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
HOSPICE - VNSWWPHC INC
Employer identification number
13-3634734
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.") .
480,788
239,491
291,051
383,951
427,149
1,822,430
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......
10,149,948
10,767,781
10,702,098
10,683,375
10,364,941
52,668,143
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.
10,630,736
11,007,272
10,993,149
11,067,326
10,792,090
54,490,573
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.
56,681
100,475
46,183
130,086
383,496
716,921
c
Add lines 7a and 7b..
56,681
100,475
46,183
130,086
383,496
716,921
8
Public support (Subtract line 7c from line 6.)
53,773,652
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...
10,630,736
11,007,272
10,993,149
11,067,326
10,792,090
54,490,573
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
49,593
66,352
61,803
94,772
70,838
343,358
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
49,593
66,352
61,803
94,772
70,838
343,358
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.)
..
76,175
78,877
68,495
65,183
71,563
360,293
13
Total support. (Add lines 9, 10c, 11, and 12.)..
10,756,504
11,152,501
11,123,447
11,227,281
10,934,491
55,194,224
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
97.426 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
97.806 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.622 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.670 %
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
HOSPICE - VNSWWPHC INC
Employer identification number
13-3634734
Return Reference
Explanation
Part VI, SECTION b, line 12c
THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY IN PLACE TO ADDRESS ANY AND ALL CONFLICTS THAT ARISE, ARE REPORTED OR ARE OTHERWISE DISCOVERED. ON AN ANNUAL BASIS, ALL MEMBERS OF THE BOARD OF DIRECTORS ALONG WITH CERTAIN MEMBERS OF THE MANAGEMENT TEAM AND OTHER EMPLOYEES ARE PROVIDED A CURRENT COPY OF THE POLICY AND ARE ALSO REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THESE QUESTIONNAIRES ARE REVIEWED BY THE BOARD CHAIR OF THE ORGANIZATION TO IDENTIFY THE NUMBER, MAGNITUDE AND NATURE OF ALL DISCLOSED CONFLICTS. ANY CONFLICTS ARE THEN REFERRED TO THE BOARD OF DIRECTORS FOR DISCUSSION AND RESOLUTION, AS NECESSARY.
Part VI, Section B, line 15a
The policy principles utilized in determining the compensation of the Executive Director are as follows: 1. A salary survey based upon salary comparisons among individuals in similar positions from other Hospice agencies as well as with other not for profit Medicare certified agencies. the board monitors and ensures that the Executive compensation continues to be commensurate with the employee's skills, abilities and experience. 2. The annual increase in compensation is reviewed against the budget expectations developed by the Board, the outcomes and objectives of the strategic plan and the quality of patient care that contributes to the achievement of the Organization's mission and goals. 3. The evaluation process provides the individual with constructive comments that enable them to develop professionally and improve performance.
PART VI, Section C, Line 19
The governing documents, conflict of interest policy and financial statements of the organization are made available to the public upon request, on a discretionary basis.
SCHEDULE L, Part IV
KATHLEEN LONERGAN IS EMPLOYED AS THE ADMINISTRATOR AT THE OSBORN. AMOUNTS PAID BY THE ORGANIZATION TO THE OSBORN FOR CONTRACTED HOME HEALTH AIDE SERVICES WERE $78,642. MARY SPENGLER IS EMPLOYED AS THE EXECUTIVE DIRECTOR OF HOSPICE - VNSW/WPHC, INC. AND SERVES ON THE BOARD OF DIRECTORS OF SCHNURMACHER NURSING HOME. AMOUNTS PAID BY THE ORGANIZATION TO SCHNURMACHER NURSING HOME FOR ROOM AND BOARD CHARGES AND RELATED ASSESSMENTS WERE $98,948. KAREN LAMONICA IS EMPLOYED AS THE ADMINISTRATOR AT WESTCHESTER CARE AT HOME, INC. (WCAH). AMOUNTS PAID BY THE ORGANIZATION TO WCAH FOR CONTRACTED HOME HEALTH AIDE SERVICES WERE $108,554. KATHLEEN McARDLE WAS EMPLOYED AS THE ADMINISTRATOR AT SARAH NEUMAN NURSING HOME. AMOUNTS PAID BY THE ORGANIZATION TO SARAH NEUMAN NURSING HOME FOR ROOM AND BOARD CHARGES AND RELATED ASSESSMENTS WERE $573,911.
Part VI, section B, Line 11B
The board of directors of the organization has delegated responsibility for reviewing The Form 990 to the Audit Committee of the organization. A copy of the Form 990 was reviewed by the audit committee of the organization and provided to the Board of Directors prior to submission.
PART VI, SECTION A, LINE 7A
THE ORGANIZATION WAS ESTABLISHED AS A COOPERATIVE EFFORT OF ITS FOUNDING SPONSORS, VISITING NURSE SERVICES IN WESTCHESTER, INC. (VNSW) AND WHITE PLAINS HOSPITAL CENTER (WPHC). AS A RESULT, THE BOARD OF DIRECTORS OF THE ORGANIZATION CONSISTS OF EQUAL MEMBERS NOMINATED AND APPROVED BY ITS FOUNDING SPONSORS.
PART III, LINE 2
During 2012, the Organization developed a Pediatric Palliative Care Program known as Comfort Crew. Children ranging from newborn to age 21, who have been diagnosed with a progressive, life limiting illness, and who reside in Westchester County are eligible for services. A team of pediatric trained professionals will collaborate with the primary physician on a plan of care and provide pain and symtom management, social and psychological support, and spiritual and bereavement counseling to the child and family. Due to the limitations on third-party reimbursement for this type of program services, the Organization is conducting a community fund raising campaign to support the program. During 2013, the first full year of program operations, Comfort Crew provided care to 5 of the 6 children referred to the program.
FORM 990 PART IX LINE 11G
DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:1216030
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.