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.) .... | 269,595 | 906,033 | 454,646 | 170,106 | 286,779 | 2,087,159 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 269,595 | 906,033 | 454,646 | 170,106 | 286,779 | 2,087,159 |
| 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).. | 188,277 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,898,882 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 269,595 | 906,033 | 454,646 | 170,106 | 286,779 | 2,087,159 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 712 | 1,021 | 853 | 42 | 49 | 2,677 |
| 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.).. | 19,847 | 28,933 | 26,324 | 6,080 | 13,720 | 94,904 |
| 11 | Total support. Add lines 7 through 10. | 2,184,740 | |||||
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) |
||||
| 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 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 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) |
||||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
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 II, Line 10 Other Income | DESCRIPTION - OTHER INCOME, COLUMN A - 19847.0, COLUMN B - 28933.0, COLUMN C - 26324.0, COLUMN D - 800.0, COLUMN E - 0.0, COLUMN F - 75904.0; DESCRIPTION - GROSS INCOME FROM FUNDRAISING EVENTS, COLUMN A - 0.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 5280.0, COLUMN E - 13720.0, COLUMN F - 19000.0; |
| Software ID: | 15000238 |
| Software Version: | 2015v2.1 |
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 III, Line 3 Significant changes in program services | EFFECTIVE 7/1/2016, AMANDA CARES, INC. CONTRIBUTED ALL OF ITS ASSETS AND LIABILITIES TO A SINGLE MEMBER LIMITED LIABILITY COMPANY IN WHICH THE HOSPICE OF CENTRAL IOWA (HCI) IS THE SOLE MEMBER. SEE SCHEDULE N FOR FURTHER INFORMATION. |
| Form 990, Part V, Line 2a FORM W-3 AND W-2 REPORTING - COMMON PAYMASTER | HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE PARENT ORGANIZATION TO AND COMMON PAYMASTER FOR HCI CARE SERVICES, VISITING NURSE SERVICES OF IOWA, HCI FOUNDATION, AND AMANDA CARES; THEREFORE ALL APPLICABLE IRS TAX COMPLIANCE FILINGS ARE REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF THESE NAMED ENTITIES. AMANDA CARES HAS APPROXIMATELY 3 EMPLOYEES. HCI VNS CARE SERVICES, THE COMMON PAYING AGENT, REPORTED 565 EMPLOYEES ON FORM W-3 FOR 2015. |
| Form 990, Part VI, Line 15 COMPENSATION OF TOP MANAGEMENT OFFICIAL AND OTHER OFFICERS/KEY EMPLOYEES | THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS PAID BY HCI VNS CARE SERVICES (EIN: 45-5189289), A RELATED TAX-EXEMPT ORGANIZATION; THE ORGANIZATION DOES NOT HAVE OTHER COMPENSATED OFFICERS OR KEY EMPLOYEES. THEREFORE LINES 15A AND 15B HAVE BEEN ANSWERED "NO" IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS. BELOW IS THE PROCESS USED BY HCI VNS CARE SERVICES TO REVIEW AND APPROVE COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL. EVERY TWO YEARS, THE ORGANIZATION'S BOARD OF DIRECTORS ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO PERFORM A COMPENSATION SURVEY FOR THE ORGANIZATION'S OFFICERS. VERISIGHT COMPLETED THE ORGANIZATION'S COMPENSATION SURVEYS IN 2009, 2011, 2013 AND 2015. THE FINDINGS OF THE SURVEYS ARE PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MEMBERS USE THE SURVEY TO REVIEW AND ESTABLISH THE AMOUNT OF COMPENSATION FOR THE PRESIDENT & CEO. THE REVIEW PROCESS IS DOCUMENTED IN THE EXECUTIVE COMMITTEE MEETING MINUTES. THE PRESIDENT AND CEO USE THE SURVEY TO REVIEW AND ESTABLISH COMPENSATION FOR THE FOLLOWING OFFICERS AND KEY EMPLOYEES: VICE PRESIDENT & CFO, CHIEF OPERATING OFFICER, AND THE CHIEF MEDICAL DIRECTOR. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | THE ORGANIZATION'S SOLE MEMBER IS HOSPICE OF CENTRAL IOWA, AN IOWA NONPROFIT CORPORATION. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THE ORGANIZATION'S DIRECTORS ARE APPOINTED BY HOSPICE OF CENTRAL IOWA; ANY DIRECTOR OF THE ORGANIZATION MAY BE REMOVED EITHER FOR OR WITHOUT CAUSE BY HOSPICE OF CENTRAL IOWA. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | NONE OF THE CORPORATION'S ASSETS OR ANY OTHER RIGHTS THERETO, WHETHER REAL, PERSONAL OR INTANGIBLE, SHALL BE SOLD, CONVEYED, ASSIGNED, TRANSFERRED, MORTGAGED, ENCUMBERED, EXCHANGED, ALIENATED, OR LEASED WITHOUT THE PRIOR APPROVAL OF HOSPICE OF CENTRAL IOWA, THE CORPORATION'S SOLE CORPORATE MEMBER. THE CORPORATION SHALL NOT BE A PARTY TO ANY MERGER, ACQUISITION, CONSOLIDATION, JOINT VENTURE, REORGANIZATION, RESTRUCTURING OR SIMILAR EVENT, NOR SHALL IT BECOME A MEMBER, PARTNER, SHAREHOLDER, TRUSTEE OR OTHER FIDUCIARY OF ANY OTHER ORGANIZATION OR ENTITY, WITHOUT THE PRIOR APPROVAL OF HOSPICE OF CENTRAL IOWA, THE CORPORATION'S SOLE CORPORATE MEMBER. NO AMENDMENT, ALTERATION OR REPEAL OF ANY OF THE PROVISIONS OF THE CORPORATION'S BYLAWS SHALL BE ADOPTED WITHOUT THE PRIOR APPROVAL OF HOSPICE OF CENTRAL IOWA, THE CORPORATION'S SOLE CORPORATE MEMBER. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE FULL FORM 990 IS PROVIDED TO HCI'S PRESIDENT AND CEO, CFO AND AUDIT COMMITTEE FOR INITIAL REVIEW. AFTER ALL QUESTIONS HAVE BEEN ADDRESSED AND ANY CHANGES HAVE BEEN MADE, THE ORGANIZATION'S TAX ADVISERS PRESENT A FINAL DRAFT OF THE FULL FORM 990 TO THE FULL BOARD OF DIRECTORS FOR FINAL REVIEW AND APPROVAL PRIOR TO SUBMISSION TO THE IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | THE DIRECTORS OF THE BOARD, OFFICERS OF THE ORGANIZATION, AND MEMBERS OF COMMITTEES REVIEW THE POLICY ANNUALLY AND PROVIDE A LISTING TO THE EXECUTIVE DIRECTOR OF ANY CONFLICTS OF INTEREST BOARD MEMBERS WILL ABSTAIN FROM VOTES WHERE THEY HAVE A CONFLICT OF INTEREST |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST |
| Form 990, Part VII, Section B, Line 1 INDEPENDENT CONTRACTORS | HCI VNS CARE SERVICES (EIN: 45-5189289) IS THE COMMON PAYMASTER FOR AMANDA CARES; THEREFORE ALL VENDORS, INCLUDING INDEPENDENT CONTRACTORS, ARE PAID AND REPORTED BY HCI VNS CARE SERVICES ON BEHALF OF AMANDA CARES. INDEPENDENT CONTRACTOR INFORMATION IS ENTERED IN PART VII, SECTION B, AT THE ORGANIZATIONAL LEVEL AS THE PAYMENTS RELATE TO EACH ENTITY'S BUSINESS. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | EQUITY TRANSFER TO AMP CARES LLC - -668158; |
| Schedule N, Part I DISSOLUTION OF AMANDA CARES, INC. | EFFECTIVE JUNE 30, 2016, AMANDA CARES, INC. WAS DISSOLVED AND ALL ASSETS/LIABILITIES WERE TRANSFERRED TO AMP CARES, LLC, AN IOWA LIMITED LIABILITY COMPANY. FOR FEDERAL TAX PURPOSES, AMP CARES LLC BECAME A DISREGARDED ENTITY OF THE HOSPICE OF CENTRAL IOWA, A RELATED 501(C)(3) NOT-FOR-PROFIT CORPORATION. |
| Software ID: | 15000238 |
| Software Version: | 2015v2.1 |