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Form
990-EZ
Department of the Treasury Internal Revenue Service
Short Form
OMB No1545-11
Return of Organization Exempt From Income Tax 201 O
Under section 501(c), 527, or 4947( a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)
/ Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities,
and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions) Open to Put All other organizations with gross receipts less than $200,000 and total assets less than $500,000
at the end of the year may use this form
The orqanization may have to use a copy of this return to satisfy state reoortmq requirements Inspection
A For the 2010 calendar year, or tax year be B Check if applicable C Naive of organization
Address change Name change Initial return Terminated Amended return Application pendinc G Accounting Method I Website: ^
D Employer identification number
HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748
Number and street ( or P O . box, if mail is not delivered to street address ) Room /suite E Telephone number
34692 CALLE ROBLES 949 - 496-7655
City or town , state or country , and ZIP + 4 F Group Exemption
C"ISTRANO BEACH CA 92624 Number ^
Cash 11 Accrual Other (specify) ^ H Check ^ 19 if the organization is not
!FUSA. cor required to attach Schedule B
J Tax -exempt status ( check only one) - lX 501 (c)(3 ) 501(c ) ( ) 4 (insert no ) 4947( a)(1) or 527 1 (Form 990 , 990-EZ , or 990-PF) K Check ^ 1-1 if the organization is not a section 509(a )(3) supporting organization and its gross receipts are normally not more than $50,000 A
Form 990-EZ or Form 990 return is not required though Form 990-N ( e-postcard ) may be required ( see instructions ) But if the organization chooses to file a return , be sure to file a complete return
L Add lines 5b, 6c, and 7b , to line U to determine gross receipts If gross receipts are $200 , 000 or more , or if total assets (Part II,
line 25, column ( B) below ) are $500,000 or more , file Form 990 instead of Form 990-EZ ^ $ 2 7 , 8 8 0
i Part i , , Revenue , Expenses , and Changes in Net Assets or Fund Balances (see the instructions for Part I.)
1 Contributions , gifts, grants , and similar amounts received
2 Program service revenue including government fees and contracts 3 Membership dues and assessments
4 Investment income . .
5a Gross amount from sale of assets other than inventory 5a
b Less : cost or other basis and sales expenses 5b
c Gain or ( loss) from sale of assets other than inventory (Subtract line 5b from line 5a) 6 Gaming and fundraising events
a Gross income from gaming ( attach Schedule G if greater than
a) $15,000) 6a
b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1 ) ( attach Schedule G if the
sum of such gross income and contributions exceeds $15 , 000) 6b c Less : direct expenses from gaming and fundraising events 6c d Net income or (loss ) from gaming and fundraising events (add lines 6a and 6b and subtract
line 6c)
7a Gross sales of inventory , less returns and allowances 7a
b Less cost of goods sold 7b
c Gross profit or (loss ) from sales of inventory ( Subtract line 7b from line 7a)
. . X1.1 8 Other revenue (describe in Schedule 0)
Z 9 Total revenue . Add lines 1 , 2, 3 , 4 , 5c , 6d , 7c, a n d -B-"'-A.
10 Grants and similar amounts paid (list in tlc, ali9) 11 Benefits paid to or for member
ti
U) 12 Salaries , other compen ion, ee benefits Q . N 13 Professional fees and of er ents to ind etONt conflactors o. 14 Occupancy , rent, utilities , alnfir^lblic ,, W 15 Printing , publications , post rid shippin
16 Other expenses ( describe I 17 Total ex penses . Add lines 1 th?o
18 Excess or (deficit ) for the yearl(Suttact line 17 from line 9) .
Z 19 Net assets or fund balances at beginning of year ( from line 27 , column (A)) (must agree with end-of-year figure reported on pnor year ' s return)
Z 20 Other changes in net assets or fund balances ( explain in Schedule 0) 21 Net assets or fund balances at end of year. Combine lines 18 throu g h 20 For Paperwork Reduction Act Notice , see the separate Instructions.
