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 | 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
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.") . | 555,599 | 614,109 | 542,702 | 561,883 | 120,909 | 2,395,202 |
| 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...... | 12,000,233 | 11,583,416 | 11,957,116 | 12,919,631 | 12,950,271 | 61,410,667 |
| 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. | 12,555,832 | 12,197,525 | 12,499,818 | 13,481,514 | 13,071,180 | 63,805,869 |
| 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. | 1,098,666 | 1,166,569 | 1,149,401 | 1,090,615 | 1,211,371 | 5,716,622 |
| c | Add lines 7a and 7b.. | 1,098,666 | 1,166,569 | 1,149,401 | 1,090,615 | 1,211,371 | 5,716,622 |
| 8 | Public support (Subtract line 7c from line 6.) | 58,089,247 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 12,555,832 | 12,197,525 | 12,499,818 | 13,481,514 | 13,071,180 | 63,805,869 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 3,808 | 2,361 | 260 | 0 | 0 | 6,429 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 3,808 | 2,361 | 260 | 0 | 0 | 6,429 |
| 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.) .. | 3,066 | 3,233 | 5,239 | 24,430 | 54,189 | 90,157 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 12,562,706 | 12,203,119 | 12,505,317 | 13,505,944 | 13,125,369 | 63,902,455 |
| 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 |
||||
|
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 III, Line 12 Other Income | DESCRIPTION - OTHER INCOME, COLUMN A - 3066.0, COLUMN B - 3233.0, COLUMN C - 5239.0, COLUMN D - 24430.0, COLUMN E - 54189.0, COLUMN F - 90157.0; |
| 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 VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL | COMPENSATION FOR EXECUTIVES, INCLUDING THE TOP MANAGEMENT OFFICIAL, IS GOVERNED BY THE RHS BOARD OF DIRECTORS (A RELATED ORGANIZATION AND SOLE CORPORATE MEMBER OF VNA). THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES FROM ALL RELATED ENTITIES (INCLUDING VNA). THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN INDEPENDENT EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS (INCLUDING VNA) SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. RHS GENERALLY CONDUCTS AN ANALYSIS OF TOTAL COMPENSATION EVERY THREE YEARS BUT MAY CHOOSE TO VARY FROM THIS SCHEDULE AS DETERMINED BY THE COMPENSATION COMMITTEE. THE VNA BOARD OF DIRECTORS CONCEDES THE AUTHORITY TO SET COMPENSATION TO RHS AS THE SOLE CORPORATE MEMBER. THIS PROCESS WAS LAST COMPLETED IN 2014. |
| Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION FOR OTHER OFFICERS | COMPENSATION FOR EXECUTIVES, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES, IS GOVERNED BY THE RHS BOARD OF DIRECTORS (A RELATED ORGANIZATION AND SOLE CORPORATE MEMBER OF VNA). THE RHS BOARD HAS ESTABLISHED A TOTAL COMPENSATION PHILOSOPHY THAT DIRECTS THE COMPENSATION PRACTICES FOR ALL EXECUTIVES FROM ALL RELATED ENTITIES (INCLUDING VNA). THIS BOARD HAS ESTABLISHED A COMPENSATION COMMITTEE TO ESTABLISH AND REVIEW ALL EXECUTIVE COMPENSATION ANNUALLY BASED ON THE ESTABLISHED PHILOSOPHY. AN INDEPENDENT EXTERNAL EXECUTIVE COMPENSATION FIRM PROVIDES CONSULTING ON RHS (INCLUDING VNA) SALARY RANGES AND COMPENSATION PHILOSOPHY. THE APPROPRIATE PEER GROUP FOR COMPENSATION COMPARISON PURPOSES IS OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS SIMILAR IN SIZE AND COMPLEXITY. RHS GENERALLY CONDUCTS AN ANALYSIS OF TOTAL COMPENSATION EVERY THREE YEARS BUT MAY CHOOSE TO VARY FROM THIS SCHEDULE AS DETERMINED BY THE COMPENSATION COMMITTEE. THE VNA BOARD OF DIRECTORS CONCEDES THE AUTHORITY TO SET COMPENSATION TO RHS AS THE SOLE CORPORATE MEMBER. THIS PROCESS WAS LAST COMPLETED IN 2014. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | VNA SHALL HAVE AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF VNA, THE IMMEDIATE PAST CHAIRPERSON AND NO MORE THAN TWO OTHER DIRECTORS. DURING THE INTERVALS BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE SHALL POSSESS AND MAY EXERCISE, ALL OF THE POWERS OF THE BOARD OF DIRECTORS IN THE MANAGEMENT AND DIRECTION OF VNA, IN SUCH MANNER AS SHALL BE FOR ITS BEST INTERESTS, EXCEPT FOR THOSE AS REFERENCED IN THE BYLAWS, SECTION 1. THE CHAIRPERSON OF VNA SHALL BE THE CHAIR OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL KEEP MINUTES OF ITS MEETINGS AND SHALL REPORT ALL ACTIONS TAKEN BY IT AT THE NEXT SUCCEEDING REGULAR MEETING OF THE BOARD OF DIRECTORS. