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.") . | 6,920 | 6,055 | 3,275 | 4,425 | 6,150 | 26,825 |
| 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...... | 1,817,123 | 1,963,415 | 1,984,018 | 2,365,811 | 2,688,747 | 10,819,114 |
| 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. | 1,824,043 | 1,969,470 | 1,987,293 | 2,370,236 | 2,694,897 | 10,845,939 |
| 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.) | 10,845,939 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,824,043 | 1,969,470 | 1,987,293 | 2,370,236 | 2,694,897 | 10,845,939 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,960 | 1,063 | 611 | 267 | 1,004 | 4,905 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,960 | 1,063 | 611 | 267 | 1,004 | 4,905 |
| 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.) .. | 327 | 139 | 466 | |||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 1,826,003 | 1,970,533 | 1,987,904 | 2,370,830 | 2,696,040 | 10,851,310 |
| 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 | ||||
| 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) |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | GUEST MEALS - 2013 AMOUNT: $ 327. 2014 AMOUNT: $ 139. |
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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 VI, SECTION A, LINE 1 | HEATH ALLIANCE FOR CARE EXECUTIVE COMMITTEE THE EXECUTIVE COMMITTEE SHALL CONSIST OF SEVEN (7) MEMBERS, INCLUDING THE PRESIDENT, VICE-PRESIDENT, SECRETARY, TREASURER, ASSISTANT SECRETARY, ASSISTANT TREASURER, AND IMMEDIATE PAST PRESIDENT. FIVE (5) MEMBERS SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF ALL BUSINESS. THE EXECUTIVE COMMITTEE SHALL MEET TO TRANSACT EMERGENCY BUSINESS BETWEEN BOARD MEETINGS AS IS NECESSARY. THE EXECUTIVE COMMITTEE SHALL HAVE ALL POWERS AND DUTIES OF THE BOARD EXCEPT IT SHALL NOT HAVE THE POWER TO REMOVE OR ELECT A TRUSTEE OR THE CEO OR TO APPROVE OR DISAPPROVE THE OPERATING OR CAPITAL EXPENSE BUDGETS. HOWEVER, IN TIMES DEEMED BY THEM TO BE OF EMERGENCY, THE EXECUTIVE COMMITTEE MAY APPROVE EXPENDITURES NOT IN THE BUDGETS BUT NOT TO EXCEED SUCH AMOUNTS AS CURRENTLY ESTABLISHED BY THE BOARD. THE SECRETARY OF THE BOARD SHALL KEEP MINUTES OF ALL MEETINGS OF THE EXECUTIVE COMMITTEE AND SEND COPIES OF SAID MINUTES TO ALL BOARD MEMBERS. THE EXECUTIVE COMMITTEE MEETS AT THE CALL OF THE PRESIDENT OR UPON WRITTEN REQUEST OF ANY OTHER TWO MEMBERS THEREOF. |
| FORM 990, PART VI, SECTION A, LINE 3 | ARTHUR DUNSMORE, ADMINISTRATOR OF THE HOUSE OF THE HOLY COMFORTER, WAS EMPLOYED BY HEATH CARE MANAGEMENT (A RELATED FOR PROFIT CORPORATION) THROUGH 5/22/15. THE HOUSE OF THE HOLY COMFORTER PAID A MONTHLY FEE FOR HIS SERVICES. THE HOUSE OF THE HOLY COMFORTER ALSO PAID A MONTHLY FEE TO HEATH CARE MANAGEMENT FOR MANAGEMENT OVERSIGHT AND ACCOUNTING SERVICES THROUGH 5/31/15. THESE SERVICES ARE PERFORMED BY THE CEO (PATRICK BRADY), COO (MARY ELLEN BOVE), CONTROLLER (ANTHONY PUCCIO) AND BUSINESS OFFICE STAFF OF HEATH VILLAGE (A RELATED NON-PROFIT CORPORATION). |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION SHALL HAVE ONE CORPORATE MEMBER (THE "MEMBER") WHICH SHALL CONSIST OF HEATH ALLIANCE FOR CARE, INC., A NEW JERSEY NOT-FOR-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER, BY A VOTE OF ITS BOARD OF TRUSTEES OR DIRECTORS, SHALL APPOINT THE TRUSTEES OF THE CORPORATION. UNLESS OTHERWISE PROVIDED BY THE BYLAWS OF THE MEMBER, ANY TRUSTEE POSITION NOT FILLED AT THE MEMBER'S ANNUAL MEETING AND ANY VACANCY, HOWEVER CAUSED, OCCURRING IN THE CORPORATION'S BOARD OF TRUSTEES MAY BE FILLED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE EXECUTIVE COMMITTEE OF THE MEMBER OR THE FULL BOARD OF TRUSTEES OF THE MEMBER. ANY TRUSTEE POSITION TO BE FILLED BY REASON OF AN INCREASE IN THE NUMBER OF TRUSTEES SHALL BE FILLED BY THE MEMBER BY ELECTION AT AN ANNUAL MEETING OR AT A SPECIAL MEETING CALLED FOR THAT PURPOSE. |
