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
VOLUNTEER HEALTH PROGRAM LTD
Employer identification number
13-3739708
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.") ....
132,606
225,767
383,077
352,834
345,259
1,439,543
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
132,606
225,767
383,077
352,834
345,259
1,439,543
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.
1,439,543
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..
132,606
225,767
383,077
352,834
345,259
1,439,543
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
477
313
319
405
606
2,120
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.)..
16,216
16,216
11
Total support (Add lines 7 through 10).
1,457,879
12
Gross receipts from related activities, etc. (see instructions)
..................
12
2,162
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
98.740 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
98.570 %
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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:
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.
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
VOLUNTEER HEALTH PROGRAM LTD
Employer identification number
13-3739708
Return Reference
Explanation
FORM 990 - ORGANIZATION'S MISSION
THE VOLUNTEER HEALTH PROGRAM, LTD. (VHP) IS A NONPROFIT HEALTH CARE PROGRAM, WHICH FOCUSES ON PRIMARY MEDICAL AND SURGICAL EYE CARE TO UNDER-SERVED RURAL AREAS IN CENTRAL AMERICA AND THE DOMINICAN REPUBLIC. IT IS AN INTEGRATED PROGRAM OFFERING HIGH QUALITY AND ACCESSIBLE EYE CARE TO OUR LATIN AMNERICAN NEIGHBORS. AN ESSENTIAL PART OF OUR EFFORT IS TO WORK IN A CLOSE PARTNERSHIP WITH THOSE WHO LIVE AND WORK IN THE REGION WE ARE SERVING. VHP IS COMMITTED TO OFFERING EDUCATIONAL SUPPORT TO HEALTH CARE PROVIDERS IN AREAS THAT WE SERVE. OUR MISSION GROUP PROVIDES COMPREHENSIVE ON SITE DIAGNOSIS, SURGICAL AND MEDICAL TREATMENT OF EYE DISEASE. THE DISTRIBUTION OF CORRECTIVE GLASSES FOR THOSE IN NEED IS ALSO AN ESSENTIAL PART OF THE PROGRAM. PHYSICIANS, NURSES AND TRAINED EYE SCREENING VOLUNTEERS ARE OUR MOST VALUED RESOURCES. THE SUPERIOR KNOWLEDGE AND SKILLS OF THIS BROAD-BASED TEAM AND THEIR COMPASSIONATE CONCERN FOR EACH PATIENT'S WELFARE IS THE BASIS FOR THE VOLUNTEER HEALTH PROGRAM. WE REMAIN COMMITTED TO DELIVERING EYE CARE TO THE UNDERSERVED AND CONSIDER IT A PRIVILEGE TO DO SO. BACKGROUND: HONDURAS 1994 AND 1995 THE VOLUNTEER HEALTH PROGRAM'S FIRST TWO EYE CARE MISSIONS WERE IN GRACIOUS, HONDURAS. AT THE INVITATION OF AND IN COORDINATION WITH THE EFFORTS OF A WELL-ORGANIZED LOCAL NONPROFIT AGENCY FEDECOH, WE SAW OVER 2000 PATIENTS EACH VISIT. THERE WAS A GREAT NEED AT THIS SITE; HOWEVER, NEEDED FOLLOW UP CARE FOR OUR PATIENTS WAS DIFFICULT. DOMINICAN REPUBLIC 1995,1996,1998,1999,2000,2001,2003,2004,2005,2006,2007,2008,2009,2010,2011, 2012, 2013, 2014 AND PLANNING 2015. THE SECOND PROJECT SITE WAS STARTED IN 1995 WITH ILAC (INSTITUTE OF LATIN AMERICAN CONCERN) IN SANTIAGO DE LOS CABALLEROS, DOMINICAN REPUBLIC. WE ARE PLEASED THAT THE OPTHALMOLOGY PROGRAM HAS LED THE WAY, AS MONTHLY MEDICAL PROVIDERS IN DIFFERENT MEDICAL FIELDS NOW WORK IN A FIRST RATE MEDICAL AND SURGICAL FACILITY AT ILAC. FOR THE PAST 47 YEARS, ILAC'S HEALTH CARE SERVICES HAVE BEEN BASED ON A TRUE AND INTEGRAL COMMITMENT TO THE STRUGGLING CAMPESINOS (FARMERS)OF THE REMOTE AREAS IN THE DOMINICAN REPUBLIC. THEY SERVICE 220 COMMUNITIES AND HAVE TRAINED OVER 265 LOCAL HEALTH CARE VOLUNTEERS (COOPERADORES) FROM THESE COMMUNITIES TO ASSIST IN THE PRIMARY HEALTH CARE AND SCREENING. THE COOPERADORES ARE TRAINED BY ILAC, WITH EDUCATIONAL AIDS FROM VHP TO SELECT PATIENTS IN NEED OF EYE CARE. THEY ACCOMPANY