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.
| (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 | |||||||||
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.") .... | 740,480 | 538,365 | 395,861 | 54,016 | 1,728,722 | |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 740,480 | 538,365 | 395,861 | 54,016 | 1,728,722 | |
| 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).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,728,722 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 740,480 | 538,365 | 395,861 | 54,016 | 1,728,722 | |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 144,224 | 237,329 | 1,697 | 195 | 238 | 383,683 |
| 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.).. | 378,115 | 107,776 | 485,891 | |||
| 11 | Total support (Add lines 7 through 10). | 2,598,296 | |||||






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.) | ||||||
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.).. | ||||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 13000170 |
| Software Version: | 2013v4.0 |
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 3: Ceased Conducting or Significant Changes To Services | During fiscal year September 30, 2012, the Board of Directors, after significant efforts over the prior two years to improve the operation's financial profitability, had determined that, in the current competitive and regulatory environment, it could no longer continue as a going concern. The Board of Directors approved a plan to proceed with liquidation on July 28, 2011, and the Association commenced liquidation shortly thereafter. The Association provided service on a winding down basis through November 30, 2011, at which time, all remaining patients were discharged to other home care and hospice organizations. The Organization has provided notice to its creditors and are in statutory termination mode. The Organization cannot formally dissolve with the Connecticut Secretary of the State until 2016. In accordance with the Organization's Certificate of Incorporation, all assets will be distributed to a similar tax-exempt IRS 501(c)(3) organization. The assets as of September 30, 2014 consisted of the $65,089 included on this IRS Form 990, plus an escrow account of $58,870 with the Connecticut Department of Labor for terminated employee unemployment benefits. |
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | The Board of Directors consists of community volunteers, who interact with each other in the normal course of business (i.e. banker, lawyer, accountant, etc.) unrelated to the activities of the Organization. |
| Form 990, Part VI, Line 11b: Form 990 Review Process | The Organization's engaged an accounting firm to prepare the IRS Form 990 from information provided by the Organization. The IRS Form 990 is signed by the Organizations President or Treasurer the governing Board of Directors. All members of the Board of Directors are provided and electronic copy of the final IRS Form 990 prior to filing with the Internal Revenue Service. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Prior to the plan to proceed with liquidation, which was approved by the Board of Directors on July 28, 2011, all members of the Board of Directors were required to read the Conflict of Interest Policy Statement, disclose any conflicts of interest and sign the policy statement annually. However, no Conflict of Interest Policy Statement has been circulated to the Board of Directors since the plan of liquidation was approved. The Organization believes there has been no operations that could have led to any possible conflicts of interest. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | Yes, but no payroll during the year ended September 30, 2014. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | Yes, but no payroll during the year ended September 30, 2014. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The Organization's governing documents, conflict of interest policy and financial statements are available upon request. Information is maintained by the senior management staff of the Organization. |
| Software ID: | 13000170 |
| Software Version: | 2013v4.0 |