DAA
24,090 3,790
7c 8
^ 9 27,880
10 11 12
13 200
14 2,013
15
16 34 , 794
^ 17 37,007
18 -9,127
"1 71
19 25,902
20
^ 21 16,775
Form 990-EZ (2010)
HCF 06/08/2011 11 53 AM Pg 7
Form'990-^Z ( 2010 ) HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748 Page 2
'Partll Balance Sheets. (see the instructions for Part II.)
Check if the org anization used Schedule 0 to res p ond to an y q uestion in this Part II
(A) Beginning of year ( B) End of year
22 Cash , savings , and investor ,nts .... ... ... . 21 , 869 22 12,742
23 Land and buildings 0 23
24 Other assets ( describe in Sr hedule 0)
4, 033 24 4, 033
25 Total assets 25,902 25 16,775
26 Total liabilities ( describe in Schedule 0) 0 26 0
27 Net assets or fund balances ( line 27 of column ( B ) must a g ree with line 21 )
25 , 902 27 16,775 Part llIA Statement of Program Service Accomplishments ( see the instructions for Part III) Expenses
Check if the o rg anization used Schedule 0 to res p ond to an y q uestion in this Part III ( Required for section
What is the organization 's primary exempt purpose? 501(c)(3) and 501(c)(4)
See Schedule 0 organizations and section
Describe what was achieved in carrying out the organization 's exempt purposes . In a clear and concise manner , describe 4947(a)(1) trusts; optional the services provided , the number of persons benefited , or other relevant information for each program title. for others )
28 See Schedule 0 ... . .. .. ...
... .. . ... ...
. .. . .
.. . ... .. .. . ... .. .. . .
( Grants $ If this amount includes fore) n rants check here ^ 28a 21,106
29 TO SUPPORT OTHER HOSPITAL CHRISTIAN FELLOWSHIP
ORGANIZATIONS ... .. ..
( Grants $ If this amount includes forei g n g ran check here ^ 29a 1,875
30
( Grants If this amount includes forei g n g rants, check here ^ 30a
31 Other program services ( describe in Schedule 0) .
( Grants $ r If this amount includes forei g n g rants , check here ^ 31a
32 Total p ro g ram service ex p enses ( add lines 28a throu g h 31a ) ^ 32 22 , 981
ffPart ,I,V List of Officers , Directors, Trustees , and Key Employees . List each one even if not compensated. (see the instructions for Part IV )
C'hcrlr if tho nrnnni7atinn neon Cchoeirrla (' to rasnnnri to nnv nupctinn in this Part IV n
(a) Name and address
(a) Title and average hours per week devoted to pos ition
(c) Compensation ( If not paid,
enter -0-.
(d) Contributions to employee benefit plans &
deferred com pensation
(e) Expense account and other allowances
AUBREY BEAUCHAMP CAPISTRANO BEACH
... . .. ... .
34692 CALLS LOS ROBLES CA 92624
PRESIDENT
0.00 0 0 0
JOANNE WHITMAN Escondido
1580 Tutela Hei ghts CA 92026
SEC'TY/TREAS
0.00 0 0 0
... . .... . . ... ... .. ..
. ... ....
.. . ... .. ... .. ... . ... . ... ..
. ... ... ...
.... ... ....
DAA Form 990-EZ (2010)
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Form`990-FZ (2010) HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748 Page 3
_Part °V_j Other Information (Note the statement requirements in the instructions for Part V )
Check if the organization used Schedule 0 to resDond to any question in this Part V ❑
33
34
35
a
b 36
37a b 38a
b 39
a b 40a
b
c
d
e
41 42a
b
c
43
Yes No
Did the organization engage in any activity not previously reported to the IRS? If "Yes," provide a detailed
description of each activity in Schedule 0 33 X
Were any significant cha.-iges made to the organizing or governing documents ? If "Yes," attached a conformed copy of the amended documents if they reflect a change to the organization ' s name. Otherwise , explain the
change on Schedule 0 ( see instructions ) . .. .. ... .. ... 34 X
If the organization had income from business activities , such as those reported on lines 2 , 6a, and 7a ( among others ), but not reported on Form 990-T, explain in Schedule 0 why the organization did not report the income on Form 990 -T.
Did the organization have unrelated business gross income of $1 , 000 or more or was it a section 501 (c)(4),
501(c )( 5), or 501 ( c)(6) on anization subject to section 6033 ( e) notice , reporting, and proxy tax requirements? 35a X If "Yes ," has it filed a tax return on Form 990 -T for this year ( see instructions)? 35b
Did the organization undergo a liquidation , dissolution, termination , or significant disposition of net assets
during the year? If "Yes ," complete applicable parts of Schedule N 36 X
Enter amount of political expenditures , direct or indirect , as described in the instructions ^ 37a
Did the organization file Form 1120 - POL for this year? 37b X
Did the organization borrow from , or make any loans to, any officer , director , trustee , or key employee or were 1% t L _ any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? 38a X If "Yes," complete Schedule L , Part II and enter the total amount involved 38b
Section 501 ( c)(7) organizations . Enter :
luded on line 9 39a
ti n in it l t b
I iti tin a onfees andcap a conri u o s c
Gross receipts , included on line 9, for public use of club facilities 39b Section 501 ( c)(3) organizations . Enter amount of tax imposed on the organization during the year under
section 4911 00- ; section 4912 ^ ; section 4955 ^
Section 501 ( c)(3) and 501(c)(4) organizations . Did the organization engage in any section 4958 excess benefit iduL s _ transaction during the year , or did it engage in an excess benefit transaction in a prior year , that has not been
reported on any of its prior Forms 990 or 990- EZ? If "Yes," complete Schedule L, Part I 40b X Section 501 ( c)(3) and 501 ( c)(4) organizations . Enter amount of tax imposed on
organization managers of disqualified persons during the year under sections 4912 ,
4955 , and 4958 ^
Section 501 ( c)(3) and 501(c)(4) organizations Enter amount of tax on line 40c
^
reimbursed by the organization ...
All organizations . At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction ? If "Yes," complete Form 8886-T 409 X
List the states with which a copy of this return is filed. ^ CA
The organization 's books are in care of ^ AUBREY BEAUCHAMP Telephone no. ^ 949
-49 6-7 655
34692 CALLE ROBLES
Located at ^ CAPISTRANO BEACH CA
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
If "Yes," enter the name of the foreign country. ^
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
At any time during the calendar year, did the organization maintain an office outside of the U.S.?
If "Yes," enter the name of the foreign country ^
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 - Check here and enter the amount of tax-exempt interest received or accrued during the tax year
44a Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ
b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ .
c Did the organization receive any payments for indoor tanning services during the year?
d if "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an
ZIP+4 ^ 92624
Yes No
42b X
42c X
^ ❑
X
X X d_ a
Form 990-EZ (2010)
^ I 43
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Form'990- Z (2010 ) HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748 Pa e,
Yes No 45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? 45 X
a Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of if M
Form 990-EZ (see instructions) ... 45a X
46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition ` ' _;
to candidates for public office? If "Yes , " com p lete Schedule C , Part I y 46 X
#tN Section 501(c )( 3) organizations and section 4947( a)(1) nonexempt charitable trusts only. All section
Pa
501(c)(3) or!lanizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52, and complete the tables for lines 50 and 51.
Check if the organization used Schedule 0 to respond to any question in this Part VI ❑
Yes No
47 Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part II 47 X 48 Is the organization a school as described in section 170(b)(1)(A)(i1)? If "Yes," complete Schedule E 48 X
49a Did the organization make any transfers to an exempt non-charitable related organization? 49a X
b If "Yes," was the related organization a section 527 organization? 49b
50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key amnlnvaac) whn oath received mnra than ti no nnn of rmmnancatinn from the nrnanvatmn If there is none center "Nona "
(a) Name and address of each employee paid more than $100,000
(b) Title and average hours per week devoted to pos ition
(c) Compensation (d) Contributions to employee benefit plans &
deferred com pe nsation
(e) Expense account and other allowances
None .... ... ..
... . .. ....
.... ... ...