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ITS BUSINESS AND ANY ACTION OF THE EXECUTIVE COMMITTEE TO BE EFFECTIVE MUST BE AUTHORIZED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THOSE MEMBERS PRESENT. A MAJORITY OF THE MEMBERS OF THE EXECUTIVE COMMITTEE MAY FIX THE PLACE OF ITS MEETINGS AND OTHERWISE FIX ITS OWN RULES AND PROCEDURES UNLESS THE BOARD OF DIRECTORS OR THE BYLAWS SHALL OTHERWISE PROVIDE. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | Rockford Health System (RHS) is the sole corporate member of VNA and has the authority to elect members to the board and ultimately has the authority to approve or deny all VNA board actions. ACCORDING TO THE BYLAWS, ARTICLE IV, SECTION I, The sole member shall have powers and voting rights to do the following: (a) APPROVE THE ELECTION OF THE BOARD OF DIRECTORS OF VNA, AND REMOVE DIRECTORS FOR CAUSE. (b) Nominate to VNA'S board of directors all candidates for selection as the CORPORATION'S PRESIDENT AND CEO. (c) Approve expressly all amendments to the VNA's articles of incorporation and by-laws. (d) Approve annual budgets and STRATEGIC, long-range AND HEALTH MANPOWER DEVELOPMENT plans of VNA. (e) Approve all contracts OF INDEBTEDNESS TO THE EXTEND NOT INCLUDED IN THE ANNUAL BUDGET. (F) APPROVE ALL CAPITAL OR OPERATING expenditures OVER $50,000 TO THE EXTENT SUCH EXPENDITURES WERE INCLUDED IN THE ANNUAL BUDGET. (G) Approve all plans of merger or consolidation. (H) Approve the sale, lease, exchange, mortgage, pledge or other disposition of all or substantially all, the property and assets of VNA. (I) Approve a voluntary dissolution of the CORPORATION. (J) APPROVE PARTICIPATION IN MANAGED CARE ARRANGEMENTS, AND REQUIRE VNA TO PARTICIPATE IN MANAGED CARE ARRANGEMENTS AS PART OF AN RHS SYSTEM-WIDE STRATEGIC PLAN. (k) Require the VNA BOARD OF DIRECTORS to take any action (including amending VNA's articles of incorporation or by-laws), or to modify or rescind an action already taken, if RHS determines that failure to take the action, or to modify or rescind an action already taken, may result in VNA's failure to obtain or maintain its exemption as an organization described in Section 501(c)(3) of the Code. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | See narrative for Form 990, Part VI, Line 6. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | See narrative for Form 990, Part VI, Line 6. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The data was gathered by the accounting staff with input from VNA and RHS executive staffs. The data was reviewed and the Form 990 prepared by the RHS staff. Once the Form 990 was completed, it was reviewed by an independent accounting firm. A copy of the Form 990 was made available to all board members before filing with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | RHS Compliance Department is responsible for sending out a copy of the policy with the Conflict of Interest form included each year. Each member of the board is to complete the Financial Interest Disclosure Statement which is a part of the policy. The RHS Compliance Department reviews and retains these statements. If a conflict is identified, all affected parties are informed, potential conflicts are reviewed and appropriate actions are taken as a result of the review. Employees are given the policy and a statement to complete at the beginning of the year or as a new party is hired or joins the VNA board. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial statements are available through the Illinois Attorney General's Office. The organization's governing documents and conflict of interest policy are available by request from Board Secretary. |
| Form 990, Part VII, Section A NONEMPLOYEE COMPENSATION | SHARON RUDY IS NOT COMPENSATED AS A BOARD MEMBER; SHE RECEIVED TAXABLE NONEMPLOYEE COMPENSATION ON A 2014 FORM 1099 FOR 2013 LEGAL SERVICES PROVIDED TO THE SYSTEM. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Unrestricted Funds -RMDF - 128400; Cum Eff Change in Accounting-Pension - -553650; Cum Eff Change in Accounting- Post Retirement - -8054; Temp Restricted Funds - 13203; Permanently Restricted Funds-RMDF - 1372; Transfer from temp restricted to unrestricted - 29000; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |