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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
VISITING NURSES ASSOCIATION OF THE ROCKFORD AREA
Employer identification number
36-2167945
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
574,607
555,599
614,109
542,702
561,883
2,848,900
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......
11,315,718
12,000,233
11,583,416
11,957,116
12,919,631
59,776,114
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.
11,890,325
12,555,832
12,197,525
12,499,818
13,481,514
62,625,014
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
0
0
0
0
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.
989,689
1,098,666
1,166,569
1,149,401
1,090,615
5,494,940
c
Add lines 7a and 7b..
989,689
1,098,666
1,166,569
1,149,401
1,090,615
5,494,940
8
Public support (Subtract line 7c from line 6.)
57,130,074
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
11,890,325
12,555,832
12,197,525
12,499,818
13,481,514
62,625,014
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
16,626
3,808
2,361
260
0
23,055
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
16,626
3,808
2,361
260
0
23,055
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.)
..
4,294
3,066
3,233
5,239
24,430
40,262
13
Total support. (Add lines 9, 10c, 11, and 12.)..
11,911,245
12,562,706
12,203,119
12,505,317
13,505,944
62,688,331
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
91.130 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
89.600 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.040 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.090 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
Additional Data
Software ID:
13000248
Software Version:
2013v3.1
-
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
VISITING NURSES ASSOCIATION OF THE ROCKFORD AREA
Employer identification number
36-2167945
Return Reference
Explanation
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
VNA SHALL HAVE AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF VNA, THE IMMEDIATE PAST CHAIRPERSON AND NO MORE THAN TWO OTHER DIRECTORS. DURING THE INTERVALS BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE SHALL POSSESS AND MAY EXERCISE, ALL OF THE POWERS OF THE BOARD OF DIRECTORS IN THE MANAGEMENT AND DIRECTION OF VNA, IN SUCH MANNER AS SHALL BE FOR ITS BEST INTERESTS, EXCEPT FOR THOSE AS REFERENCED IN THE BYLAWS, SECTION 1. THE CHAIRPERSON OF VNA SHALL BE THE CHAIR OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL KEEP MINUTES OF ITS MEETINGS AND SHALL REPORT ALL ACTIONS TAKEN BY IT AT THE NEXT SUCCEEDING REGULAR MEETING OF THE BOARD OF DIRECTORS. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ITS BUSINESS AND ANY ACTION OF THE EXECUTIVE COMMITTEE TO BE EFFECTIVE MUST BE AUTHORIZED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THOSE MEMBERS PRESENT. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE MAY FIX THE PLACE OF ITS MEETINGS AND OTHERWISE FIX ITS OWN RULES AND PROCEDURES UNLESS THE BOARD OF DIRECTORS OR THE BYLAWS SHALL OTHERWISE PROVIDE.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders
ROCKFORD HEALTH SYSTEM (RHS) IS THE SOLE CORPORATE MEMBER OF VNA AND HAS THE AUTHORITY TO ELECT MEMBERS TO THE BOARD AND ULTIMATELY HAS THE AUTHORITY TO APPROVE OR DENY ALL VNA BOARD ACTIONS. ACCORDING TO THE BYLAWS, ARTICLE IV, SECTION I, THE SOLE MEMBER SHALL HAVE POWERS AND VOTING RIGHTS TO DO THE FOLLOWING: (A) APPROVE THE ELECTION OF THE BOARD OF DIRECTORS OF VNA, AND REMOVE DIRECTORS FOR CAUSE. (B) NOMINATE TO VNA'S BOARD OF DIRECTORS ALL CANDIDATES FOR SELECTION AS THE CORPORATION'S PRESIDENT AND CEO. (C) APPROVE EXPRESSLY ALL AMENDMENTS TO THE VNA'S ARTICLES OF INCORPORATION AND BY-LAWS. (D) APPROVE ANNUAL BUDGETS AND STRATEGIC, LONG-RANGE AND HEALTH MANPOWER DEVELOPMENT PLANS OF VNA. (E) APPROVE ALL CONTRACTS OF INDEBTEDNESS TO THE EXTEND NOT INCLUDED IN THE ANNUAL BUDGET. (F) APPROVE ALL CAPITAL OR OPERATING EXPENDITURES OVER $50,000 TO THE EXTENT SUCH EXPENDITURES WERE INCLUDED IN THE ANNUAL BUDGET. (G) APPROVE ALL PLANS OF MERGER OR CONSOLIDATION. (H) APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF VNA. (I) APPROVE A VOLUNTARY DISSOLUTION OF THE CORPORATION. (J) APPROVE PARTICIPATION IN MANAGED CARE ARRANGEMENTS, AND REQUIRE VNA TO PARTICIPATE IN MANAGED CARE ARRANGEMENTS AS PART OF AN RHS SYSTEM-WIDE STRATEGIC PLAN. (K) REQUIRE THE VNA BOARD OF DIRECTORS TO TAKE ANY ACTION (INCLUDING AMENDING VNA'S ARTICLES OF INCORPORATION OR BY-LAWS), OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, IF RHS DETERMINES THAT FAILURE TO TAKE THE ACTION, OR TO MODIFY OR RESCIND AN ACTION ALREADY TAKEN, MAY RESULT IN VNA'S FAILURE TO OBTAIN OR MAINTAIN ITS EXEMPTION AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE CODE.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body
