NOTED IN THE MINUTES OF THE MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE COMPENSATION FOR THE ORGANIZATION'S CEO IS APPROVED BY THE BOARD AFTER AN INTERNAL REVIEW IS COMPLETED. THE ORGANIZATION USES THE FOLLOWING ITEMS TO HELP AID IN DETERMINING THE APPROPRIATE COMPENSATION: FORM 990S OF OTHER ORGANIZATION THAT ARE SIMILAR IN SIZE AND OPERATIONS, AND A COMPENSATION SURVEY OR STUDY. AFTER THE BOARD REVIEWS THIS INFORMATION, AN APPROPRIATE SALARY IS DETERMINED BY THE BOARD FOR THAT POSITION AND APPROVED. THE BOARD'S APPROVAL IS DOCUMENTED IN THE MINUTES TO THE MEETING. THIS PROCESS WAS LAST UNDERTAKEN IN JULY 2018. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS POSTED ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECTLY. |
| FORM 990, PART IX, LINE 11G | CONSULTING: PROGRAM SERVICE EXPENSES 27,979. MANAGEMENT AND GENERAL EXPENSES 6,217. FUNDRAISING EXPENSES 345. TOTAL EXPENSES 34,541. INPATIENT SERVICES: PROGRAM SERVICE EXPENSES 856,130. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 856,130. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 57,199. MANAGEMENT AND GENERAL EXPENSES 11,487. FUNDRAISING EXPENSES 638. TOTAL EXPENSES 69,324. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 541,479. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 541,479. PENSION ADMINISTRATION EXPENSE: PROGRAM SERVICE EXPENSES 6,009. MANAGEMENT AND GENERAL EXPENSES 1,618. FUNDRAISING EXPENSES 77. TOTAL EXPENSES 7,704. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR. |
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