| FORM 990, PART VI, SECTION A, LINE 7B | ASIDE FROM APPOINTING TRUSTEES AND THE CHAIRPERSON, HEATH ALLIANCE FOR CARE, AS THE CORPORATE MEMBER, SHALL ALSO DETERMINE BY RESOLUTION THE TERM OF EACH NEW TRUSTEE WHO IS APPOINTED TO THE BOARD OF TRUSTEES OF THE HOUSE OF THE HOLY COMFORTER. THE MEMBER MAY ALSO REMOVE ANY OFFICER BY A SIXTY-SIX AND TWO-THIRDS VOTE OF THE MEMBER'S TRUSTEES. ANY CHANGES TO THE BYLAWS ARE CONDITIONED UPON APPROVAL OF THE MEMBER. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE SENIOR ACCOUNTANT, CONTROLLER, AND SECRETARY/TREASURER REVIEW THE FORM PRIOR TO FILING. THE HEATH ALLIANCE FOR CARE FINANCE AND CORPORATE DEVELOPMENT COMMITTEE REVIEWS THE FORM AT A BOARD MEETING. THEN THE FINAL FORM IS DISTRIBUTED TO ALL MEMBERS OF THE HOUSE OF THE HOLY COMFORTER BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS AND OFFICERS ARE REQUIRED TO COMPLETE THE DISCLOSURE OF POSSIBLE CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. THE PERSONNEL AND POLICY COMMITTEE IS RESPONSIBLE FOR DISTRIBUTING, COLLECTING AND REVIEWING ALL DISCLOSURE STATEMENTS ON AN ANNUAL BASIS. BOARD MEMBERS ARE REQUIRED TO REFRAIN FROM DISCUSSING, AS WELL AS VOTING ON, SUCH MATTERS IN WHICH A CONFLICT OF INTEREST EXISTS. IN SOME INSTANCES, THE INDIVIDUAL HAS BEEN RESPECTFULLY ASKED TO RESIGN FROM THEIR POSITION ON THE BOARD AS A RESULT OF A DISCLOSED CONFLICT. IN INSTANCES WHERE A CONFLICT OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE BOARD OF TRUSTEES MUST DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES PRESENT, THAT THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND FOR ITS OWN BENEFIT, IS FAIR AND REASONABLE TO THE ORGANIZATION, AND THAT THE ORGANIZATION CANNOT OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS. THE CEO ALSO REVIEWS THE COMPLETED FORMS AND RETAINS A FILE OF COMPLETED FORMS AFTER THE PROCESS OF COLLECTING AND REVIEWING THEM IS COMPLETED EACH YEAR. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HEATH ALLIANCE FOR CARE BOARD OF TRUSTEES EMPLOYS A CHIEF EXECUTIVE OFFICER WHO IS RESPONSIBLE FOR THE MANAGEMENT AND OPERATION OF ALL AFFILIATES, INCLUDING THIS ENTITY, AND HE IS COMPENSATED ANOTHER AFFILIATE. THE CEO'S COMPENSATION IS DETERMINED AS FOLLOWS PER AN EXECUTED EMPLOYMENT AGREEMENT: "EMPLOYEE'S BASE SALARY IN EACH SUBSEQUENT YEAR OF THE PERIOD OF EMPLOYMENT SHALL BE REASONABLY ADJUSTED AND THE REASONABILITY OF SUCH ADJUSTMENT SHALL BE MADE WITH REFERENCE TO THE ANNUAL COMPENSATION SURVEYS PRODUCED BY THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING AND THE NEW JERSEY HOSPITAL ASSOCIATION FOR LIKE ORGANIZATIONS IN THE NORTHERN NEW JERSEY AREA, AND SUCH OTHER RELEVANT SALARY SURVEYS THAT MAY BE AVAILABLE FROM TIME TO TIME FROM OTHER INDEPENDENT INDUSTRY AND PROFESSIONAL ORGANIZATIONS. UPON CONSIDERATION OF RELEVANT SALARY DATA OF EMPLOYEES PERFORMING SERVICES COMMENSURATE WITH THOSE PERFORMED BY EMPLOYEE AND THE PERCENTAGE INCREASE GIVEN TO VILLAGE MANAGEMENT, THE PERSONNEL AND POLICY COMMITTEE, OR ANY SUCCESSOR COMMITTEE OF THE ALLIANCE BOARD, IN ITS SOLE DISCRETION, SUBJECT TO APPROVAL BY THE ALLIANCE BOARD, MAY ADJUST SUCH BASE SALARY INCREASES." IN ADDITION, HIS INCENTIVE BONUS IS ALSO COMPARED IN THE SAME MANNER. THE DIRECTOR OF HUMAN RESOURCES ALSO PROVIDES THE BOARD WITH INFORMATION FOR SIMILAR FACILITIES FROM GUIDESTAR. THIS WAS LAST PROVIDED TO THE BOARD ON 6/5/15 FOR THE CEO'S LAST ANNUAL REVIEW COMPLETED AT A BOARD MEETING ON 7/14/15. THIS COMPENSATION DETERMINATION PROCESS IS DOCUMENTED IN THE BOARD MINUTES. THE ORGANIZATION CONTRACTED WITH A RELATED ENTITY FOR MANAGEMENT SERVICES THROUGH 5/22/15 AND PAID A MANAGEMENT FEE. THE RELATED ENTITY DETERMINED THE COMPENSATION OF THE INDIVIDUALS PERFORMING SERVICES FOR THIS ENTITY. THERE WERE NO MANAGEMENT LEVEL OR KEY EMPLOYS WHO WERE EMPLOYED AND COMPENSATED DIRECTLY BY THIS ENTITY UNTIL THE ADMINISTRATOR WAS HIRED ON 5/23/15. THIS EMPLOYEE WAS TRANSFERRED FROM A RELATED ORGANIZATION. THE ORGANIZATION HONORED THE ADMINISTRATOR'S CURRENT SALARY THAT WAS ESTABLISHED BY THE RELATED ORGANIZATION. THE ADMINISTRATOR'S RAISES WILL BE DETERMINED AT THE COO'S DISCRETION UPON COMPLETION OF THE ANNUAL PERFORMANCE REVIEW. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
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