Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
VISITING NURSE SERVICE INC
Employer identification number
34-0714779
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% 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
11
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)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(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 U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 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 Support
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
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.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
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 the 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
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 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 Support
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.") .
534,396
328,725
435,359
325,005
314,781
1,938,266
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......
11,329,507
14,836,238
13,529,131
12,852,285
12,715,240
65,262,401
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.
11,863,903
15,164,963
13,964,490
13,177,290
13,030,021
67,200,667
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.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
67,200,667
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
11,863,903
15,164,963
13,964,490
13,177,290
13,030,021
67,200,667
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
12,536
12,536
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
12,536
12,536
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, 10c, 11 and 12.).
11,863,903
15,177,499
13,964,490
13,177,290
13,030,021
67,213,203
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
99.980 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.980 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.020 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.020 %
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
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (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 to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
VISITING NURSE SERVICE INC
Employer identification number
34-0714779
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
VISITING NURSE SERVICE, INC. HAS ONE MEMBER, COMMUNITY HEALTH VENTURES, INC. COMMUNITY HEALTH VENTURES, INC. IS ORGANIZED IN OHIO AS A NON-PROFIT ORGANIZATION AND IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 501(C)(3). COMMUNITY HEALTH VENTURES, INC. IS NOT A PRIVATE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7A
COMMUNITY HEALTH VENTURES, INC. IS THE SOLE MEMBER OF VISITING NURSE SERVICE, INC. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF COMMUNITY HEALTH VENTURES, INC. IN ACCORDANCE WITH THE ORGANIZATION'S CODE OF REGULATIONS, AKRON GENERAL HEALTH SYSTEM NOMINATES CANDIDATES FOR OPENINGS ON THE ORGANIZATION'S BOARD. COMMUNITY HEALTH VENTURES, INC. ELECTS THE MEMBERS FROM AMONG THOSE NOMINEES.
FORM 990, PART VI, SECTION A, LINE 7B
COMMUNITY HEALTH VENTURES, INC. IS THE SOLE MEMBER OF VISITING NURSE SERVICE, INC. AKRON GENERAL HEALTH SYSTEM IS THE SOLE MEMBER OF COMMUNITY HEALTH VENTURES, INC. COMMUNITY HEALTH VENTURES, INC.'S RESPONSIBILITIES INCLUDE PROVIDING LONG TERM PLANNING, ESTABLISHING SYSTEM POLICIES AND PROCEDURES, AND ASSISTING ORGANIZATIONS WITHIN THE SYSTEM IN CARRYING OUT THEIR EXEMPT PROGRAMS. GENERALLY, COMMUNITY HEALTH VENTURES, INC. LIMITS ITS POWER OF APPROVAL OVER DECISIONS MADE BY THE BOARD OF VISITING NURSE SERVICE, INC., TO THOSE CONCERNING MEMBERSHIP OF THAT BOARD AND THAT ORGANIZATION'S ANNUAL BUDGET.
FORM 990, PART VI, SECTION A, LINE 8B
ALL DECISIONS REQUIRING THE AUTHORITY OF THE BOARD OF DIRECTORS ARE MADE AT THAT LEVEL. THE BOARD OF DIRECTORS DOES NOT DELEGATE BOARD AUTHORITY TO ANY COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 11
VISITING NURSE SERVICE, INC. IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. VISITING NURSE SERVICE, INC. PREPARES ITS FORM 990 INTERNALLY. THE RETURN IS SUBJECT TO FINANCIAL REVIEW BY THE CHIEF FINANCIAL OFFICER OF AKRON GENERAL HEALTH SYSTEM, THE VICE PRESIDENT OF ACCOUNTING AND FINANCE OF AKRON GENERAL HEALTH SYSTEM, AND REVIEWED FOR COMPLIANCE WITH THE REPORTING REQUIREMENTS OF FORM 990 BY THE DIRECTOR OF CORPORATE TAX FOR AKRON GENERAL HEALTH SYSTEM.
