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 |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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 | ||||||
| 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 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| 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. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on 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.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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) |
||||
| 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): |
|||||
| 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | THE ORGANIZATION OPERATES A BIBLICALLY-BASED, HOLISTIC MENTAL HEALTH AND REHABILITATION CLINIC. THE ORGANIZATION PROVIDES A PLACE FOR BROKEN AND BURNED OUT PEOPLE STRUGGLING WITH DEPRESSION AND OTHER MENTAL ILLNESSES, AS WELL AS FOR PEOPLE STRUGGLING WITH SUBSTANCE ABUSE OR ADDICTIONS. THE ORGANIZATION SERVES THESE INDIVIDUALS THROUGH OUTPATIENT TREATMENT, RESIDENTIAL DETOXIFICATION, AFTERCARE, AND INTERVENTION AND CASE MANAGEMENT. ALL PATIENTS ARE ASSIGNED A TREAMENT TEAM WHO ASSUMES THE RESPONSIBILITY OF ENGAGING PATIENTS IN THE TREATMENT AND RECOVERY PROCESS, OVERSEEING THE COORDINATION OF CARE, SERVING AS ADVOCATES FOR THE PATIENTS, PROVIDING EDUCATION AND CONTINUAL SUPPORT, AND OTHERWISE WORKING WITH THE PATIENTS THROUGHOUT THE RESIDENTIAL AND OUTPATIENT PROGRAMS. THE ORGANIZATION ALSO HAS A SPECIALIZED PASTORAL TRACK FOR PASTORS AND MINISTRY LEADERS. THE ORGANIZATION RECOGNIZES THE SIGNIFICANT NEED IN THIS AREA - TO PROVIDE CHRISTIAN COUNSELING AND REHABILITATION FOR PASTORS WHO ARE LEADING AND LIVING ON EMPTY. THE ORGANIZATION UTILIZES ITS CONNECTIONS WITH MINISTRIES AND CHURCHES ACROSS THE U.S. TO IDENTIFY PATIENTS THAT WOULD BE A GOOD FIT FOR THIS SPECIALIZED PROGRAM. |
| FORM 990, PAGE 5, PART V, LINE 3B | THE ORGANIZATION HAD NO UNRELATED BUSINESS TAXABLE INCOME IN THE CURRENT YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 2 | DAVID HOSKINS KIM NACHTWEY OTHER BUSINESS RELATIONSHIP DAVID HOSKINS KARL BENZIO OTHER BUSINESS RELATIONSHIP KIM NACHTWEY KARL BENZIO OTHER BUSINESS RELATIONSHIP |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS THREE PERMANENT MEMBERS: CCJI MINISTRY, LLC, A SINGLE-MEMBER LLC OF WHICH CELEBRATION CHURCH OF JACKSONVILLE, INC., AN UNRELATED TAX-EXEMPT CHURCH, IS THE SOLE MEMBER; CELEBRATION CARE MINISTRIES, AN UNRELATED TAX-EXEMPT ORGANIZATION; AND LIGHTKEEPERS INTERNATIONAL, INC., AN UNRELATED TAX-EXEMPT ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE ORGANIZATION'S MEMBERS HAVE THE AUTHORITY TO APPOINT THE NUMBER OF DIRECTORS SPECIFIED IN THE ORGANIZATION'S BYLAWS. