Sample Form 990 - Return Of Organization Exempt From Income Tax - 2015

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26P0007 10/13/2016 12:54 PM
990
Return of Organization Exempt From Income Tax
OMB No. 1545-0047
2015
Form
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Open to Public
Do not enter social security numbers on this form as it may be made public.
Department of the Treasury
Inspection
Internal Revenue Service
Information about Form 990 and its instructions is at
A
For the 2015 calendar year, or tax year beginning
, and ending
Check if applicable:
C
Name of organization
D
Employer identification number
B
PHILADELPHIA VETERANS COMFORT HOUSE
Address change
PHILADELPHIA VETERANS HOUSE
23-2694118
Doing business as
Name change
Number and street (or P.O. box if mail is not delivered to street address)
Room/suite
E
Telephone number
4108 Baltimore Ave
267-292-2052
Initial return
Final return/
City or town, state or province, country, and ZIP or foreign postal code
terminated
Philadelphia
PA 19104
141,330
Gross receipts
$
G
Amended return
F Name and address of principal officer:
X
Yes
No
Is this a group return for subordinates?
H(a)
Application pending
JOHN KIHM
Yes
No
4108 BALTIMORE AVE
H(b)
Are all subordinates included?
PHILADELPHIA
PA 19104
If "No," attach a list. (see instructions)
X
(
)
I
Tax-exempt status:
501(c)(3)
501(c)
(insert no.)
4947(a)(1) or
527
J
Website:
H(c)
Group exemption number
X
1992
PA
Form of organization:
Corporation
Trust
Association
Other
Year of formation:
State of legal domicile:
K
L
M
Part I
Summary
1
Briefly describe the organization's mission or most significant activities:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
See Schedule O
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
Check this box
if the organization discontinued its operations or disposed of more than 25% of its net assets.
8
3
Number of voting members of the governing body (Part VI, line 1a)
3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
4
Number of independent voting members of the governing body (Part VI, line 1b)
4
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
5
Total number of individuals employed in calendar year 2015 (Part V, line 2a)
5
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
6
Total number of volunteers (estimate if necessary)
6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
7a
Total unrelated business revenue from Part VIII, column (C), line 12
7a
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
b
Net unrelated business taxable income from Form 990-T, line 34
7b
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prior Year
Current Year
91,827
39,019
8
Contributions and grants (Part VIII, line 1h)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
153,742
57,287
9
Program service revenue (Part VIII, line 2g)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2,070
1,064
10
Investment income (Part VIII, column (A), lines 3, 4, and 7d)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34,348
11
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
. . . . . . . . . . . . . . . . . . .
247,639
131,718
12
Total revenue – add lines 8 through 11 (must equal Part VIII, column (A), line 12)
. . . . . . .
0
13
Grants and similar amounts paid (Part IX, column (A), lines 1–3)
. . . . . . . . . . . . . . . . . . . . . . . . .
0
14
Benefits paid to or for members (Part IX, column (A), line 4)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
102,480
57,482
15
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)
. . . . . . .
0
16a
Professional fundraising fees (Part IX, column (A), line 11e)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8,834
b
Total fundraising expenses (Part IX, column (D), line 25)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
246,927
189,763
17
Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
349,407
247,245
18
Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)
. . . . . . . . . . . . . . .
-101,768
-115,527
19
Revenue less expenses. Subtract line 18 from line 12
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Beginning of Current Year
End of Year
223,248
106,908
20
Total assets (Part X, line 16)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1,513
700
21
Total liabilities (Part X, line 26)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
221,735
106,208
22
Net assets or fund balances. Subtract line 21 from line 20
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign
Signature of officer
Date
Here
JOHN KIHM
PRESIDENT
Type or print name and title
Print/Type preparer's name
Preparer's signature
Date
PTIN
if
Check
Paid
CRAIG J. FIRESTONE, CPA
10/13/16
P00357144
self-employed
Preparer
FIRESTONE AND COMPANY LLC
46-1727112
Firm's name
Firm's EIN
Use Only
455 Pennsylvania Avenue Suite 2LF
Ft. Washington, PA
19034-3405
215-646-3814
Firm's address
Phone no.
X
May the IRS discuss this return with the preparer shown above? (see instructions)
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
990
For Paperwork Reduction Act Notice, see the separate instructions.
Form
(2015)
DAA

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