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.") .... | 2,816,496 | 2,231,628 | 2,059,724 | 2,638,496 | 2,053,998 | 11,800,342 |
| 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 | 2,816,496 | 2,231,628 | 2,059,724 | 2,638,496 | 2,053,998 | 11,800,342 |
| 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).. | 5,491,699 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 6,308,643 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,816,496 | 2,231,628 | 2,059,724 | 2,638,496 | 2,053,998 | 11,800,342 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 13,966 | 13,340 | 14,946 | 13,410 | 20,706 | 76,368 |
| 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.).. | ||||||
| 11 | Total support Add lines 7 through 10. | 11,876,710 | |||||
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) |
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| 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) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
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 |
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| Return Reference | Explanation |
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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, PAGE 2, PART III, LINE 4D | BREAST AND CERVICAL CANCER PROGRAM (BCCP) THE BCCP PROGRAM IS PART OF A STATE-WIDE PROGRAM DEDICATED TO REDUCING MORTALITY FROM BREAST AND CERVICAL CANCER AMONG WOMEN AGES 40-64 IN INDIANA. THIS STATE-WIDE PROGRAM PROVIDES FREE ANNUAL EXAMS AND MAMMOGRAMS TO WOMEN ENROLLED IN OUR PROGRAM, FREE FOLLOW-UP CARE FOR ANY ABNORMALITY FOUND DURING THEIR ANNUAL EXAM, AND ONE ON ONE CASE MANAGEMENT SERVICES. THE BCCP PROGRAM STAFF PROVIDES RECRUITMENT AND MARKETING FOR THE PROGRAM, PROCESSES ALL ENROLLMENTS AND BILLINGS, AND PROVIDES TRAINING, MONITORING AND EVALUATION OF PROGRAM PROVIDERS FOR LAKE, PORTER AND LAPORTE COUNTIES IN INDIANA. HEALTHVISIONS OF FORT WAYNE (HVFW) HVFW PROVIDES SERVICES TO THE POPULATION OF FORT WAYNE, IN INCLUDING A HEALTH AND NUTRITION PROGRAM IN THE SOUTHEAST QUADRANT OF FORT WAYNE TARGETING AFRICAN AMERICAN YOUTH AND SENIORS; THE BIENVENIDO PROGRAM WHICH PROVIDES AN EDUCATIONAL CURRICULUM TO ENHANCE AWARENESS OF MENTAL HEALTH IN THE LATINO IMMIGRATION COMMUNITY; AND THE DIABETES EDUCATION EMPOWERMENT PROGRAM (DEEP). THIS DIABETES PROJECT IS TO MEASURE THE EFFECTIVENESS OF DIABETES TRAINING TO IMPROVE SELF-MANAGEMENT OF DIABETES IN THE AFRICAN AMERICAN/BLACK AND LATINO/HISPANIC POPULATIONS. THE PROJECT AIMS TO INCREASE AWARENESS, BELIEFS, AND ABILITY TO MANAGE DIABETES. HEALTHVISIONS OF EAST ST. LOUIS (HVESL) HVESL PROVIDES SERVICES TO THE POPULATION OF EAST ST. LOUIS, IL INCLUDING THE FAITH IN ACTION TO SERVE AND TRANSFORM (FAST) PROGRAM WHICH PROVIDES SUPPORTIVE SERVICES TO COMMUNITY RESIDENTS WHO ARE ELDERLY AND HOMEBOUND, WHICH INCLUDES TRANSPORTATION SERVICES, AND THE MISSION OUTREACH REACHING EVERYONE (MORE) PROGRAM, WHICH WORKS WITH LOCAL CONGREGATIONS TO IDENTIFY THEIR NEEDS FOR TRAINING AND SUPPORT IN EDUCATING THEIR SENIOR CONGREGATION ON IMPORTANT HEALTH ISSUES. NORTHEAST INDIANA AREA HEALTH EDUCATION CENTER (NEIAHEC) NEIAHEC FACILITATES THE DELIVERY OF PROGRAMS ACROSS THE REGION THROUGH THE ISSUE AND ADMINISTRATION OF REQUESTS FOR SERVICES FOR PROGRAMMING IN THE THREE KEY FOCUS AREAS OF THE INDIANA AHEC. INDIANA AHEC'S MISSION IS TO IMPROVE HEALTH BY RECRUITING, EDUCATING AND RETAINING HEALTHCARE PROFESSIONALS FOR UNDERSERVED COMMUNITIES IN INDIANA. NEIAEC SERVES 17 COUNTIES IN NORTHEAST INDIANA BY PERFORMING FOUR BASIC FUNCTIONS: ASSIST IN THE AMBULATORY TRAINING OF HEALTH PROFESSIONAL; PROVIDE CONTINUING EDUCATION, ESPECIALLY FOR PROVIDERS TO THE UNDERSERVED; RECRUIT MINORITY STUDENTS INTO THE HEALTH PROFESSIONS CAREERS; RESPOND TO EMERGING HEALTH ISSUES. |