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE ORGANIZATION'S MEMBERS HAVE THE AUTHORITY TO APPROVE OR REJECT ANY AMENDMENT TO THE ORGANIZATION'S ARTICLES OR BYLAWS THAT MAY MATERIALLY REDUCE, ELIMINATE, OR AFFECT ANY SUCH MEMBER'S RIGHTS OR PRIVILEGES THEREUNDER, AND TO APPROVE OR REJECT DISSOLUTION OF THE ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL AND TOP FINANCIAL OFFICIAL EACH REVIEW THE FORM 990 PRIOR TO ITS FILING WITH THE IRS. A COPY OF THE FINAL FORM 990 IS ALSO PROVIDED TO THE VOTING MEMBERS OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO TIS FILING WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO EACH MEMBER OF THE ORGANIZATION'S GOVERNING BODY, ITS OFFICERS AND ITS KEY EMPLOYEES ON AN ANNUAL BASIS. EACH SUCH INDIVIDUAL PROVIDES AN ANNUAL DISCLOSURE STATEMENT INDICATING THAT THEY HAVE RECEIVED, READ, UNDERSTOOD AND AGREED TO COMPLY WITH THE POLICY, CERTIFYING THAT: (1) THEY HAVE NO RELATIONSHIPS OR INTERESTS THAT PRESENT A CONFLICT OF INTEREST, (2) THEY HAVE ONE OR MORE CONFLICTS OF INTEREST THAT HAVE BEEN FULLY DISCLOSED AS REQUIRED BY THE POLICY AND HAVE BEEN PROPERLY ADMINISTERED IN CONFORMITY WITH THE POLICY, OR (3) THEY HAVE PREVIOUSLY UNDISCLOSED CONFLICTS OF INTEREST AND DISCLOSING THE DETAILS OF SUCH CONFLICTS. ANY DISCLOSURE STATEMENTS WITH PREVIOUSLY UNDISCLOSED CONFLICTS OF INTEREST ARE FORWARDED TO APPROPRIATE ORGANIZATION OFFICIALS TO TAKE APPROPRIATE ACTIONS AS REQUIRED BY THE POLICY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ORGANIZATION'S BOARD OF DIRECTORS, OR AN INDEPENDENT COMMITTEE THEREOF, ANNUALLY REVIEWS AND APPROVES THE COMPENSATION LEVELS OF THE ORGANIZATION'S CEO, OFFICERS, KEY EMPLOYEES, AND DIRECTORS (INCLUDING COMPENSATION PAID TO ENTITIES OWNED OR CONTROLLED BY SUCH INDIVIDUALS). THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE ARE CONTEMPORANEOUSLY SUBSTANTIATED. THE COMMITTEE UTILIZES COMPARABILITY DATA IN ITS DELIBERATIONS; UPDATED COMPARABILITY DATA IS GENERALLY OBTAINED EVERY TWO TO THREE YEARS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE ORGANIZATION'S BOARD OF DIRECTORS, OR AN INDEPENDENT COMMITTEE THEREOF, ANNUALLY REVIEWS AND APPROVES THE COMPENSATION LEVELS OF THE ORGANIZATION'S CEO, OFFICERS, KEY EMPLOYEES, AND DIRECTORS (INCLUDING COMPENSATION PAID TO ENTITIES OWNED OR CONTROLLED BY SUCH INDIVIDUALS). THE DELIBERATIONS AND DECISIONS OF THE COMMITTEE ARE CONTEMPORANEOUSLY SUBSTANTIATED. THE COMMITTEE UTILIZES COMPARABILITY DATA IN ITS DELIBERATIONS; UPDATED COMPARABILITY DATA IS GENERALLY OBTAINED EVERY TWO TO THREE YEARS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION PROVIDES, UPON REQUEST, COPIES OF ITS ARTICLES OF INCORPORATION, BYLAWS, CONFLICT OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS. |
| FORM 990, PAGE 12, PART XII, LINE 1 | THE METHOD OF ACCOUNTING ON THE PRIOR YEAR FORM 990 INCORRECTLY STATED THAT THE ACCRUAL METHOD OF ACCOUNTING WAS USED WHEN IN FACT THE ORGANIZATION USED THE TAX BASIS OF ACCOUNTING. FORMALLY, THERE WAS NO CHANGE AND NO ADJUSTMENTS WERE REQUIRED. THE ORGANIZATION PREPARES ITS FINANCIAL STATEMENTS ON THE INCOME TAX BASIS OF ACCOUNTING; CONSEQUENTLY, REVENUE IS RECOGNIZED AS PAYMENT IS RECEIVED BY THE ORGANIZATION. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE RECOGNITION OF REVENUE AS WHEN IT IS EARNED. ADDITIONALLY, THE TAX BASIS OF ACCOUNTING REQUIRES THAT BAD DEBTS BE RECOGNIZED WHEN RECEIVABLES ARE DEEMED FULLY UNCOLLECTIBLE; GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRES THE RECOGNITION OF BAD DEBTS USING AN ALLOWANCE METHOD. |
| Software ID: | |
| Software Version: |