... . .. ... ...
52 Did the organization complete Schedule A? Note: All section 501(c)(3) nonexempt charitable trusts must attach a completed Schedule A Under penalties of perjury, I declare that I have examined this return, including accompar true, correct, and complete Dec4aratipn of preparer (other than officer) is based on all infi
Sign Here
Paid Preparer Use Only
f Total number of other employees paid over $100,000 ^
51 Complete this table for the organization's five highest compensated independent contractors who each received more than
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SCHEDULEA Public Charity Status and Public Support OMB No
1545-0047(Form 990 or 990-EZ)
2010 Complete if the organization is a section 501(c)( 3) organization or a section
4947( a)(1) nonexempt charitable trust . -7rl--- --- -'- -71
Department of the Treasury Open to Public
Internal Revenue Service 0, Attach to Form 990 or Form 990- EZ. 100, See separate instructions. Inspection
Name of the organization Employer Identification number
HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748
Part I Reason for Public Charity Status (All organizations must complete this p art. ) S ee inst ru ctio ns .
The organization is not a private foundation because it is : ( For lines 1 through 11, check only one box.) 1 A church, convention of churches , or association of churches described in section 170 ( b)(1)(A)(i).
2 A school described in section 170 ( b)(1)(A)(ii). (Attach Schedule E.)
3 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4 A medical research organization operated in conjunction with a hospital described in section 170 ( b)(1)(A)(iii). Enter the hospital's name, city, and state:
5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170 ( b)(1)(A)(iv). ( Complete Part II.)
6 A federal , state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7 X An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170 ( b)(1)(A)(vi ). ( Complete Part II.)
8 A community trust described in section 170 ( b)(1)(A)(vi ). ( Complete Part II.)
9 An organization that normally receives : ( 1) more than 33 1/3% of its support from contributions , membership fees , and gross receipts from activities related to its exempt functions-subject to certain exceptions, and (2 ) no more than 33 1/3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a )( 2). (Complete Part III.)
10 An organization organized and operated exclusively to test for public safety . See section 509(a)(4).
11 F] An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509 ( a)(1) or section 509(a)(2). See section 509(a )( 3). Check the box that describes the type of supporting organization and complete lines 1le through 11 h
a [ ] Type I b F] Type li c [] Type III-Functionally integrated d [] Type III-Other e By checking this box , I certify that the organization is not controlled directly or indirectly by one or more disqualified persons
other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509( a)(2).
f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization , check this box
g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls , either alone or together with persons described in (ii) and Yes No (iii) below, the governing body of the supported organization ? .. , , ... , , , , , , 11 i
(ii) A family member of a person described in (I) above? 11 ii
(iii) A 35% controlled entity of a person described in (i) or (it) above? 11 fiI
h Provirip the fnllnwinn information about the suonorted oraamzation(s) (i) Name of supported
organization
(II) EIN (III) Type of organization (described on lines 1-9 above or IRC section (see Instructions ))
(Iv) Is the organization In col (I) listed in your governing document?
(v) Did you notify the organization in col (I) of your
support?
(vi) Is the organization in col (i) organized in the
US?
