Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 91,359 | 65,429 | 156,151 | 174,079 | 271,915 | 758,933 |
| 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 | 91,359 | 65,429 | 156,151 | 174,079 | 271,915 | 758,933 |
| 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).. | 44,177 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 714,756 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 91,359 | 65,429 | 156,151 | 174,079 | 271,915 | 758,933 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 439 | 11 | 7 | 7 | 6 | 470 |
| 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 VI.).. | 84,634 | 89,529 | 3,600 | 4,660 | 4,260 | 186,683 |
| 11 | Total support Add lines 7 through 10. | 946,086 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part II, Line 10 Other Income | DESCRIPTION - GROSS INCOME FROM FUNDRAISING, COLUMN A - 84634.0, COLUMN B - 89529.0, COLUMN C - 3600.0, COLUMN D - 4660.0, COLUMN E - 4260.0, COLUMN F - 186683.0; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 1 ORGANIZATION'S MISSION | (CONTINUED FROM PART III, LINE 1) CAREGIVERS CAN BE A SPOUSE, AN ADULT CHILD, OR EVEN A FRIEND. AFS PROVIDES CURRENT AND UPDATED KNOWLEDGE AND TREATMENT INFORMATION TO THE FAMILY. SERVICES ARE PROVIDED COMMENSURATE WITH THE CAPABILITIES OF THE STAFF AND WITH THE KNOWLEDGE AND APPROVAL OF THE BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 15a COMPENSATION OF TOP MANAGEMENT OFFICIAL | THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS COMPENSATED BY COVENANT HOSPICE, INC. COVENANT HOSPICE, INC. PROCURES SALARY COMPARABILITY DATA AND HIRES AN INDEPENDENT FIRM TO DO A SALARY COMPARISON FOR ALL SENIOR ADMINISTRATIVE STAFF. THE SALARY COMPARISON WITH THE INDEPENDENT FIRM IS UNDERTAKEN ANNUALLY. THE CEO'S COMPENSATION IS REVIEWED AND APPROVED BY THE COVENANT HOSPICE BOARD WITH INSIGHT GIVEN FROM THE SALARY COMPARISON OF THE INDEPENDENT FIRM. THIS PROCESS IS DONE ANNUALLY AND IS DOCUMENTED. BECAUSE THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS NOT COMPENSATED BY THE FILING ORGANIZATION, THIS QUESTION IS MARKED "NO" IN ACCORDANCE WITH FORM 990 INSTRUCTIONS. |
| Form 990, Part VI, Line 15b COMPENSATION OF OTHER OFFICERS | THE ORGANIZATION DOES NOT HAVE ANY OTHER OFFICERS WHO RECEIVE COMPENSATION. THEREFORE THIS QUESTION HAS BEEN ANSWERED "NO" IN ACCORDANCE WITH FORM 990 INSTRUCTIONS. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | PURSUANT TO THE ORGANIZATION'S BYLAWS, ARTICLE IX: THE EXECUTIVE COMMITTEE OF THE BOARD SHALL BE COMPOSED OF THE ELECTED OFFICERS OF THE CORPORATION, THE PRESIDENT & CEO OF COVENANT HOSPICE (A RELATED ORGANIZATION), AND THE IMMEDIATE PAST CHAIRPERSON. THE EXECUTIVE DIRECTOR OF THE CORPORATION WILL BE A NON-VOTING MEMBER OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL MAKE RECOMMENDATIONS OF ACTION TO THE BOARD; HAVE POWER TO ACT FOR THE BOARD BETWEEN MEETINGS OF THE BOARD, EXCEPT THAT IT MAY NOT MODIFY ANY ACTION TAKEN BY THE BOARD, NOR AMEND, ADOPT OR REPEAL CORPORATION'S BYLAWS; SUCH ACTIONS SHALL BE REPORTED TO THE BOARD AT ITS NEXT REGULAR MEETING; PERFORM SUCH OTHER DUTIES AS THE BOARD FROM TIME TO TIME MAY DEEM EXPEDIENT; A MAJORITY OF THE COMMITTEE SHALL CONSTITUTE A QUORUM; ESTABLISH AND ADVOCATE SUCH AD HOC COMMITTEES AS NEEDED; PROVIDE FINANCIAL OVERSIGHT OF BUDGETARY AND FISCAL PROCEDURES; ASSURE THAT ADEQUATE FINANCIAL CONTROLS ARE CONSISTENTLY EMPLOYED AND ARRANGE FOR AN INDEPENDENT AUDIT ANNUALLY. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The sole member is Covenant Hospice, Inc., a related organization. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Covenant Hospice, Inc. has the authority to approve the election of all board members of Alzheimer's Family Services, Inc. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | The following actions require approval of Covenant Hospice, Inc.: -the election of board members of Alzheimer's Family Services; -amendments to the by-laws and articles of incorporation of the organization; -annual capital and operating budgets of the corporation; -incurrence by Alzheimer's Family Services of any indebtedness not allowed for in the approved operating or capital budgets of the corporation; -transfer by the corporation, during any fiscal year, of any assets not in the ordinary course of business; -the sale, lease, or other transfer of, or the entering into of any partnership, joint venture, or other arrangement; -the merger of the corporation into another entity or of another entity into the corporation, or the consolidation of the corporation and any other entity; -the liquidation or dissolution of the corporation; -any affiliation agreement between the corporation and Covenant Hospice, Inc. and any amendments thereto. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | Both Staff and designated Board members review the return before signing. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Conflict of Interest statements are sent annually to members of the Board of Directors, and all key staff members reportable on the Form 990. The forms are reviewed for responses indicating a possible conflict of interest. In addition, the Director of Accounting reviews transactions with vendors with which the Board may be affiliated to determine that all transactions are made at arm's length. If a possible conflict is identified, the person with a conflict is prohibited from participating in the Board of Directors deliberations and decisions in the transaction. |
| Form 990, Part VI, Line 19 Required documents available to the public | GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE ON WRITTEN REQUEST. |
| Form 990, Part IX, Line 11g Other Fees | administrative fees - Total Expense: 102166, Program Service Expense: 96486, Management and General Expenses: 5097, Fundraising Expenses: 583; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |