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
ADVANCED HOME CARE INC
Employer identification number
56-1844651
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.") .
16,452
9,791
6,974
50,118
108,218
191,553
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......
118,118,593
115,061,871
122,328,898
161,016,908
165,674,352
682,200,622
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
7,661
7,661
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.
118,135,045
115,071,662
122,335,872
161,067,026
165,790,231
682,399,836
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
682,399,836
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...
118,135,045
115,071,662
122,335,872
161,067,026
165,790,231
682,399,836
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
138,622
186,889
74,386
13,593
413,490
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
138,622
186,889
74,386
13,593
413,490
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.)
..
93,193
59,012
-3,047
-7,858
300,595
441,895
13
Total support. (Add lines 9, 10c, 11, and 12.)..
118,366,860
115,317,563
122,407,211
161,072,761
166,090,826
683,255,221
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
99.870 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.900 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.060 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.070 %
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
ADVANCED HOME CARE INC
Employer identification number
56-1844651
Return Reference
Explanation
FORM 990, PART III, LINE 2
ADVANCED HOME CARE PREVIOUSLY LISTED ALL PROGRAMS UNDER ONE DESCRIPTION. IN THE CURRENT YEAR, THE COMPANY HAS CHOSEN TO BREAK OUT PROGRAMS INTO THE THREE DESCRIPTIONS SHOWN IN PART III. THIS DOES NOT REPRESENT ANY NEW OR CHANGED PROGRAMS FROM THE PRIOR YEAR, BUT PROVIDES A BETTER DESCRIPTION OF SERVICES.
FORM 990. PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:
UNCOMPENSATED CARE: TOTAL CHARITY CARE: $ 6,916,043 BAD DEBTS TIMES COST/CHARGE RATIO $ 3,934,003 NON-REIMBURSED COST OF TREATING MEDICARE AND MEDICAID PATIENTS $ 2,852,573 NON-REIMBURSED COST OF TREATING MANAGED CARE PATIENTS $ 12,995,073 CASH DONATIONS $ 18,741 SUBSIDIZED COMMUNITY SERVICES $ 165,055 EMPLOYEE DONATIONS TO COMMUNITY ORGANIZATIONS THROUGH COMPANY SPONSORED EVENTS $ 92,992 TOTAL COMMUNITY BENEFIT $ 26,974,480
FORM 990, PART VI, SECTION A, LINE 1
THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS SHALL BE COMPOSED OF DIRECTORS APPOINTED BY MEMBERS WHOSE MEMBERSHIP INTEREST IS EQUAL TO OR GREATER THAN 5%. EACH MEMBER WHOSE MEMBERSHIP IS EQUAL TO OR GREATER THAN 5% MAY APPOINT ONE OF THE TWO DIRECTORS THAT SUCH MEMBER APPOINTS TO SERVE ON THE BOARD OF DIRECTORS TO ALSO SERVE ON THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. NO MEMBER SHALL BE ENTITLED TO APPOINT MORE THAN ONE DIRECTOR TO SERVE ON THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS AND AFFAIRS OF THE CORPORATION DURING INTERVALS BETWEEN MEETINGS.
FORM 990, PART VI, SECTION A, LINE 6
THE COMPANY CURRENTLY HAS TWELVE MEMBERS INCLUDING MOSES H CONE MEMORIAL HOSPITAL, HIGH POINT REGIONAL HEALTH SERVICES, INC., NOVANT HEALTH, INC., MISSION HOSPITALS, INC., VIDANT, CAREPARTNERS HEALTH SERVICES, CAROMONT HEALTH SERVICES, INC., WELLMONT HEALTH SYSTEM, MOREHEAD MEMORIAL HOSPITAL, INC., WAKEMED, WELLSTAR HEALTH SYSTEM, AND CENTRAL GEORGIA HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 7A
ONE DIRECTOR SHALL BE AN EMPLOYEE OF ADVANCED HOME CARE, INC. THE REMAINING DIRECTORS SHALL BE VOTING DIRECTORS AND SHALL BE APPOINTED BY THE MEMBERS SUCH THAT EACH MEMBER SHALL APPOINT TWO VOTING DIRECTORS. AN APPOINTED DIRECTOR MAY BE REMOVED FROM OFFICE AT ANY TIME WITH OR WITHOUT CAUSE BY THE MEMBER THAT APPOINTED THAT DIRECTOR TO OFFICE. IF A DIRECTOR IS REMOVED, A NEW DIRECTOR MAY BE APPOINTED BY THE APPROPRIAT MEMBER TO FILL THE VACANCY AT THE SAME TIME AS THE REMOVAL.
FORM 990, PART VI, SECTION A, LINE 7B
DECISIONS OF THE BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THE MEMBER BODY.
FORM 990, PART VI, SECTION B, LINE 11
THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. FOLLOWING MANAGEMENT REVIEW, THE RETURN WAS SUBMITTED TO ALL BOARD MEMBERS FOR REVIEW AND WAS DISCUSSED AS AN AGENDA ITEM AT A BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 12C
AS PART OF ITS ANNUAL REIVEW AND CONFIRMATION PROCESS, ADVANCED HOME CARE REQUIRES ANY EMPLOYEE HOLDING A POSITION AT THE DIRECTOR LEVEL OR ABOVE (INCLUDING OFFICERS AND BOARD MEMBERS) TO SIGN AN ANNUAL STATEMENT CONFIRMING HIS OR HER KNOWLEDGE AND UNDERSTANDING OF, AND COMPLIANCE WITH, ITS CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15
A COMPENSATION COMMITTEE IS COMPRISED OF THREE BOARD MEMBERS THAT REPRESENT THE LARGEST OWNERSHIP OF ADVANCED HOME CARE. THE COMMITTEE IS RESPONSIBLE FOR REVIEWING AND APPROVING THE COMPENSATION PROGRAM FOR ALL SENIOR MANAGERS. THE COMMITTEE USES AN OUTSIDE CONSULTING SERVICE, FINDLEY DAVIES, TO PROVIDE SURVEY DATA TO DETERMINE APPROPRIATE PAY RANGES. THE PROCESS IS COMPLETED EVERY TWO YEARS.
FORM 990, PART VI, SECTION C, LINE 18
PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVILIABLE ONLINE AT WWW.GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19
PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART VII, SECTION A, COLUMN F
THE COMPANY, IN A FULL TRANSPARENCY POSTURE TO REPORTING, IS REPORTING ALL BENEFITS IN FULL IN COLUMN F, PART VII AND IS NOT APPLYING THE $10,000 PER ITEM EXCEPTION FOR CERTAIN BENEFITS.
FORM 990, PART XI, LINE 9:
CONTRIBUTIONS FROM MEMBERS 4,196,000. MEMBER BUY-OUTS -306,436.
FORM 990, PART XII, LINE 2C:
THE COMPANY HAS A COMMITTEE THAT REVIEWS THE SELECTION OF THE INDEPENDENT AUDITOR. THERE HAVE BEEN NO CHANGES IN THE SELECTION PROCESS SINCE THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.