(vii) Amount of support
Yes No Yes No Yes No
(A)
(B)
(C)
(D)
(E)
Total ',.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Schedule A (Form 990 or 990 -EZ) 2010
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ScheduleA (Form 990 or990-EZ) 2010 HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748 Page 2 Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170 (b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Su pp ort
Calendar year (or fiscal year beginning in ) 10- (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 ( f) Total 1 Gifts, grants, contributions, and
membership fees received. (Do not
include any " unusual grants.") 42,516 33 , 264 37,333 69 , 596 24 , 090 206,799
2 Tax revenues levied for the
organization's benefit anJ 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 .. ... 42,516 33 , 264 37,333 69 , 596 24,090 206,799
5 The portion of total contributions by g) a n'
each person (other than a;^ 10
governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount
shown on line 11, column (f) 45 , 455
6 Public su pp ort. Subtract line 5 from line 4 161, 344
Section B . Total Su pp ort
Calendar year (or fiscal year beginning in) ^ (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4 42 , 516 33,264 37 , 333 69 , 596 24 , 090 206,799
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources
9 Net income from unrelat6d business activities, whether or not the business is regularly carried on
10
11 12 13
Other income. Do not include gain or loss from the sale of capital assets
(Explain in Part IV.) , .. . 6,2801 6, 2801 7 , 0451 4 , 6501 3,790 28,045
234, 844
I L A
Total support. Add lines 7 through 10 V-IA AM Nis, ,
Gross receipts from related activities, etc. (see instructions) 12 3,790
First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here ^ ❑
Section C. Com p utation of Public Su pport Percenta g e
14 Public support percentage for 2010 (line 6, column (f) divided by line 11, column (f)) 14 68.70%
15 Public support percentage from 2009 Schedule A, Part II, line 14 15 84.19%
16a 33 1 /3% support test-2010 . If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this
box and stop here . The organization qualifies as a publicly supported organization .... ^
b 33 1/3% support test-2009 . If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more,
check this box and stop here . The organization qualifies as a publicly supported organization ^ ❑
17a 10%-facts -and-circumstances test-2010 . If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here . Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ^ ❑
b 10%-facts - and-circumstances test-2009 . If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test The organization qualifies as a publicly
supported organization ^ ❑
18 Private foundation . If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ^ ❑
Schedule A (Form 990 or 990-EZ) 2010
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ScheduleA (Form 990 or 990-EZ) 2010 HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748 Page 3 'Part!Ill Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II.
If the organization fails to qualify under the tests listed below, please complete Part II.) Section A. Public Su pp ort
Calendar year (or fiscal year beginning in) ^ ( a ) 2006 ( b ) 2007 ( c ) 2008 d 2009 (e) 2010 ( 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 govemmertal 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.)
Section B. Total Support
Calendar year (or fiscal year beginning in) ^ 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 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 IV.)
13 Total support. (Add lines 9, 1Oc, 11, and 12.) ... . . . .. .. .
a 2006 ( b ) 2007 c 2008 ( d ) 2009 a 2010 Total
14 First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here ^ ❑
Section C . Com p utation of Public Su pp ort Percenta g e
15 Public support percentage for 2010 (line 8, column (f) divided by line 13, column ( f)) 15 %
16 Public su pp ort p ercenta g e from 2009 Schedule A , Part III line 15 16 %
Section D . Com p utation of Investment Income Percenta g e
17 Investment income percentage for 2010 (line 10c, column (f) divided by line 13, column (f)) 17 %
18 Investment income percentage from 2009 Schedule A, Part III, line 17 18 %
19a 33 1 /3% support tests-2010 . If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line
17 is not more than 33 1/3%, check this box and stop here . The organization qualifies as a publicly supported organization ^ ❑ b 33 1 /3% support tests-2009 . If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and stop here . The organization qualifies as a publicly supported organization ^ 20 Private foundation . If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ...
Schedule A (Form 990 or 990 - EZ) 2010 DAA
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Schedule A (Form 990 or 990-EZ) 2010 HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748 Page 4 it Pait N, Supplemental Information . Complete this part to provide the explanations required by Part II, line 10;
Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Part II, Line 10 - Other Income Detail
NEW HEART SUBSCRIPTIONS ... ... . $ 28,045 .. ...
. .. .... ... ....
. ... . ... ... . . . ...
.... . . . .. . .. . ... .. .. .. . . . . . . ... ... .
... ... .... .. ...
... .... ... .. ....
. . ... ...
.... . . ... . . ...
DAA Schedule A (Form 990 or 990 - EZ) 2010
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SCHEDULE 0 (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide Information for responses to specific questions on Form 990 or 990-EZ or to provide any additional information.
^ Attach to Form 990 or 990-EZ.