PATIENTS TO THE ILAC MISSION HEADQUARTES, STAY AT THEIR SIDE DURING TREATMENT AND/OR SURGERY AND MONITOR THEIR PROGRESS IN THE VILLAGES. AS THE PATIENTS FROM THE RURAL COMMUNITIES COME IN TO THE MISSION SITE FOR EYE CARE THEY REGISTERED, GIVEN AN EYE EXAMINATION AND CORRECTIVE LENSES AS NEEDED. MEDICAL AND SURGICAL PROBLEMS ADDRESSED AND TREATED AS NEEDED. THIS YEAR 1,677 PATIENTS NEEDED EYE CARE. THIS YEAR WE PERFORMED 305 SURGERIES,74 LASER TREATMENTS, FIT 24 PATIENTS WITH PROSTHETICS, AND 83 MINOR DERMATOLOGICAL SURGERIES THE MAJORITY OF CASES EACH YEAR ARE CATARACT REMOVALS. ADULT BLINDNESS SECONDARY TO MATURE CATARACT FORMATION CAN BE TREATED SUCCESSFULLY, RESTORING USEFUL VISION TO THESE PATIENTS. MANY OF THE SURGICAL CASES ARE CHILDREN WITH STRABISMUS (CROSSING OF THE EYES). OUR OCULAR PLASTIC AND RECONSTRUCTION SURGICAL TEAM HELP WITH TUMORS, CONGENITAL AND TRAUMATIC DEFORMITIES. MOST OF THE LASER TREATMENTS ARE TO TREAT GLAUCOMA AND RETINAL DISEASE. THROUGH ILAC, WE HAVE WORKED IN CONJUNCTION WITH A LOCAL OPTHALMOLOGISTS THAT HAS HELPED WITH FOLLOW UP CARE FOR THE SURGICAL PATIENTS. EARLY IN 2004 ILAC FINISHED CONSTRUCTION ON THEIR CLINIC/HOSPITAL AT THE MISSION SITE. WE WERE THE FIRST TO USE THIS WONDERFUL FACILITY ON OUR MARCH/APRIL '04 MISSION. THIS MAKES IT MUCH EASIER FOR OUR GROUP AND SEVERAL OTHERS, IN DIFFERENT DISCIPLINES, TO OFFER THEIR VOLUNTEER SERVICES TO THE PEOPLE. OTHER AREAS THAT WE HAVE HELPED OPTHALMOLOGISTS WORK ARE: JERUSALEM, IN 2002, '03, '04,'05,'06, 2012, 2013 WORKING WITH ST. JOHNS EYE HOSPITAL FOR 10 DAYS. WE SUPPORTED THE PHILIPPINE MISSION EYE MISSION, DIRECT BY NELSON CO, CRNA, THEY WORKED FOR ONE WEEK, 2003,'04,'05,'06,'07,'08,'09,'10, '11,2012,AND 2013. THIS IS A SINCERE THANK YOU NOTE AS WELL. WE ARE MOST GRATEFUL FOR THE SUPPORT THAT WE HAVE RECEIVED FROM ALL; DONATING AND SURGICAL SUPPLIES, PHARMACEUTICALS, USED EYEGLASSES, USED MEDICAL EQUIPMENT AND THE MONETARY SUPPORT. OUR NEED IS TO PURCHASE ITEMS THAT ARE NOT RECEIVED IN DONATION AND PAY FOR THE SHIPPING SUPPLIES TO THE SITE. WE FEEL THAT THOSE WHO HELP WITH THE MISSION HERE, IN THEIR MAY DIFFERENT WAYS, ARE AS MUCH A PART OF THE TEAM AS THE VOLUNTEERS THAT TRAVEL TO THE HOST COUNTRY SITES. THOSE OF US THAT HAVE WORKED WITH THESE SPECIAL PATIENTS CAN ATTEST TO THEIR DEEP GRATITUDE. MANY PAIENTS HAVE EXPRESSED WISHES OF "GODS BLESSINGS AND THANKS" OR "I CANNOT PAY YOU BUT GOD WILL REPAY YOU". IT IS IMPORTANT TO HEAR FROM YOU. WE CONTINUE TO NEED SUPPORT. WE REMAIN COMMITTED TO DELIVERING EYE CARE TO THE UNDER-SERVED AND CONSIDER IT A PRIVILEGE TO DO SO. DARLENE DELLA ROCCA, R.N., CO-FOUNDER, CHAIR, PROJECT MANAGER ROBERT C. DELLA ROCCA, M.D., CO-FOUNDER/COORDINATOR NELSON CO, CRNA, DIRECTOR OF PHILIPPIANS MISSION JULE SILVI, R.N., VICE CHAIR AND PROJECT COORDINATOR ROBERT MORELLO, M.D., MEDICAL ADVISOR/COORDINATOR
FORM 990, PAGE 2, PART III, LINE 4D
MEDICAL CARE SUPPLIES UTILIZED DURING MISSION TO PROVIDE PRIMARY MEDICAL AND SURGICAL EYE CARE TO UNDER-SERVED RURAL AREAS IN CENTRAL AMERICA AND THE DOMINICAN REPUBLIC.
FORM 990, PAGE 6, PART VI, LINE 2
DARLENE DELLA ROCCA ROBERT DELLA ROCCA CO-FOUNDER CO-FOUNDER FAMILY RELATIONSHIP
FORM 990, PAGE 6, PART VI, LINE 11B
REPORT IS REVIEWED BY MANAGEMENT PRIOR TO ISSUANCE. THE 990 IS PREPARED BY AN INDEPENDENT CPA AND SENT TO MANAGEMENT FOR REVIEW AND THE ENTIRE GOVERNING BODY PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE BY POSTING IT ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, THE FINANCIAL STATEMENTS, ARTICLES OF INCORPORATION AND BY-LAWS ARE ALSO AVAILABLE UPON WRITTEN REQUEST OR BY CALLING THE ORGANIZATION DIRECLTY.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.