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.") . | 1,227,809 | 941,881 | 407,455 | 541,263 | 789,599 | 3,908,007 |
| 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...... | 33,212,838 | 35,551,596 | 36,883,628 | 37,082,816 | 39,229,021 | 181,959,899 |
| 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. | 34,440,647 | 36,493,477 | 37,291,083 | 37,624,079 | 40,018,620 | 185,867,906 |
| 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.) | 185,867,906 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 34,440,647 | 36,493,477 | 37,291,083 | 37,624,079 | 40,018,620 | 185,867,906 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 461,143 | 697,559 | 475,279 | 458,123 | 467,081 | 2,559,185 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 461,143 | 697,559 | 475,279 | 458,123 | 467,081 | 2,559,185 |
| 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.) .. | 14,966 | 32,400 | 9,570 | 244,734 | 70,707 | 372,377 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 34,916,756 | 37,223,436 | 37,775,932 | 38,326,936 | 40,556,408 | 188,799,468 |
| 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) |
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| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2011 AMOUNT: $ 14,966. 2012 AMOUNT: $ 32,400. 2013 AMOUNT: $ 4,145. 2014 AMOUNT: $ 20,615. 2015 AMOUNT: $ 60,904. CLINICAL EDUCATION - 2013 AMOUNT: $ 3,575. 2014 AMOUNT: $ 5,838. 2015 AMOUNT: $ 8,422. MEDICAL RECORD FEES - 2013 AMOUNT: $ 1,850. 2014 AMOUNT: $ 783. 2015 AMOUNT: $ 1,381. BUSINESS INTERRUPTION - 2014 AMOUNT: $ 217,498. |
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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 6 | THE SOLE MEMBER OF VALLEY HOME CARE, INC. (VHC) SHALL BE VALLEY HEALTH SYSTEM, INC. ("THE PARENT"). |
| FORM 990, PART VI, SECTION A, LINE 7A | VALLEY HEALTH SYSTEM, INC. ('THE PARENT") SHALL HAVE RIGHT TO APPROVE OR REJECT SLATE OF NOMINEES FOR THE BOARD OF TRUSTEES. THE PARENT SHALL ALSO ESTABLISH AN EXECUTIVE COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION A, LINE 7B | VALLEY HEALTH SYSTEM, INC. ("THE PARENT"), SOLE MEMBER OF VHC, SHALL HAVE THE POWER TO APPROVE AN ACTION MADE BY AND/OR INITIATE AN ACTION RELATING TO ANY OF FOLLOWING: 1) STRATEGIC ACTIONS, WHICH SHALL INCLUDE, BUT NOT LIMITED TO NEW STRATEGIC PLANS, MODIFICATIONS OF EXISTING STRATEGIC PLANS OR MISSION STATEMENTS, THE ADDITION OR RELOCATION OF A CLINICAL SERVICE OR PROGRAM GENERATING OR EXPECTED TO GENERATE REVENUES IN EXCESS OF $2,000,000 IN ANY FISCAL YEAR, THE DEVELOPMENT OF A MANAGEMENT SERVICE ORGANIZATION, OR THE FORMATION OR DISSOLUTION OF VHC; 2) MAJOR CORPORATE DECISIONS, WHICH MAY POTENTIALLY IMPACT THE PHILOSOPHY OF THE SYSTEM, WHICH SHALL INCLUDE, BUT NOT BE LIMITED TO, JOINT VENTURES, CORPORATE ACQUISITIONS, PROGRAMMATIC AFFILIATIONS, MERGERS OR CONSOLIDATIONS, CONVERSION OF THE TAX-EXEMPT STATUS, SALE OR TRANSFER OF SUBSTANTIALLY ALL OF THE ASSETS OF ANY SUBSIDIARY