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.") . | 137,681 | 176,221 | 165,406 | 99,564 | 221,208 | 800,080 |
| 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...... | 11,146,527 | 11,068,613 | 13,141,397 | 15,403,155 | 18,424,551 | 69,184,243 |
| 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. | 11,284,208 | 11,244,834 | 13,306,803 | 15,502,719 | 18,645,759 | 69,984,323 |
| 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.) | 69,984,323 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 11,284,208 | 11,244,834 | 13,306,803 | 15,502,719 | 18,645,759 | 69,984,323 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 91,832 | 107,866 | 87,205 | 14,838 | 10,325 | 312,066 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 91,832 | 107,866 | 87,205 | 14,838 | 10,325 | 312,066 |
| 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.).. | 11,376,040 | 11,352,700 | 13,394,008 | 15,517,557 | 18,656,084 | 70,296,389 |
| 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 |
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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 |
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| Return Reference | Explanation |
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| Software Version: |
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 6 | AS STATED IN THE VNA HOME HEALTH & HOSPICE BYLAWS: THERE SHALL BE TWO MEMBERS OF THE CORPORATION. THE CLASS A MEMBER OF THE CORPORATION SHALL BE MERCY HEALTH SYSTEM OF MAINE, A MAINE NONPROFIT CORPORATION. THE CLASS B MEMBER OF THE CORPORATION SHALL BE EASTERN MAINE HEALTHCARE SYSTEMS, A MAINE NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS STATED IN THE VNA HOME HEALTH & HOSPICE BYLAWS: THE SOLE POWER AND RIGHT OF THE CLASS A MEMBER SHALL BE TO RECIEVE SUCH REPORTS FROM THE MANAGEMENT AND BOARD OF DIRECTORS OF THE CORPORATION FROM TIME TO TIME AS THE CLASS A MEMBER MAY REASONABLY REQUEST. THE CLASS A MEMBER SHALL HAVE NO RIGHT TO VOTE ON ANY MATTER THAT SHALL COME BEFORE THE CORPORATION. ALL RIGHTS OF MEMBERS UNDER THE LAWS OF THE STATE OF MAINE TO VOTE OR OTHERWISE TAKE ACTION WITH RESPECT TO THE CORPORATION ARE RESERVED EXCLUSIBELY TO THE CLASS B MEMBER. THE CLASS B MEMBER SHALL ACT ON ANY MATTERS BROUGHT TO IT BY THE BOARD OF DIRECTORS OF THE CORPORATION AS SET FORTH IN THIS ARTICLE II, ARTICLE X OR OTHERWISE, AND SHALL EXERCISE SUCH OTHER POWERS AS MAY BE CONFERRED ON THE CLASS B MEMBER BY LAW, THE ARTICLES OF INCORPORATION, OR BY THESE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL RIGHTS OF MEMBERS UNDER THE LAWS OF THE STATE OF MAINE TO VOTE OR OTHERWISE TAKE ACTION WITH RESPECT TO THE CORPORATION ARE RESERVED EXCLUSIVELY TO THE CLASS B MEMBER. THE CLASS B MEMBER SHALL ACT ON ANY MATTERS BROUGHT TO IT BY THE BOARD OF DIRECTORS OF THE CORPORATION AS SET FORTH IN THIS ARTICLE II, ARTICLE X OR OTHERWISE, AND SHALL EXERCISE SUCH OTHER POWERS AS MAY BE CONFERRED ON THE CLASS B MEMBER BY LAW, THE ARTICLES OF INCORPORATION, OR BY THESE BYLAWS. THE CLASS B MEMBER (ACTING INDEPENDENTLY) AND THE CORPORATION (SUBJECT TO CLASS B MEMBER BOARD APPROVAL) SHALL HAVE THE POWER AND AUTHORITY TO AUTHORIZE THE FOLLOWING ACTIONS DESCRIBED AS JOINT INITIATORY POWERS. ANY EXERCISE OF JOINT INITIATORY POWERS SHALL FURTHER THE GOAL OF DEVELOPING AND STRENGTHENING PATIENT CARE SERVICES WITHIN THE EMHS SYSTEM FOR THE BENEFIT OF PATIENTS WITHIN THE CORPORATION'S SERVICE AREA, AND SUCH POWERS SHALL BE EXERCISED ONLY AFTER REASONABLE CONSULTATION BETWEEN THE CLASS B MEMBER AND THE CORPORATION. ACTION INITIATED THROUGH THE CLASS B MEMBER'S EXERCISE OF ITS JOINT INITIATORY POWERS IS SUBJECT TO THE RIGHT OF THE CORPORATION, UPON A TWO-THIRDS VOTE OF THE FULL BOARD OF DIRECTORS, TO TRIGGER THE FORMAL REVIEW FUNCTION OF THE EMHS COUNCIL OF CHAIRS, AS DESCRIBED IN THE EMHS BYLAWS AND COUNCIL OF CHAIRS COMMITTEE CHARTER. ACTION INITIATED THROUGH THE CORPORATION'S EXERCISE OF ITS JOINT INITIATORY POWERS IS SUBJECT TO THE CLASS B MEMBER'S BOARD APPROVAL OR, IF AUTHORIZED THROUGH DELEGATION BY THE CLASS B MEMBER'S BOARD, EMHS CEO APPROVAL. THE JOINT INITIATORY POWERS ARE AS FOLLOWS: I. AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS; II. CHANGE IN LEGAL FORM OF ORGANIZATION OF THE CORPORATION; III. ELECTION OF THE DIRECTORS OF THE CORPORATION; IV. ACTION CONCERNING THE CORPORATION'S OPERATING BUDGET AND CAPITAL EXPENDITURES; V. THE CORPORATION'S ACQUISITION OF ASSETS OR ASSUMPTION OF LIABILITIES OF A THIRD PARTY; VI. TRANSFER OF 5% OR MORE OF THE ASSETS OF THE CORPORATION; VII. FINANCING TRANSACTIONS CONCERNING THE CORPORATION; VIII. MERGER, CONSOLIDATION, SALE, LEASE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS OF THE CORPORATION; IX. ADD OR REVISE A HEALTH CARE SERVICE OF THE CORPORATION; X. DISCONTINUE OR CLOSE A HEALTH CARE SERVICE OF THE CORPORATION; XI. ACTION CONCERNING THE CORPORATION'S COMPONENT OF EMHS STRATEGIC PLAN; XII. ACTION CONCERNING THE CORPORATION'S PARTICIPATION IN KEY STRATEGIC AFFILIATIONS WITH THIRD PARTIES NOT AFFILIATED WITH EMHS; AND XIII. DISSOLUTION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEW OF COMPLETED 990 WITH FINANCE COMMITTEE, BOARD OF DIRECTORS, AND AFFILIATES. |
| FORM 990, PART VI, SECTION B, LINE 12C | THROUGH ANNUAL REVEIW BY QUALITY MANAGER. |
| FORM 990, PART VI, SECTION B, LINE 15 | SEMIANNUAL STATE COMPARATIVE MARKET ANALYSIS |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER TO AFFILIATES -10,034,089. |
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