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
BRRH HOME HEALTH SERVICES INC
Employer identification number
65-0044715
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
BOCA RATON REGIONAL HOSPITAL INC
591006663
03
Yes
Yes
Yes
0
Total
0
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.") .
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 governmental 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)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
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, 10c, 11 and 12.).
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
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
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
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
BRRH HOME HEALTH SERVICES, INC. PROVIDED NON-MONETARY SUPPORT IN THE FORM OF HOME HEALTH CARE SERVICES TO BOCA RATON REGIONAL HOSPITAL PATIENTS IN THE AMOUNT OF $1,796,137 DURING FYE 6/30/11. MONETARY SUPPORT IS NOT REQUIRED TO QUALIFY AS A 509(A)(3) SUPPORTING ORGANIZATION.
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
BRRH HOME HEALTH SERVICES INC
Employer identification number
65-0044715
Identifier
Return Reference
Explanation
FAMILY OR BUSINESS RELATIONSHIPS
FORM 990, PART VI, LINE 2 JERRY FEDELE AND DAWN JAVERSACK HAVE A BUSINESS RELATIONSHIP, IN THAT, IN THEIR MANAGEMENT CAPACITY FOR BRRH CORPORATION AND AFFILIATES, THEY ALSO SERVE ON THE BOARDS OF THE FOLLOWING FOR-PROFIT CORPORATIONS WHICH ARE WHOLLY OWNED BY BOCA RATON REGIONAL HOSPITAL, INC.: BOCACARE, INC. BOCACARE EAST, INC. BOCACARE 9TH AVE., INC. BRRH WOMEN'S INSTITUTE FOR HEALTH & WELLNESS, INC. MATTHEW KLEIN AND ANDREW ROSS HAVE A BUSINESS RELATIONSHIP, IN THAT THEY ARE CO-OWNERS IN A FOR-PROFIT PHYSICIAN PRACTICE. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 6 THE SOLE CORPORATE MEMBER OF BRRH HOME HEALTH SERVICES, INC. IS BRRH CORPORATION, INC. DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A BRRH CORPORATION, THE SOLE MEMBER HAS THE EXPRESS AUTHORITY TO SELECT OR REPLACE THE TRUSTEES AND OFFICERS. DESCRIPTION OF CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B BRRH CORPORATION, THE SOLE MEMBER HAS THE EXPRESS AUTHORITY TO AMEND THE ARTICLES OF INCORPORATION OF THE BRRH HOME HEALTH SERVICE ("THE SERVICE"), TO AMEND, ALTER, RESCIND OR REPEAL THE BYLAWS, PROVIDED HOWEVER, THAT SAID BYLAWS AND ANY AMENDMENTS HERETO SHALL NOT BE INCONSISTENT WITH PROVISIONS OF THE ARTICLES OF INCORPORATION OF THE SERVICE, AND TO EXERT ITS POWER AT ITS SOLE DISCRETION. DESCRIBE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, LINE 11B THE FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT. THE FORM 990 IS ALSO REVIEWED AND DISCUSSED WITH THE FINANCE COMMITTEE, A SUBCOMMITTEE COMPRISED OF MEMBERS OF THE BRRH CORPORATION'S BOARD OF TRUSTEES, PRIOR TO FILING. THE 990 IS PRESENTED TO BRRH CORPORATION'S BOARD OF TRUSTEES AFTER FILING. ANY QUESTIONS AND CONCERNS OF THE MEMBERS OF THE FINANCE COMMITTEE ARE ADDRESSED PRIOR TO THE SUBMISSION OF THE FORM 990 TO THE INTERNAL REVENUE SERVICE. NOT ALL MEMBERS OF THE FINANCE COMMITTEE OR BOARD OF TRUSTEES ARE PRESENT AT THE RESPECTIVE MEETINGS. WRITTEN POLICIES FORM 990, PART VI, LINES 12A, 13 & 14 BRRH HOME HEALTH, INC. DOES HAVE WRITTEN CONFLICT OF INTEREST, WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICIES. HOWEVER, AS OF FYE 6/30/11 THEY HAD NOT BEEN FORMALLY ADOPTED BY BRRH HOME HEALTH INC.'S BOARD OF TRUSTEES. OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINES 15A & 15B ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC FORM 990, PART VI, LINE 19 THE FINANCIAL STATEMENTS ARE AVAILABLE FOR REVIEW ON WWW.DACBOND.COM. THE CONFLICT OF INTEREST POLICIES ARE NOT AVAILABLE TO THE GENERAL PUBLIC. THE GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, COLUMN B ESTIMATED HOURS PER WEEK WORKED BY OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AT THE FOLLOWING RELATED ENTITIES: BOCA RATON REGIONAL HOSPITAL, INC.: RICHARD L SCHMIDT - 2 CHRISTINE E LYNN - 2 JERRY FEDELE - 40 DAWN JAVERSACK - 40 MARC E TAUB, MD - 2 WILLIAM D HAGER - 2 HARVEY SANDLER - 2 CHRISTOPHER WHEELER - 2 RONALD G ASSAF - 2 DONALD KOHNKEN - 2 WARREN ORLANDO - 2 A.E. BUD OSBORNE - 2 ANDREW ROSS, MD - 2 MATTHEW KLEIN, MD - 2 DEBBIE LEISING - 2 JUDY HLAFCSAK - 40 ANDRE SUSLA - 40 BRRH FOUNDATION: JANNA KING - 2 JERRY FEDELE - 2 DAWN JAVERSACK - 2 WARREN ORLANDO - 1 RICHARD SCHMIDT - 1 CHRISTOPHER WHEELER - 1 DEBBIE LEISING - 1 JUDY HLAFCSAK - 2 ANDRE SUSLA - 2 BRRH CORPORATION, INC. RICHARD L SCHMIDT - 2 CHRISTINE E LYNN - 2 JERRY FEDELE - 2 DAWN JAVERSACK - 2 MARC E TAUB, MD - 2 HARVEY SANDLER - 2 CHRISTOPHER WHEELER - 2 RONALD G ASSAF - 2 DONALD KOHNKEN - 2 A.E. BUD OSBORNE - 2 ANDREW ROSS, MD - 2 MATTHEW KLEIN, MD - 2 DEBBIE LEISING - 2 JUDY HLAFCSAK - 2 ANDRE SUSLA - 2 WARREN HAGER - 2 WARREN ORLANDO - 2 OVERSIGHT OF THE AUDIT, REVIEW OR COMPILATION OF FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE AT THE BRRH CORPORATION, INC. LEVEL IS THE COMMITTEE WITH OVERSIGHT OVER THE CONSOLIDATED AUDIT, WHICH INCLUDES BRRH HOME HEALTH SERVICES, INC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.