OR THE DISSOLUTION OF VHC; 3) ANY SINGLE EXPENDITURE GREATER THAN FIVE PERCENT (5%) OF THE ANNUAL OPERATING BUDGET AND ANY AMENDMENTS THERETO: 4) THE SELECTION OF AUDITORS; 5) THE APPOINTMENT AND REMOVAL OF THE PRESIDENT OF VHC (OR THE APPROVAL OF ANY RECOMMENDATION OF THE BOARD OF THE VHC FOR REMOVAL); AND 6) MAJOR CORPORATE DECISIONS REGARDING THE INCURRENCE OF DEBT IN EXCESS OF FIVE PERCENT (5%) OF THE OPERATING BUDGET AND THE TRANSFER OR LOAN OF CASH OR THE CONVEYANCE, LEASE OR OTHER DISPOSITION OF OTHER ASSETS TO AN AFFILIATE OR SUBSIDIARY WITHOUT RECEIVING EQUIVALENT VALUE IN RETURN. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY THE ORGANIZATION'S PERSONNEL AND REVIEWED BY THE OUTSIDE ACCOUNTANTS. THE ACCOUNTANT THEN PRESENTS THE 990 TO THE FINANCIAL COMMITTEE FOR THEIR REVIEW AND PROVIDES ANY COMMENTS. THE COMMENTS ARE REVIEWED AND ADDRESSED UNTIL THE RETURN IS APPROVED FOR SUBMISSION TO THE MEMBERS OF THE BOARD FOR THEIR COMMENTS. AFTER MEMBERS OF THE BOARD RECEIVE A HARD COPY OF THE 990 AND APPROVE THE RETURN IT IS FINALIZED AND FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD MANDATES THAT ANNUALLY ALL MEMBERS OF MANAGEMENT AND THE GOVERNING BODY SIGN A CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS THAT MAY EXIST. IF A CONFLICT OF INTERST EXISTS THE ORGANIZATION WILL NOTIFY MEMBERS OF MANAGEMENT OR THE GOVERNING BODY AND INVESTIGATE THE CONFLICT. IF IT IS DETERMINED THAT AN ACTUAL CONFLICT OF INTEREST EXISTS, THE MEMBER OF MANAGEMENT OR THE GOVERNING BODY INVOLVED WILL BE NOTIFIED IMMEDIATELY AND WILL NOT BE ALLOWED TO VOTE OR BE PART OF ANY DECISIONS ABOUT SUCH TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE VALLEY HOME CARE INC. HAS ESTABLISHED A POLICY FOR COMPENSATION OF ITS OFFICERS, TOP MANAGEMENT AND KEY EMPLOYEES. THE POLICY MANDATES THAT COMPENSATION FOR ITS OFFICERS, TOP MANAGEMENT AND KEY EMPLOYEES BE PERIODICALLY REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES FREE OF ANY MEMBERS WITH CONFLICT OF INTEREST RELATED THERETO. THE COMMITTEE DETERMINES THAT THE EXECUTIVES ARE BEING PAID AN APPROPRIATE LEVEL OF COMPENSATION BY USING COMPARATIVE DATA FOR SIMILARLY SITUATED ORGANIZATIONS. THIS PROCESS IS DONE ANNUALLY, LAST UNDERTAKEN IN 2015. COMPENSATION DECISION ON THE AMOUNT OF COMPENSATION PAID AND TERM IS ADEQUATELY DOCUMENTED IN A CONTEMPORANEOUSLY WRITTEN FORMAT. |
| FORM 990, PART VI, SECTION C, LINE 19 | VALLEY HOME CARE, INC MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE BY POSTING IT ON GUIDESTAR.ORG AND OTHER SIMILAR TYPES OF WEBSITES. IN ADDITION, FORMS 990 AND 1023, AS WELL AS THE FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON WRITTEN REQUEST AT 15 ESSEX ROAD 3RD FLOOR, PARAMUS, NJ 07652 OR AT 201-291-6000. |
| FORM 990, PART XII, LINE 2C | THE PROCESS FOR SELECTING AN INDEPENDENT ACCOUNTANT AND ESTABLISHING A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM PRIOR YEAR. |
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