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
2012
Open to Public Inspection
Name of the organization
Visiting Nurse Services In Westchester Inc
Employer identification number
13-2601443
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
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 Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
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 Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
209,714
90,483
53,809
56,738
108,949
519,693
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......
22,463,574
23,566,108
24,520,413
25,850,916
28,349,871
124,750,882
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
22,673,288
23,656,591
24,574,222
25,907,654
28,458,820
125,270,575
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.)
125,270,575
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
22,673,288
23,656,591
24,574,222
25,907,654
28,458,820
125,270,575
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
20,110
10,707
11,031
6,407
1,024
49,279
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
20,110
10,707
11,031
6,407
1,024
49,279
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
333,590
378,640
347,090
366,047
10,065
1,435,432
13
Total support. (Add lines 9, 10c, 11, and 12.)..
23,026,988
24,045,938
24,932,343
26,280,108
28,469,909
126,755,286
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
98.829 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
98.442 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.039 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.089 %
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
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).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2012
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
2012
Open to Public Inspection
Name of the organization
Visiting Nurse Services In Westchester Inc
Employer identification number
13-2601443
Identifier
Return Reference
Explanation
PRESENATION OF PROVISION FOR BAD DEBTS
FORM 990, PART VIII, LINE 2C - PROGRAM SERVICE REVENUE
The Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2011-07, "Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for Certain Health Care Entities". ASU 2011-07 requires certain health care entities that recognize significant amounts of patient service revenue at the time the services are rendered without assessing the patient's ability to pay to present the provision for bad debts related to patient service revenue as a deduction from patient service revenue in the statement of operations rather than as an operating expense. Additional disclosures relating to sources of patient service revenue and the allowance for uncollectible accounts will also be required. This new guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2011, with early adoption permitted. The Corporatioan has adopted the provisions of ASU 2011-07 and retrospectively applied the presentation requirements.
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION'S SOLE MEMBER IS WESTCHESTER VISITING NURSE SERVICES GROUP, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE ORGANIZATION'S SOLE MEMBER, WESTCHESTER VISITING NURSE SERVICES GROUP, INC. ELECTS MEMBERS TO THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11B
THE BOARD OF DIRECTORS OF THE ORGANIZATION HAS DELEGATED RESPONSIBILITY FOR REVIEWING THE FORM 990 TO CERTAIN MANAGEMENT OFFICIALS OF THE ORGANIZATION. PRIOR TO THE SUBMISSION OF THE FORM, MEMBERS OF THE GOVERNING BODY RECEIVED PROGRESS UPDATES FROM MANAGEMENT. A FINAL VERSION OF THE COMPLETED FORM 990 WAS REVIEWED BY SELECTED MANAGEMENT OFFICIALS OF THE ORGANIZATION AND DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY IN PLACE TO ADDRESS ANY CONFLICTS THAT ARISE, ARE REPORTED OR OTHERWISE DISCOVERED. ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ALONG WITH ALL MEMBERS OF THE MANAGEMENT TEAM AND CERTAIN OTHER EMPLOYEES ARE PROVIDED A CURRENT COPY OF THE POLICY AND ARE ALSO REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THESE DISCLOSURE STATEMENTS ARE REVIEWED BY THE PRESIDENT/CEO TO IDENTIFY THE NUMBER, MAGNITUDE AND NATURE OF ALL DISCLOSED CONFLICTS. THE CONFLICT OF INTEREST DISCLOSURE STATEMENT COMPLETED BY THE PRESIDENT/CEO OF THE ORGANIZATION IS REVIEWED BY THE BOARD CHAIRPERSON. ANY CONFLICTS ARE REFERRED TO THE BOARD OF DIRECTORS FOR DISCUSSION AND RESOLUTION.
FORM 990, PART VI, SECTION B, LINES 15A & 15B
THE ORGANIZATION HAS A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS THAT IS RESPONSIBLE FOR REVIEWING AND APPROVING THE COMPENSATION OF THE PRESIDENT/CEO, CFO/COO AND DIRECTOR OF PATIENT SERVICES OF THE ORGANIZATION. ON AN ANNUAL BASIS, THE COMMITTEE REVIEWS THE TOTAL COMPENSATION LEVELS FOR EACH POSITION BASED ON PERFORMANCE REVIEWS AND RECOMMENDATIONS AND A SELF EVALUATION COMPLETED BY THE PRESIDENT/CEO. IN ADDITION, INDUSTRY COMPENSATION COMPARISONS ARE MADE BASED UPON DATA PROVIDED BY VARIOUS SOURCES.
FORM 990, PART VI, SECTION C, LINE 19
UPON REQUEST, THE ORGANIZATION WILL MAKE AVAILABLE ONLY THOSE DOCUMENTS REQUIRED TO BE DISCLOSED UNDER THE PUBLIC INSPECTION LAWS.
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:OTHER FEES TOTAL FEES:93705
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:CONTRACTUAL SERVICES TOTAL FEES:3346503
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.