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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| 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, PART V, LINE 1C: | THE ORGANIZATION DID NOT HAVE ANY INSTANCES WHERE BACKUP WITHHOLDING WAS REQUIRED; HOWEVER, IF THE SITUATION WOULD ARISE, THE ORGANIZATION IS AWARE OF THE REPORTING REQUIREMENTS AND WOULD HANDLE THAT ACCORDINGLY. |
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT DUTIES FOR THE BERKS VISITING NURSE ASSOCIATION, INC. ARE CARRIED OUT AND PAID BY HOME HEALTH CARE MANAGEMENT, INC., A RELATED ORGANIZATION REPORTED ON THE SCHEDULE R. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER SHALL BE HOME HEALTH CARE MANAGEMENT, INC., OR ITS SUCCESSOR MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | BERKS VISITING NURSE ASSOCIATION, INC. HAS ONE MEMBER WITH SOLE VOTING RIGHTS AS THE MEMBER OF THE CORPORATION. THE SOLE MEMBER SHALL BE HOME HEALTH CARE MANAGEMENT, INC., OR ITS SUCCESSOR MEMBER. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO PUBLIC RELEASE VIA SECURE ACCESS ON THE COMPANY'S WEBSITE. THE FINANCE COMMITTEE MEETS TO REVIEW THE ANNUAL FORM 990 AND WILL MAKE A REPORT TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, EMPLOYEE AND VOLUNTEER WILL SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT. THE ORGANIZATION'S POLICY REQUIRES DIRECTORS, EMPLOYEES, AND VOLUNTEERS TO AVOID ALL CONFLICTS OF INTEREST AND THE APPEARANCE OF ANY CONFLICT OF INTEREST. TO AVOID THE APPEARANCE OF A CONFLICT OF INTEREST, A DIRECTOR, EMPLOYEE OR VOLUNTEER CAN NOT PARTICIPATE IN MAKING ANY DECISION OR RECOMMENDATION CONCERNING A MATTER WHICH MAY RESULT IN ANY BENEFIT OR FINANCIAL GAIN, EITHER DIRECTLY OR INDIRECTLY, TO THE DIRECTOR, EMPLOYEE OR VOLUNTEER OR A MEMBER OF HER/HIS IMMEDIATE FAMILY. IN ADDITION, FULL DISCLOSURE OF THE PERTINENT FACTS REGARDING THE POTENTIAL CONFLICT OF INTEREST IS REQUIRED TO BE PROVIDED BY THE DIRECTOR, EMPLOYEE OR VOLUNTEER. TO FURTHER AVOID THE APPEARANCE OF A CONFLICT OF INTEREST, A DIRECTOR, EMPLOYEE OR VOLUNTEER MAY NOT SOLICIT OR ACCEPT GIFTS, TIPS OR OTHER SPECIAL CONSIDERATIONS OF ECONOMIC VALUE INCLUDING PERSONAL INSURANCE BENEFICIARY STATUS, FROM CLIENTS, THEIR FAMILIES, VISITORS OR VENDORS. IMPARTIAL DECISION-MAKING BASED ON THE BEST INTEREST OF THE ORGANIZATION SHALL ALSO APPLY TO RELATIONS WITH VENDORS. DECISIONS REGARDING PRODUCTS AND VENDORS SHALL BE MADE OBJECTIVELY AND WITHOUT FAVORITISM. ANY ACTUAL, APPARENT OR POTENTIAL CONFLICTS OF INTEREST SHALL BE REPORTED TO AN APPROPRIATE MEMBER OF THE ORGANIZATION'S MANAGEMENT. IF A MATTER ARISES WITH RESPECT TO WHICH A MEMBER OF THE BOARD OR MANAGEMENT STAFF HAVE A REASON TO BELIEVE THAT HE OR SHE MAY HAVE A CONFLICT OF INTEREST, IT SHALL BE PROMPTLY DISCLOSED BY THE BOARD/STAFF MEMBER TO THE BOARD OF DIRECTORS OR PRESIDENT AND CEO. THE BOARD MEMBER SHALL FURTHER DISCLOSE ANY REASON KNOWN TO HIM OR HER WHY THE PROPOSED ACTION MAY OR MAY NOT BE IN THE BEST INTEREST OF THE ORGANIZATION. EXCEPT FOR SUCH DISCLOSURES, THE BOARD/STAFF MEMBER SHALL NOT PARTICIPATE IN BY VOTE OR OTHERWISE, ANY DECISION OR CONSIDERATION OF THE PROPOSED ACTION. HIS/HER ABSTENTION AND THE REASON FOR IT SHALL BE RECORDED IN THE MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15 | ON AN ANNUAL BASIS, VICE PRESIDENT-HUMAN RESOURCES & FACILITIES REVIEWS SALARY DATA AVAILABLE FROM NATIONALLY RECOGNIZED COMPENSATION SURVEY DATA, COMPILES THAT DATA AND PROVIDES A RECOMMENDATION FOR SALARY RANGES FOR ALL EXECUTIVE LEVEL POSITIONS TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR HOME HEALTH CARE MANAGEMENT. THAT