2010
.Opento,P ubli
Name of the organization Employer identification number
HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748
Form 990-EZ , Part I, Line 16 - Other Expenses
Description Amount
Expenses
TRAVEL $ 734
AUTOMOBILE EXPENSE $ 3,238
BANK CHARGES $ 58
MEDICAL/DENTAL $ 661
NURSING/CONT. ED PROVIDER $ 1,875
OFFICE MAINTENANCE
$ 499
POSTAGE & SHIPPING $ 1,264
PRINT & PUBLICATION EXP $ 17,799
PROMOTION .. ... . $ ... .. 3,759
SUPPLIES $ 3,062
TELEPHONE $ 966
UTILITIES $ 879
Total . ... $ . 34,794 ...
Form 990-EZ, Part II, Line 24 - Other Assets
Description .... Beg. of Year End of Year
$ 20,624 $ 20,624
Less Accumulated Depreciation $ 16,591 $ 16,591
Total $ 4,033 $ 4,033
Form 990-EZ , Part III - Primary Exempt Purpose
TO TEACH HEALTHCARE PROFESSIONALS, CAREGIVERS AND
For Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990 - EZ. Schedule 0 (Form 990 or 990-EZ ) ( 2010) DAA
HCF 06/08/2011 11 53 AM Pg 15 Schedule ,O (Form 990 or 9
Employer Identification number
95-3190748
VOLUNTEERS HOW TV MET TtiE bk ZU TUAL NNr;US VF rt1Nix
PATIENTS AND FELLOW WORKERS THROUGH EVANGELISM, PRAYER AND
DISCIPLESHIP. THIS IS ACCOMPLISHED THROUGH CONFERENCES,
SEMINARS, LITERATURE, TAPES, A PRAYER NETWORK, PERSONAL
VISITS AND 'A NEW HEART' MAGAZINE.
Form 990-EZ, Part III, Line 28 - First Achievement
TO TEACH HEALTHCARE PROFESSIONALS, CAREGIVERS AND
VOLUNTEERS HOW TO MEET THE SPIRITUAL NEEDS OF THEIR
PATIENTS AND FELLOW WORKERS THROUGH EVANGELISM, PRAYER AND
DISCIPLESHIP.' THIS IS ACCOMPLISHED THROUGH CONFERENCES,
SEMINARS, LITERATURE, TAPES, . A PRAYER NETWORK, PERSONAL
VISITS AND 'A NEW HEART' MAGAZINE.
Schedule 0 ( Form 990 or 990-EZ) (2010) DAA
HCF 06/08/2011 11 53 AM Pg 16
F6rm
4562
Department of the Treasury Internal Revenue Service
(9g)
Depreciation and Amortization (Including Information on Listed Property)
^ See seaarate instructions. ^ Attach to your tax return.
2010
chment uence No 67
Name(s) shown on return Identifying number
HOSPITAL CHRISTIAN FELLOWSHIP 95-3190748
Business or activity to which this form relates
Indirect Depreciation
ParttI _ j Election To Expense Certain Property Under Section 179
Note: If you have any listed p ro pe rty, com p lete Part V before you com p lete Part I.
1 Maximum amount (see in tructions) . . . ... 1 500, 000
2 Total cost of section 179 )roperty placed in service (see instructions) 2
3 Threshold cost of section 179 property before reduction in limitation (see instructions) 3 2,000,000
4 Reduction in limitation Subtract line 3 from line 2 If zero or less, enter -0- 4
5 Dollar limitation for tax year. Subtract line 4 from line 1 If zero or less , enter -0- If married filin g se paratel y, see instructions 5
6 (a) Dascnption of property (b) Cost (business use only) (c) Elected cost
7 Listed property. Enter the amount from line 29 7
8 Total elected cost of section 179 property Add amounts in column (c), lines 6 and 7 8
9 Tentative deduction. Enter the smaller of line 5 or line 8 9
10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562 10
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 11 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 12
13 Carryover of disallowed deduction to 2011 Add lines 9 and 10 , less line 12 ^ 13 ' '
Note : Do not use Part II or Part III below for listed property. Instead, use Part V.