| FORM 990, PAGE 6, PART VI, LINE 2 | SR RELIGIOUS ORDER SR |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE PROVINCIAL OF THE AMERICAN PROVINCE OF THE POOR HANDMAIDS AND THE INDIVIDUALS HOLDING MEMBERSHIP POSITIONS IN THE PROVINCIAL COUNCIL OF THE AMERICAN PROVINCE OF THE POOR HANDMAIDS ARE THE VOTING MEMBERS OF HEALTHVISIONS MIDWEST, INC. (HVM). |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE MEMBERS OF HVM APPROVE NEW MEMBERS OF THE BOARD OF DIRECTORS. THE MEMBERS OF HVM APPOINT THE CHAIRPERSON OF HVM. |
| FORM 990, PAGE 6, PART VI, LINE 7B | THE APPROVAL OF THE MEMBERS IS REQUIRED WITH RESPECT TO THE FOLLOWING: -ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS -THE ACQUISITION, SALE, LEASE, TRANSFER, ASSIGNMENT, MORTGAGE OR ENCUMBRANCE OF ANY FIXED CAPITAL, BUILDINGS OR REAL ESTATE -ANY ACTION WHICH MIGHT BE CONSIDERED INCONSISTENT WITH THE OBJECTIVES AND PURPOSES SET FORTH IN THE BYLAWS -THE INCURRENCE OF DEBT WHICH WOULD BIND HVM IN AN AMOUNT EXCEEDING THE LESSER OF ONE MILLION DOLLARS OR TEN PERCENT OF THE BOOK VALUE OF THE FIXED ASSET OF HVM -THE ACQUISITION OF, OR ESTABLISHMENT OF ANY ENTITY WHICH HVM PROPOSES TO OWN OR CONTROL ON AN ON-GOING BASIS -THE ACCEPTANCE OF A DONATION/BEQUEST WHICH WOULD IMPOSE AN OBLIGATION ON THE CORPORATION OR ITS MEMBERS -ANY MAJOR STRUCTURAL CHANGES - MERGER, CONSOLIDATION, DISSOLUTION, OR SALE OF SUBSTANTIALLY ALL THE ASSETS OF HVM -THE SELECTION OF THE CERTIFIED PUBLIC ACCOUNTANTS |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 WAS PREPARED BY HAINES, ISENBARGER AND SKIBA, LLC, INDEPENDENT AUDITORS OF HVM AND REVIEWED BY THE HVM CONTROLLER AND THE TREASURER OF ANCILLA DOMINI SISTERS, INC. A COPY OF THE FORM 990 WAS PROVIDED TO ALL DIRECTORS FOR REVIEW AT THE NOVEMBER 2, 2015 BOARD MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE ARE REQUIRED TO COMPLETE A DISCLOSURE STATEMENT, WHICH IDENTIFIES CONFLICTS OF INTEREST, ANNUALLY. THE COMPLIANCE OFFICER REVIEWS THE DISCLOSURE STATEMENTS AND REPORTS ANY POTENTIAL CONFLICTS OF INTEREST TO THE PRESIDENT/CEO, WHO WOULD SUBSEQUENTLY DISCLOSE THE POTENTIAL CONFLICTS OF INTEREST TO THE BOARD. IN 2014, NO POTENTIAL CONFLICTS OF INTEREST WERE NOTED. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE DIRECTOR OF HUMAN RESOURCES PREPARES AN ANALYSIS BY COMPARING THE CEO POSITION WITH OTHER NOT-FOR-PROFIT ORGANIZATIONS USING MARKET COMPENSATION INFORMATION FROM WWW.SALARY.COM, AT EVERY OPPORTUNITY, ALSO COMPARES DATA FROM THIS DATABASE WITH OTHER COMPENSATION REPORTS. ONCE THIS ANALYSIS IS COMPILED THE REPORT IS FORWARDED TO THE BOARD OF DIRECTORS, WHICH REVIEW AND APPROVE THE CEO'S COMPENSATION. |
| FORM 990, PAGE 6, PART VI, LINE 19 | HVM DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, EXCEPT TO THE EXTENT THAT THEY ARE PUBLICLY AVAILABLE DOCUMENTS SUCH AS FORM 990 OR 1023. |
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