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  5. HOSPICE OF JEFFERSON COUNTY INC.

HOSPICE OF JEFFERSON COUNTY INC.

Company Details

Name: HOSPICE OF JEFFERSON COUNTY INC.
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 07 May 1986 (39 years ago)
Entity Number: 1080382
ZIP code: 13601
County: Jefferson
Place of Formation: New York
Address: PO BOXL 677, WATERTOWN, NY, United States, 13601

Contact Details

Phone +1 315-788-7323

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2023 161266041 2024-09-18 HOSPICE OF JEFFERSON COUNTY, INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM STREET, WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2024-09-18
Name of individual signing ANNA PATTERSON
Valid signature Filed with authorized/valid electronic signature
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2022 161266041 2023-10-06 HOSPICE OF JEFFERSON COUNTY, INC. 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM STREET, WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2023-10-06
Name of individual signing MICHELE RICHTER
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2021 161266041 2022-05-23 HOSPICE OF JEFFERSON COUNTY, INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM STREET, WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2022-05-23
Name of individual signing DAVID SANFORD
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2020 161266041 2021-07-27 HOSPICE OF JEFFERSON COUNTY, INC. 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM STREET, WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2021-07-27
Name of individual signing DAVID SANFORD
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2019 161266041 2020-10-06 HOSPICE OF JEFFERSON COUNTY, INC. 78
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM STREET, WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2020-10-06
Name of individual signing DIANA WOODHOUSE
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2018 161266041 2019-07-12 HOSPICE OF JEFFERSON COUNTY, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM ST., WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2019-07-12
Name of individual signing DIANA WOODHOUSE
Role Employer/plan sponsor
Date 2019-07-12
Name of individual signing DIANA WOODHOUSE
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2017 161266041 2019-02-22 HOSPICE OF JEFFERSON COUNTY, INC. 68
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM ST., WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2019-02-22
Name of individual signing DIANA WOODHOUSE
Role Employer/plan sponsor
Date 2019-02-22
Name of individual signing DIANA WOODHOUSE
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2016 161266041 2018-03-05 HOSPICE OF JEFFERSON COUNTY, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM ST., WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2018-03-05
Name of individual signing DIANA WOODHOUSE
Role Employer/plan sponsor
Date 2018-03-05
Name of individual signing DIANA WOODHOUSE
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2015 161266041 2017-04-03 HOSPICE OF JEFFERSON COUNTY, INC. 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM ST., WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2017-04-03
Name of individual signing DIANA WOODHOUSE
Role Employer/plan sponsor
Date 2017-04-03
Name of individual signing DIANA WOODHOUSE
HOSPICE OF JEFFERSON COUNTY, INC. SAVINGS & RETIREMENT PLAN 2014 161266041 2016-05-13 HOSPICE OF JEFFERSON COUNTY, INC. 59
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-10-01
Business code 621610
Sponsor’s telephone number 3157887323
Plan sponsor’s address 1398 GOTHAM ST., WATERTOWN, NY, 13601

Signature of
Role Plan administrator
Date 2016-05-13
Name of individual signing DIANA WOODHOUSE
Role Employer/plan sponsor
Date 2016-05-13
Name of individual signing DIANA WOODHOUSE

DOS Process Agent

Name Role Address
HOSPICE OF JEFFERSON COUNTY INC. DOS Process Agent PO BOXL 677, WATERTOWN, NY, United States, 13601

Filings

Filing Number Date Filed Type Effective Date
B355583-7 1986-05-07 CERTIFICATE OF INCORPORATION 1986-05-07

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
16-1266041 Corporation Unconditional Exemption 1398 GOTHAM ST, WATERTOWN, NY, 13601-9704 1992-06
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Organization that receives a substantial part of its support from a governmental unit or the general public 170(b)(1)(A)(vi)
Tax Period 2023-09
Asset 5,000,000 to 9,999,999
Income 1,000,000 to 4,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 8690467
Income Amount 3560115
Form 990 Revenue Amount 3560115
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 202209
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 202109
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 202009
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 201909
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 201809
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 201709
Filing Type E
Return Type 990
File View File
Organization Name HOSPICE OF JEFFERSON COUNTY INC
EIN 16-1266041
Tax Period 201609
Filing Type E
Return Type 990
File View File

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
5415977106 2020-04-13 0248 PPP 1398 Gotham Street, WATERTOWN, NY, 13601-3800
Loan Status Date 2021-07-21
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 410000
Loan Approval Amount (current) 410000
Undisbursed Amount 0
Franchise Name -
Lender Location ID 56102
Servicing Lender Name KeyBank National Association
Servicing Lender Address 127 Public Sq, CLEVELAND, OH, 44114-1217
Rural or Urban Indicator R
Hubzone N
LMI N
Business Age Description Unanswered
Project Address WATERTOWN, JEFFERSON, NY, 13601-3800
Project Congressional District NY-24
Number of Employees 48
NAICS code 621610
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Non-Profit Organization
Originating Lender ID 56102
Originating Lender Name KeyBank National Association
Originating Lender Address CLEVELAND, OH
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 414920
Forgiveness Paid Date 2021-07-12

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Date of last update: 16 Mar 2025

Sources: New York Secretary of State

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