Part II S pecial De p reciation Allowance and Other De p reciation ( Do not include listed roe (See instructions )
14 Special depreciation allowance for qualified property (other than listed property) placed in service
during the tax year (see instructions) 14
15 Property subject to sectidn 168(0(1) election 15
16 Other de p reciation ( includin g ACRS ) 16
,Part III MACRS Depreciation ( Do not include listed property.) (See instructions.)
Section A
17 MACRS deductions for assets placed in service in tax years beginning before 2010 n 17 0
18 If you are electing to group any assets placed in service dunng the tax year into one or more general asset accounts, check here ^ I I Section B-Assets Placed in Service During 2010 Tax Year Using the General Depreciation System
(b) Month and year (c) Basis for depreciation (d) Recovery (a) Classification of property placed in (business/investment use
penod (e) Convention (f) Method (g) Depreciation deduction service onl y--see instructions )
19a 3-year p ro p erty b 5 -year p ro p erty
d 1
f r.t.^
S/L
h Residential rental 27.5 Y rs. MM S/L
property 27.5 y rs. MM S/L
i Nonresidential real 39 yrs. MM S/L
property MM S/L
cep i^^ c-A...t; Placed in Service During 2010 Tax Year Using the Alternative Depreciation System
20a Class life S/L
b 12-y ear . 12 yrs. S/L
c 40-year 40 y rs. MM S/L
PartIV i Summa ry ( See instructions. )
21 Listed property Enter amount from line 28 1
22 Total . Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here
and on the appropriate lines of your retum. Partnerships and S corporations-see instructions 22
23 For assets shown above and placed in service dunng the current year, enter the 'i
p ortion of the basis attributable to section 263A costs 23 r =
For Paperwork Reduction Act Notice, see separate instructions . Form 4562 (2010)
DAA
"c / tJMAt%J7.ISTIAN FELLOWSHIP 95-3190748
Form 4562(2010) Page 2
PPart-VJ Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment, recreation, or amusement.)
Note : For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section Ar-Depreciation and Other Information (Caution : See the instructions for limits for passenger automobiles 1
24a Do you have evidence to support the business/investment use claimed? X Yes No 24b If "Yes," is the evidence written? Yes X No
(a) (b) (c) (d ) ( e) (f) (g) (h) (i)
Type of property Date placed Business/
use Cost or other basis Basis for depreciation Recovery Method/ Depreciation Elected section 179 list vehicles first)
( ) in service percentage (business/investment period Convention deduction cost
use only)
25 Special depreciation allo%ance for qualified listed property placed in service during a
the tax year and used more than 50% in a q ualified business use ( see instructions ) 25
9R Prnnnrfv i icert mnrn than Rna/ in n ni inhfierl hi icinuee a icn•
TOYOT
RAV4
06/15 / 0: 80.00%% 20 , 624 7 230 5.0 20ODBH
O/C
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 29 Add amounts in column (i). line 26. Enter here and on line 7. oaae 1
(a) (b) (c) (d ) ( e) (f)
30 Total business/investment miles driven during Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6 the year ( do not include commuting miles) 4 , 615
31 Total commuting miles driven during the year 32 Total other personal (noncommuting) miles
driven
1,154.
33 Total miles driven during the year. Add lines
30 through 32 5,769
34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No
during off-duty hours? X
35 Was the vehicle used primarily by a more
than 5% owner or related person? X
36 Is another vehicle available for p ersonal use?
Section C-Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions)
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by Yes No your employees?
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners 39 Do you treat all use of vehicles by employees as personal use?
40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the vehicles, and retain the information received?
41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) Note : If your answer to 37 , 38 , 39 , 40 , or 41 is "Yes , " do not com p lete Section B for the covered vehicles
(a) (b) (c) (d) Amortization
Date amortization Amortizable amount Code section period or Amortization for this year
Description of costs begins percentage
42 Amortization of
43 Amortization of costs that began before your 2010 tax year 43
44 Total. Add amounts in column (f). See the instructions for where to report 44
DAA Form 4562 (2010)
Section B-Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles to vni it emntnvoo¢ fircf nncwer tha ni iactinnc in Cartinn C fn cap if vni t mast nn orrontinn to rmmnietinn this cortinn fnr thnco vohiriac