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.") . | 0 | 0 | 0 | 0 | 0 | 0 |
| 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...... | 1,900,924 | 1,572,673 | 1,642,093 | 1,423,317 | 1,310,018 | 7,849,025 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 1,900,924 | 1,572,673 | 1,642,093 | 1,423,317 | 1,310,018 | 7,849,025 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | 0 | ||||
| 8 | Public support (Subtract line 7c from line 6.) | 7,849,025 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,900,924 | 1,572,673 | 1,642,093 | 1,423,317 | 1,310,018 | 7,849,025 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 47,154 | 54,484 | 55,895 | 71,265 | 83,486 | 312,284 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 47,154 | 54,484 | 55,895 | 71,265 | 83,486 | 312,284 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 1,948,078 | 1,627,157 | 1,697,988 | 1,494,582 | 1,393,504 | 8,161,309 |
| 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 |
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| Return Reference | Explanation |
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| Software ID: | |
| 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 |
|---|---|
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 COVENANT HEALTHCARE SYSTEM IS THE SOLE CORPORATE MEMBER OF VISITING NURSE SPECIAL SERVICES. |
| DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS | FORM 990, PART VI, LINE 7A THE SOLE CORPORATE MEMBER MAY ELECT ONE OR MORE PERSONS OF THE GOVERNING BODY. |
| DESCRIPTION OF CONTROL BY GOVERNING BODY | FORM 990, PART VI, LINE 7B THE FOLLOWING ACTIONS MAY BE TAKEN BY THIS CORPORATION AND ITS BOARD OF DIRECTORS ONLY UPON PRIOR WRITTEN APPROVAL OF THE CORPORATE MEMBER: A. ADOPTION, AMENDMENT, OR OTHER MODIFICATION OF THE BYLAWS OR ARTICLES OF INCORPORATION OF THIS CORPORATION. B. ANY MERGER, CONSOLIDATION, REORGANIZATION, OR OTHER CHANGE IN THE CORPORATE STRUCTURE OF THIS CORPORATION OR THE CREATION OF ANY CORPORATE SUBSIDIARY THEREOF. C. THE PARTICIPATION OF THE CORPORATION IN ANY PARTNERSHIP, LIMITED PARTNERSHIP, CORPORATION, ASSOCIATION, OR OTHER FORM OF JOINT VENTURE OR SHARED SERVICE WITH ANY OTHER PARTY OR ORGANIZATION. D. CREATION, INCURRENCE, OR ASSUMPTION OF INDEBTEDNESS, COMMITMENTS, OR ANY CONTRACTUAL OBLIGATIONS WITH RESPECT TO BORROWED MONEY, GUARANTEES, ENDORSEMENTS, LEASES, OR OTHER TYPE OF DIRECT CONTINGENT LIABILITIES, IN EXCESS OF $50,000 FOR ANY ONE ITEM. E. CREATION, INCURRENCE OR ASSUMPTION OF ANY MORTGAGE, PLEDGE, SECURITY, ENCUMBRANCE, OR OTHER LIEN OF ANY KIND IN ANY PROPERTY OF ASSETS OF THIS CORPORATION. F. ACQUISITION, BY PURCHASE, LEASE, OR BY ANY OTHER METHOD, OF ANY REAL ESTATE, CAPITAL IMPROVEMENTS, OR EQUIPMENT IN EXCESS OF A VALUE OF $50,000 FOR ANY ONE SUCH ITEM. G. ANY CONTRIBUTIONS OF ENDOWMENT PRINCIPAL. H. ANY CONTRIBUTIONS OF EARNED INCOME, EXCLUSIVE OF CONTRIBUTIONS, IN EXCESS OF FIVE (5%) PERCENT OF SUCH INCOME IN ANY FISCAL YEAR, TO ANY ORGANIZATION OR FOR ANY PURPOSE OTHER THAN COVENANT HEALTHCARE SYSTEM OR THE CORPORATE MEMBER. I. ANY CHANGE IN THE SERVICES OF PROGRAMS OF THE CORPORATION, INCLUDING THE TERMINATION OF EXISTING SERVICES, THE ADDITION OF NEW SERVICES, OR ANY MAJOR EXPANSION OR CONTRACTION OF EXISTING SERVICES OR PROGRAMS. J. ADOPTION, OR FORMAL AMENDMENT OR MODIFICATION OF THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION. K. ADOPTION, AMENDMENT, OR MODIFICATION OF THE MISSION AND GOALS OF THE CORPORATION, AND ITS LONG RANGE OR SHORT RANGE STRATEGIC PLANS. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11B MANAGEMENT PRESENTS AND REVIEWS THE 990 WITH THE BOARD FOR ITS APPROVAL PRIOR TO FILING. THE BOARD IS PROVIDED FINAL COPIES FOR REVIEW VIA THE INTERNET, ONCE APPROVED BY THE BOARD, THE FINAL 990 IS ULTIMATELY FILED WITH THE IRS. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST | FORM 990, PART VI, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST DISCLOSURE STATEMENTS TO ITS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES. EACH PERSON COVERED BY THE POLICY IS REQUIRED TO SUBMIT AND AFFIRM IN WRITING TO THE DIRECTOR AN ANNUAL CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL INTERESTS, FAMILY AND BUSINESS RELATIONSHIPS, AND POTENTIAL CONFLICTS OF INTEREST AND ALL MATERIAL FACTS TO THE BOARD AND MEMBERS OF THE COMMITTEES WITH BOARD DELEGATED POWERS. POTENTIAL CONFLICTS IDENTIFIED ARE BROUGHT TO THE ATTENTION OF THE CHAIRMAN AND VICE CHAIR OF THE BOARD. THE CHAIRMAN OF THE BOARD IS REQUIRED TO BE AWARE OF SUCH POTENTIAL CONFLICTS SO AS TO BE ABLE TO DETERMINE THE PROPER COURSE OF ACTION SHOULD A MATTER INVOLVING SUCH SITUATION ARISE THAT WOULD REQUIRE ACTION. AFTER DISCLOSURE OF A POTENTIAL CONFLICT TO THE BOARD OR COMMITTEE, SUCH PERSON IS EXCUSED AND ALL OTHER REMAINING BOARD OR COMMITTEE MAKE A DETERMINATION OF WHETHER A CONFLICT EXISTS. ANY PERSON WITH A POTENTIAL CONFLICT CAN MAKE A PRESENTATION TO THE BOARD OR COMMITTEE ON THE PROPOSED TRANSACTION, BUT MUST RECUSE HIMSELF FROM DELIBERATION AND VOTING ON THE PROPOSED TRANSACTION OR ARRANGEMENT. THE BOARD OR COMMITTEE SHALL EXPLORE WHETHER A MORE ADVANTAGEOUS TRANSACTION OR AGREEMENT WITH REASONABLE EFFORTS CAN BE ENTERED INTO WITH A PERSON OR ENTITY THAT DOES NOT HAVE A CONFLICT OF INTEREST. IF NO REASONABLE ALTERNATIVE EXIST, THE BOARD OR COMMITTEE SHALL DECIDE WHETHER SUCH TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION AND IS FAIR AND REASONABLE BEFORE MAKING ITS DECISION ON WHETHER OR NOT TO ENTER INTO THE TRANSACTION. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT AN OFFICER, DIRECTOR, KEY EMPLOYEE OR TRUSTEE FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTERESTS, IT SHALL INFORM THE OFFICER, DIRECTOR, TRUSTEE OR KEY EMPLOYEE OF THE BASIS FOR SUCH BELIEF AND AFFORD SAID PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE, CORRECTIVE ACTION WILL BE TAKEN IF IT IS DETERMINED THAT A CONFLICT THAT WAS DISCLOSED DOES EXIST. |
| Process for determining compensation | FORM 990, PART VI, LINES 15A & 15B THE EXECUTIVE DIRECTOR IS A CONTRACT POSITION AND THE CONTRACT IS APPROVED BY THE BOARD OF DIRECTORS. |
| Process for making documents available to the public | FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS ORGANIZING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. |
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