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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 57,419 | 637,953 | 366,879 | 160,676 | 340,234 | 1,563,161 |
| 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 | 834,816 | 823,303 | 870,245 | 815,408 | 778,965 | 4,122,737 |
| 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 | 892,235 | 1,461,256 | 1,237,124 | 976,084 | 1,119,199 | 5,685,898 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 168,868 | 119,044 | 191,170 | 233,099 | 237,098 | 949,279 |
| c | Add lines 7a and 7b.. | 168,868 | 119,044 | 191,170 | 233,099 | 237,098 | 949,279 |
| 8 | Public support. (Subtract line 7c from line 6.) | 4,736,619 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 892,235 | 1,461,256 | 1,237,124 | 976,084 | 1,119,199 | 5,685,898 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,463 | 2,463 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 2,463 | 2,463 | ||||
| 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.) .. | 5,002 | 7,885 | 753 | 1,410 | 15,050 | |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 897,237 | 1,461,256 | 1,247,472 | 976,837 | 1,120,609 | 5,703,411 |
| 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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2019 AMOUNT: $ 1,354. 2021 AMOUNT: $ 7,885. 2022 AMOUNT: $ 753. 2023 AMOUNT: $ 1,410. BAD DEBT RECOVERY - 2019 AMOUNT: $ 3,648. |
| Software ID: | |
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| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | HEBREW COMMUNITY SERVICES, INC. ("THE CORPORATION") HAS ONLY ONE MEMBER. THE SOLE MEMBER OF THE CORPORATION SHALL BE HEBREW HEALTH CARE, INC., A CONNECTICUT NONSTOCK CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | PERSUANT TO THE BYLAWS, THE BOARD SHALL HAVE THREE (3) EX-OFFICIO TRUSTEES. THE PERSONS WHO HOLD THE FOLLOWING OFFICES OR POSITIONS SHALL BE THE EX-OFFICIO TRUSTEES OF THE CORPORATION AT ALL TIMES WHILE SERVING IN SUCH OFFICES OR POSITIONS, AUTOMATICALLY AND WITHOUT THE NEED FOR ANY ACTION BY THE MEMBER OR THE OTHER TRUSTEES. (I) THE CHAIRPERSON OF THE BOARD OF TRUSTEES OF HEBREW HEALTH CARE, INC., A CONNECTICUT NONSTOCK CORPORATION; (II) THE PRESIDENT OF HEBREW HEALTH CARE, INC., A CONNECTICUT NONSTOCK CORPORATION; (III) THE SENIOR VICE PRESIDENT OF HEBREW HEALTH CARE, INC., A CONNECTICUT NONSTOCK CORPORATION; A PERSON SHALL CEASE TO BE AN EX-OFFICIO TRUSTEE IMMEDIATELY UPON CEASING TO HOLD THE OFFICE OR POSITION FROM WHICH HIS OR HER EX-OFFICIO TRUSTEE STATUS DERIVED, AND HIS OR HER SUCCESSOR IN SUCH OFFICE OR POSITION SHALL AUTOMATICALLY BE AN EX-OFFICIO TRUSTEE WITHOUT THE NEED FOR ANY ACTION BY THE MEMBER OR THE OTHER TRUSTEES. THE EX-OFFICIO TRUSTEES SHALL BE COUNTED FOR PURPOSES OF DETERMINING THE PRESENCE OF A QUORUM AT MEETINGS OF THE BOARD OF TRUSTEES AND EACH EX-OFFICIO TRUSTEE SHALL HAVE A VOTE ON ALL MATTERS THAT COME BEFORE THE BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | PURSUANT TO THE BYLAWS, THE MEMBER SHALL HAVE THE RIGHT TO VOTE ON ALL MATTERS UPON WHICH MEMBERS OF A CONNECTICUT NONSTOCK CORPORATION ARE AFFORDED THE RIGHT TO VOTE UNDER THE ACT. WITHOUT LIMITING THE FOREGOING, EACH OF THE FOLLOWING MATTERS SHALL REQUIRE THE APPROVAL OF THE MEMBER: (A) ADOPTION OF THE CORPORATION'S ANNUAL BUDGET FOR ANTICIPATED REVENUES AND EXPENDITURES, BOTH OPERATING AND CAPITAL, AND ADOPTION OF ANY CHANGES TO SUCH