COMMITTEE REVIEWS SUCH RECOMMENDATIONS AND APPROVES THE SALARY RANGE FOR THOSE SPECIFIC POSITIONS. THE AMOUNT OF MONEY AVAILABLE EACH YEAR FOR SALARY INCREASES IS BUDGETED WITH THAT SPECIFIC YEAR'S ANNUAL BUDGET. SALARY RECOMMENDED INCREASES AND PERFORMANCE APPRAISALS FOR EXECUTIVE LEVEL POSITIONS ARE PRESENTED TO THE EXECUTIVE COMMITTEE BY THE PRESIDENT/CEO. THE EXECUTIVE COMMITTEE PROVIDES THE APPROVAL FOR THOSE RECOMMENDATIONS. THE EXECUTIVE COMMITTEE CONSISTS OF INDEPENDENT MEMBERS OF THE BOARD AND THE DELIBERATION AND DECISIONS OF THE COMMITTEE ARE DOCUMENTED CONTEMPORANEOUSLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON WRITTEN REQUEST. |
| FORM 990, PART VII, COLUMN B: | LUCILLE D GOUGH, PRESIDENT/CEO (TILL 6/2015) CONSTANCE L. MORRISON, PRESIDENT/CEO (START 7/2015) TERRY GORDON, TREASURER AMICIE S ZIMMERMAN, SECRETARY (TILL 12/2015) ALL THE ABOVE WORK A 40 HOUR WEEK EMPLOYED BY HOME HEALTH CARE MANAGEMENT, THE RELATED PARENT COMPANY. THEIR TIME IS SPLIT BETWEEN HOME HEALTH CARE MANAGEMENT, INC., ADVANTAGE HOME CARE, INC., BERKS VISITING NURSE ASSOCIATION, INC., AND VISITING NURSE ASSOCIATION OF POTTSTOWN AND VICINITY, INC. KIM R. BERRY, SECRETARY (START 12/2015) VOLUNTEER BOARD MEMBER |
| FORM 990, PART XI, LINE 9: | BENEFICIAL INTEREST IN PERPETUAL TRUST -75,141. CHANGE IN VALUE OF CHARITABLE REMAINDER TRUST -4,659. |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE ASSISTS THE BOARD OF DIRECTORS IN FULFILLING ITS RESPONSIBILITY FOR FIDUCIARY OVERSIGHT OF THE QUALITY AND INTEGRITY OF THE ACCOUNTING, AUDITING, AND REPORTING PRACTICES OF THE ASSOCIATION, AND SUCH OTHER DUTIES AS DIRECTED BY THE BOARD (SUCH AS REVIEW OF THE ANNUAL IRS FORM 990). THE COMMITTEE WILL OVERSEE THE ACCOUNTING AND FINANCIAL REPORTING PROCESSES OF THE ASSOCIATION, THE AUDITS OF THE ASSOCIATION'S FINANCIAL STATEMENTS, AND THE QUALIFICATIONS OF THE PUBLIC ACCOUNTING FIRM ENGAGED AS THE ASSOCIATION'S INDEPENDENT AUDITOR TO PREPARE A YEARLY AUDIT REPORT. THE COMMITTEE ALSO REVIEWS AND ASSESSES THE QUALITATIVE ASPECTS OF FINANCIAL REPORTING, THE ASSOCIATION'S PROCESSES TO MANAGE BUSINESS AND FINANCIAL RISK, AND COMPLIANCE WITH SIGNIFICANT APPLICABLE LEGAL AND REGULATORY REQUIREMENTS. THE COMMITTEE IS DIRECTLY RESPONSIBLE FOR THE APPOINTMENT, COMPENSATION, RETENTION, AND OVERSIGHT OF THE INDEPENDENT AUDITOR. THE COMMITTEE WILL ALSO REVIEW THE ANNUAL IRS FORM 990 PRIOR TO PUBLIC RELEASE AND WILL MAKE A REPORT TO HOME HEALTH CARE MANAGEMENT'S BOARD OF DIRECTORS. THE INDEPENDENT AUDITOR REPORTS DIRECTLY TO THE FINANCE COMMITTEE. THE COMMITTEE IS EXPECTED TO MAINTAIN AN OPEN COMMUNICATION WITH THE INDEPENDENT AUDITOR, THE FINANCIAL ADMINISTRATOR, AND COMPANY MANAGEMENT. THE COMMITTEE RELIES ON THE EXPERTISE AND KNOWLEDGE OF COMPANY MANAGEMENT AND THE INDEPENDENT AUDITOR IN CARRYING OUT ITS OVERSIGHT RESPONSIBILITIES. MANAGEMENT OF THE ASSOCIATION IS RESPONSIBLE FOR ASSURING THE ACCURACY OF THE ASSOCIATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES AND ESTABLISHING SATISFACTORY INTERNAL CONTROLS OVER FINANCIAL REPORTING. THE INDEPENDENT AUDITOR IS RESPONSIBLE FOR AUDITING THE ASSOCIATION'S FINANCIAL STATEMENTS AND THE EFFECTIVENESS OF THE ASSOCIATION'S INTERNAL CONTROLS. IT IS NOT THE DUTY OF THE COMMITTEE TO PLAN OR CONDUCT AUDITS; DETERMINE THAT THE FINANCIAL STATEMENTS ARE COMPLETE AND ACCURATE AND IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES; CONDUCT INVESTIGATIONS, ASSURE COMPLIANCE WITH LAWS AND REGULATIONS OR STANDARDS OF BUSINESS CONDUCT, CODES OF ETHICS, INTERNAL POLICIES, PROCEDURES, AND CONTROLS. |
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