FORM 990, PART VI, SECTION B, LINE 12C
VISITING NURSE SERVICE, INC. IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM (SYSTEM). AKRON GENERAL HEALTH SYSTEM IS THE PARENT ORGANIZATION OF THE SYSTEM AND AS SUCH IT DETERMINES CERTAIN POLICIES AND PROCEDURES APPLICABLE TO ALL MEMBER ORGANIZATIONS. IN THE CASE OF CONFLICT OF INTEREST REPORTING, AKRON GENERAL HEALTH SYSTEM NOT ONLY DETERMINES THE POLICY AND THE PROCEDURE, IT CARRIES OUT THE PROCEDURE FOR ALL SYSTEM ORGANIZATIONS ITSELF. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO ALL BOARD MEMBERS, MANAGEMENT PERSONNEL, EMPLOYED PHYSICIANS AND ANY OTHER PERSONNEL THAT HAVE BEEN DESIGNATED BY MANAGEMENT. THE DISTRIBUTION COVERS ALL SYSTEM ORGANIZATIONS. ALL RESPONSES THAT INDICATE A PERCEIVED CONFLICT OF INTEREST ARE TURNED OVER TO THE GOVERNANCE AND COMPLIANCE COMMITTEE (THE COMMITTEE) OF AKRON GENERAL HEALTH SYSTEM FOR REVIEW. THE COMMITTEE MAKES A DETERMINATION AS TO WHETHER THE PERCEIVED CONFLICT IS LIKELY TO BE AN ACTUAL CONFLICT, THE MATERIALITY OF ANY ACTUAL CONFLICTS AND THE EXTENT OF SAFEGUARD REQUIRED FOR ANY ACTUAL CONFLICTS. SAFEGUARDS INCLUDE, BUT ARE NOT LIMITED TO, REQUIRING, IN THE CASE OF A BOARD MEMBER, THAT THE PERSON RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS OR VOTING THAT MAY BE AFFECTED BY THE CONFLICT, REQUIRING THE PERSON TO DISENGAGE FROM THE CONDUCT CREATING THE CONFLICT OR REQUIRING THE PERSON TO RESIGN FROM THE POSITION AFFECTED BY THE CONFLICT. THIS PROCESS IS CONDUCTED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL DEPARTMENT ANNUALLY IN JANUARY. THE CONFLICT OF INTEREST LETTER PUTS THE RECIPIENT ON NOTICE THAT HE OR SHE IS UNDER AN ONGOING DUTY TO REPORT ANY POTENTIAL CONFLICTS THAT MAY ARISE SUBSEQUENT TO THIS FORMAL PROCESS. SUBSEQUENT EVENT REPORTING IS MONITORED BY AKRON GENERAL HEALTH SYSTEM'S LEGAL DEPARTMENT. ANY SUBSEQUENTLY REPORTED ITEMS ARE SUBJECT TO THE AFOREMENTIONED REVIEW PROCESS BY AKRON GENERAL HEALTH SYSTEM'S GOVERNANCE AND COMPLIANCE COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 15
THE REPORTING ORGANIZATION IS A MEMBER OF THE AKRON GENERAL HEALTH SYSTEM. THE EXEMPT PURPOSE OF THE SYSTEM PARENT, AKRON GENERAL HEALTH SYSTEM (AGHS), IS TO SUPPORT THE MEMBERS OF THAT SYSTEM. ONE OF THE SUPPORT SERVICES THAT AGHS PROVIDES IS DETERMINING THE COMPENSATION OF THE TOP MANAGEMENT PERSONNEL OF THE REPORTING ORGANIZATION. AGHS FOLLOWS A PROCESS FOR DETERMINING THE COMPENSATION OF THE REPORTING ORGANIZATION'S TOP MANAGEMENT PERSONNEL THAT IS BASED ON THE SAFE HARBOR DESCRIBED BY INTERNAL REVENUE CODE SECTION 4958 FOR ESTABLISHING THE PRESUMPTION OF REASONABLE COMPENSATION. THEREFORE, THE PROCESS CALLS FOR RECOMMENDATIONS - DEVELOPED BY AN INDEPENDENT COMPENSATION CONSULTANT, BASED ON COMPARABLE MARKET DATA FROM PUBLISHED SURVEYS AND THE FORMS 990 OF COMPARABLE ORGANIZATIONS - THAT ARE WITHIN THE RANGE OF THE COMPENSATION OF SIMILARLY SITUATED PERSONS AT SIMILARLY SITUATED ORGANIZATIONS. THESE RECOMMENDATIONS ARE REVIEWED BY THE COMPENSATION COMMITTEE OF THE REPORTING ORGANIZATION'S BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND THE DELIBERATIONS ARE DOCUMENTED, CONTEMPORANEOUSLY, IN THE COMMITTEE'S MINUTES. THE COMPENSATION FOR ALL TOP MANAGEMENT WAS REVIEWED FOR REASONABLENESS USING THIS PROCESS IN 2008.
FORM 990, PART VI, SECTION C, LINE 19
CURRENTLY, VISITING NURSE SERVICE, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR ITS FINANCIAL STATEMENTS GENERALLY AVAILABLE TO THE PUBLIC. VISITING NURSE SERVICE, INC. DOES MAKE THESE DOCUMENTS AVAILABLE ON A CASE BY CASE BASIS.
TITLE AND HOURS FOR RELATED ORGANIZATION
FORM 990, PART VII, COLUMNS A AND B
KAREN L. TALBOTT - PRESIDENT, TREASURER, AND DIRECTOR OF THE REPORTING ORGANIZATION. MS. TALBOTT ALSO SERVED AS PRESIDENT, TREASURER, AND DIRECTOR OF COMMUNITY HEALTH VENTURES, INC. - 60.0 HOURS AVERAGE PER WEEK, PRESIDENT AND DIRECTOR OF ROSE LANE, INC. - .5 HOURS AVERAGE HOURS PER WEEK, PRESIDENT AND TREASURER OF VISITING HOURS, INC. - .3 HOURS AVERAGE PER WEEK AND PRESIDENT, TREASURER, SECRETARY, AND DIRECTOR OF HOSPICE CARE OHIO - .5 HOURS AVERAGE PER WEEK.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 95,221. CHANGE IN INTEREST IN FUND NET ASSETS 8,267. TOTAL TO FORM 990, PART XI, LINE 5: 103,488.
990, PART XII, LINE 2C
VISITING NURSE SERVICE, INC. ISSUES AUDITED FINANCIAL STATEMENTS PREPARED IN ACCORDANCE WITH GAAP. AKRON GENERAL HEALTH SYSTEM ISSUES AUDITED FINANCIAL STATEMENTS, PREPARED IN ACCORDANCE WITH GAAP, THAT REPRESENT THE CONSOLIDATION OF ITS FINANCIAL STATEMENTS WITH THOSE OF EACH ORGANIZATION WITHIN THE AKRON GENERAL HEALTH SYSTEM (COLLECTIVELY, THE "SYSTEM"). THE FINANCE AND AUDIT COMMITTEE OF AKRON GENERAL HEALTH SYSTEM'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF SYSTEM'S AUDIT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.