BUDGET; (B) UNLESS ADOPTED AS PART OF THE CORPORATION'S ANNUAL BUDGET: (1) THE SALE, LEASE, EXCHANGE OR OTHER TRANSFER OR DISPOSITION (OTHER THAN AS PROVIDED FOR IN SUBPARAGRAPH (B)(2) BELOW) OF ANY OF THE CORPORATION'S PROPERTY OR ASSETS OF ANY NATURE; (2) THE MORTGAGE PLEDGE, OR OTHER ENCUMBRANCE OF ANY OF THE CORPORATION'S PROPERTY OR ASSETS OF ANY NATURE THAT IS NOT IN CONNECTION WITH A PLANNED GIVING OR OTHER CHARITABLE ARRANGEMENT, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S ISSUANCE OF CHARITABLE GIFT ANNUITIES; (3) THE INCURRENCE BY THE CORPORATION OF INDEBTEDNESS FOR BORROWED MONEY OR ISSUANCE BY THE CORPORATION OF A GUARANTY OR OTHER UNDERTAKING TO BECOME OBLIGATED FOR ANY DEBT OR OBLIGATION OF ANY PARTY (IN EACH CASE, OTHER THAN IN CONNECTION WITH A PLANNED GIVING OR OTHER CHARITABLE ARRANGEMENT, INCLUDING BUT NOT LIMITED TO THE CORPORATION'S ISSUANCE OF CHARITABLE GIFT ANNUITIES); (4) THE EXPENDITURE OF, OR COMMITMENT TO MAKE ANY EXPENDITURE OF, FUNDS OF THE CORPORATION, WHETHER OPERATING OR CAPITAL, IN EXCESS OF $5,000; (5) THE MAKING OF ANY LOAN BY THE CORPORATION TO ANY PARTY IN EXCESS OF $500; (C) ANY AMENDMENT OR REPEAL OF ANY PROVISION OF THE BYLAWS OF THE CORPORATION; (D) ANY CHANGE IN THE PURPOSES OR MISSION OF THE CORPORATION; (E) ANY MERGER INVOLVING THE CORPORATION; (F) THE DISSOLUTION OF THE CORPORATION; (G) PARTICIPATION BY THE CORPORATION IN ANY JOINT VENTURE, PARTNERSHIP OR SIMILAR ACTIVITY; (H) ENGAGING IN ANY TRANSACTION IN WHICH THE CORPORATION BECOMES A SHAREHOLDER, MEMBER OR EQUITY OWNER OF A CORPORATION, LIMITED LIABILITY COMPANY OR OTHER ENTITY; (I) THE ANNUAL APPOINTMENT OF A FIRM OF PUBLIC ACCOUNTANTS TO CONDUCT AN INDEPENDENT AUDIT OF THE CORPORATION'S FINANCIAL AFFAIRS; OR (J) ANY AMENDMENT OR REPEAL OF ANY PROVISION OF THE AMENDED AND RESTATED CERTIFICATE OF INCORPORATION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE ASSISTANCE OF MANAGEMENT. AN ELECTRONIC COPY OF THE RETURN WAS DISTRIBUTED TO THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THIS ORGANIZATION HAS ADOPTED THE POLICY OF ITS SOLE MEMBER HEBREW HEALTH CARE, INC. REGARDING CONFLICT OF INTEREST. PER THE CONFLICT OF INTEREST POLICY WHICH APPLIES TO ALL ORGANIZATIONS IN THE HEBREW SENIOR CARE SYSTEM, OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES HAVE A DUTY TO DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST. FOLLOWING DISCLOSURE OF AN ACTUAL OR POSSIBLE CONFLICT, THE OTHER MEMBERS OF THE BOARD OR COMMITTEE WILL DETERMINE WHAT FURTHER STEPS MAY BE REQUIRED TO INVESTIGATE THE SITUATION. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT WILL RECUSE THEMSELF FROM THE DISCUSSION OF THE MATTER. THE POLICY INCLUDES PROVISIONS FOR VIOLATION AND FAILURE TO DISCLOSE WHICH COULD LEAD TO DISCIPLINARY AND CORRECTIVE ACTION, INCLUDING, BUT NOT LIMITED TO REMOVAL FROM THE BOARD OR COMMITTEE IN ACCORDANCE WITH THE BYLAWS OF THE ENTITY. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE REVIEWED BY THE ADMINISTRATIVE SECRETARY OF HEBREW HOME & HOSPITAL, A MEMBER OF THE HEBREW SENIOR CARE SYSTEM. |
| FORM 990, PART VI, SECTION B, LINE 15 | ALL COMPENSATION FOR THE PRESIDENT AND OFFICERS ARE PAID BY THE SOLE MEMBER, HEBREW HEALTH CARE, INC. THIS ORGANIZATION HAS ADOPTED THE POLICY OF ITS SOLE MEMBER HEBREW HEALTH CARE, INC. REGARDING COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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