SEE NARRATIVE FOR FORM 990, PART VI, LINE 6.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders
SEE NARRATIVE FOR FORM 990, PART VI, LINE 6.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
THE DATA WAS GATHERED BY THE ACCOUNTING STAFF WITH INPUT FROM VNA AND RHS EXECUTIVE STAFFS. THE DATA WAS REVIEWED AND THE FORM 990 PREPARED BY THE RHS STAFF. ONCE THE FORM 990 WAS COMPLETED, IT WAS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL BOARD MEMBERS ON A SECURE INTRACOMPANY WEBSITE BEFORE FILING WITH THE IRS.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
RHS COMPLIANCE DEPARTMENT IS RESPONSIBLE FOR SENDING OUT A COPY OF THE POLICY WITH THE CONFLICT OF INTEREST FORM INCLUDED EACH YEAR. EACH MEMBER OF THE BOARD IS TO COMPLETE THE FINANCIAL INTEREST DISCLOSURE STATEMENT WHICH IS A PART OF THE POLICY. THE RHS COMPLIANCE DEPARTMENT REVIEWS AND RETAINS THESE STATEMENTS. IF A CONFLICT IS IDENTIFIED, ALL AFFECTED PARTIES ARE INFORMED, POTENTIAL CONFLICTS ARE REVIEWED AND APPROPRIATE ACTIONS ARE TAKEN AS A RESULT OF THE REVIEW. EMPLOYEES ARE GIVEN THE POLICY AND A STATEMENT TO COMPLETE AT THE BEGINNING OF THE YEAR OR AS A NEW PARTY IS HIRED OR JOINS THE VNA BOARD.
FORM 990, PART VI, LINE 15A, PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL
COMPENSATION FOR EXECUTIVES, INCLUDING THE TOP MANAGEMENT OFFICIAL, IS GOVERNED BY THE RHS BOARD OF DIRECTORS (A RELATED ORGANIZATION AND SOLE CORPORATE MEMBER OF VNA). THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES FROM ALL RELATED ENTITIES (INCLUDING VNA). THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN INDEPENDENT EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS (INCLUDING VNA) SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. RHS GENERALLY CONDUCTS AN ANALYSIS OF TOTAL COMPENSATION EVERY THREE YEARS BUT MAY CHOOSE TO VARY FROM THIS SCHEDULE AS DETERMINED BY THE COMPENSATION COMMITTEE. THE VNA BOARD OF DIRECTORS CONCEDES THE AUTHORITY TO SET COMPENSATION TO RHS AS THE SOLE CORPORATE MEMBER. THIS PROCESS WAS LAST COMPLETED IN 2013.
FORM 990, PART VI, LINE 15B, PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES
COMPENSATION FOR EXECUTIVES, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES, IS GOVERNED BY THE RHS BOARD OF DIRECTORS (A RELATED ORGANIZATION AND SOLE CORPORATE MEMBER OF VNA). THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES FROM ALL RELATED ENTITIES (INCLUDING VNA). THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN INDEPENDENT EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS (INCLUDING VNA) SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. RHS GENERALLY CONDUCTS AN ANALYSIS OF TOTAL COMPENSATION EVERY THREE YEARS BUT MAY CHOOSE TO VARY FROM THIS SCHEDULE AS DETERMINED BY THE COMPENSATION COMMITTEE. THE VNA BOARD OF DIRECTORS CONCEDES THE AUTHORITY TO SET COMPENSATION TO RHS AS THE SOLE CORPORATE MEMBER. THIS PROCESS WAS LAST COMPLETED IN 2013.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ILLINOIS ATTORNEY GENERAL'S OFFICE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE BY REQUEST FROM BOARD SECRETARY.
FORM 990, PART VII, SECTION A, NONEMPLOYEE COMPENSATION
SHARON RUDY IS NOT COMPENSATED AS A BOARD MEMBER; SHE RECEIVED TAXABLE NONEMPLOYEE COMPENSATION ON A FORM 1099 FOR 2013 LEGAL SERVICES PROVIDED TO THE SYSTEM.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances
UNRESTRICTED FUNDS-RMDF - 242174; CUM EFF CHG IN ACCTG-PENSION - 515278; CUM EFF CHG IN ACCTG-POST RETIREMENT - 62596; TEMP RESTRICTED FUNDS-RMDF - 15306; PERMANENT RESTRICTED FUNDS-RMDF - 19780;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.