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 | |||||
| (A)
CHARLES COLE |
240802108 | Yes | 0 | 0 | ||
Total 1
|
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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.") . | ||||||
| 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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 | ||||
| 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 |
|---|---|
| FORM 990, PART III, LINE 1 | ORGANIZATION'S MISSION: HENDORN, INC PROVIDES ASSISTED LIVING FOR OLDER ADULTS IN COUDERSPORT, PA, THROUGH THE OPERATION OF COLE MANOR, A RESIDENTIAL FACILITY. IN-HOME PERSONAL CARE IS ALSO PROVIDED THROUGH THE HOMEMAKER PROGRAM. OUR MISSION AT COLE MANOR IS TO PROVIDE OUR RESIDENTS WITH THE HIGHEST QUALITY OF CARE POSSIBLE. TO ENHANCE OUR RESIDENT'S QUALITY OF LIFE BY CREATING A HOME-LIKE SETTING THAT FOSTERS INDEPENDENCE, DIGNITY AND CHOICE. WE CONTINUALLY STRIVE TO IMPROVE AND ARE COMMITTED TO OUR VISION: TO BE THE PERSONAL CARE HOME OF CHOICE IN THE COMMUNITY WE SERVE BY DELIVERING QUALITY SERVICES IN A WARM, FRIENDLY AND HOME-LIKE SETTING. |
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT DUTIES: COLE MEMORIAL, THE ORGANIZATION'S PARENT COMPANY, PROVIDES MANAGEMENT SERVICES TO THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 4 | SIGNIFICANT CHANGES TO BYLAWS: THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE ORGANIZATION'S BYLAWS DURING THE FISCAL YEAR: THE BYLAWS NOW STATE THE CORPORATION HAS NO MEMBERS. THE FOLLOWING POWERS ARE RESERVED TO THE BOARD OF DIRECTORS OF COLE MEMORIAL HOSPITAL: - TO ELECT AND REMOVE, WITH OR WITHOUT CAUSE, ANY AND ALL DIRECTORS OF THE CORPORATION. - TO FILL VACANCIES WITH RESPECT TO ANY AND ALL OFFICERS OF THE CORPORATION. - TO ADDRESS CONFLICT OF INTEREST ISSUES AND ETHICS POLICIES OF THE CORPORATION. - TO APPROVE ALL ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION (INCLUDING ALL AMENDMENTS THERETO) AND ALL UNBUDGETED EXPENDITURES IN EXCESS OF $50,000. - TO APPROVE ALL STRATEGIC PLANS AND INVESTMENT POLICIES OF THE CORPORATION. - TO SELECT AND OVERSEE THE WORK OF THE INDEPENDENT AUDITORS AND LEGAL COUNSEL OF THE CORPORATION. SPECIFIC DUTIES OF THE PRESIDENT AND CEO WERE REMOVED AND ARE NOW SHOWN AS "SUCH DUTIES AND AUTHORITY AS ARE CUSTOMARILY REQUIRED BY THAT POSITION". THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF COLE MEMORIAL IS SPECIFIED TO ALSO SERVE AS THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF HENDORN. THE GOVERNANCE OVERSIGHT COMMITTEE WAS FORMED AND IS RESPONSIBLE FOR, AMONG OTHER FUNCTIONS: - OVERSEEING AUDIT AND FINANCE FUNCTIONS. - PROVIDING INDEPENDENT JUDGMENT AND SERVING AS AN OBJECTIVE BODY TO MONITOR THE CORPORATION'S FINANCIAL REPORTING PROCESS AND INTERNAL AND EXTERNAL AUDITING PROCESSES. - REVIEWING AND EVALUATING THE AUDIT EFFORTS OF THE CORPORATION'S INDEPENDENT ACCOUNTANTS. SPECIFICS REGARDING THE CONFLICT OF INTEREST POLICY HAVE BEEN REMOVED FROM THE BYLAWS. THE BYLAWS NOW STATE THE BOARD OF DIRECTORS SHALL COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. SPECIFIC INSTRUCTIONS HAVE BEEN REMOVED REGARDING THE DISSOLUTION OF PROPERTY IN THE EVENT THAT THE CORPORATION IS DISSOLVED, BUT COLE MEMORIAL IS SPECIFICALLY LISTED AS HAVING THE RIGHTS TO DETERMINE THE DISTRIBUTION OF ASSETS UPON DISSOLUTION. |
| FORM 990, PART VI, SECTION A, LINES 7A & 7B | MEMBERS: THE DIRECTORS ARE ELECTED BY THE BOARD OF COLE MEMORIAL. ADDITIONALLY, COLE MEMORIAL'S BOARD RESERVES THE RIGHT TO APPROVE ANY AMENDMENTS TO THE BYLAWS, AMONG OTHER POWERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE 990 IS THEN REVIEWED BY THE ACCOUNTING DEPARTMENT AND THE CONTROLLER. IT IS THEN PRESENTED TO THE GOVERNANCE OVERSIGHT COMMITTEE FOR REVIEW. AFTER THE GOVERNANCE OVERSIGHT COMMITTEE HAS REVIEWED, A FULL COPY IS DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO THE CEO'S FINAL SIGNATURE. THE OVERSIGHT COMMITTEE WILL REPORT THEIR REVIEW OF FORM 990 TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, QUESTION 12C | MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: MEMBERS OF THE BOARD OF DIRECTORS; BOARD COMMITTEES; MANAGEMENT EMPLOYEES; AND MEDICAL STAFF WITH ADMINISTRATIVE RESPONSIBILITIES ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. THE LEVELS AT WHICH ACTUAL CONFLICTS ARE REVIEWED ARE THE COMPLIANCE OFFICER AND GOVERNANCE OVERSIGHT COMMITTEE OF THE BOARD OF DIRECTORS. RESTRICTIONS INCLUDE: A MEMBER OF THE BOARD/BOARD COMMITTEE MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST. A VOTING MEMBER OF ANY COMMITTEE WHOSE SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE HOSPITAL FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. PHYSICIANS WHO RECEIVE COMPENSATION, DIRECTLY OR INDIRECTLY, FROM THE HOSPITAL, WHETHER AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE PRIMARY SCOPE OF RESPONSIBILITIES INCLUDES COMPENSATION MATTERS. A MANAGEMENT EMPLOYEE, OR A MEDICAL STAFF MEMBER WITH ADMINISTRATIVE RESPONSIBILITIES MUST DISCLOSE TO THE SENIOR LEADER THE EXISTENCE OF THE FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS. |
| FORM 990, PART VI, SECTION B, QUESTIONS 15A & 15B | COMPENSATION DETERMINATION: A REVIEW WAS CONDUCTED IN 2013 FOR PRESIDENT & CEO EDWARD PITCHFORD BY 3C COMPENSATION CONSULTING CONSORTIUM, LLC, LOCATED IN PITTSBURGH, PENNSYLVANIA. THE BOARD WOULD HAVE TO APPROVE ANY INCREASE RECOMMENDED BY THE GOVERNANCE OVERSIGHT COMMITTEE. |
| FORM 990, PART VI, SECTION C, QUESTION 19 | DOCUMENT AVAILABILITY: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS CAN BE VIEWED ONSITE THROUGH A WRITTEN REQUEST TO THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER. REQUESTS FOR FINANCIAL STATEMENTS AND 990'S ARE FORWARDED TO THE FINANCE / ACCOUNTING DEPARTMENT AND ARE OPEN FOR PUBLIC INSPECTION. |
| FORM 990, PART VII, SECTION A | BOARD MEMBER COMPENSATION: NO BOARD MEMBERS RECEIVE ANY COMPENSATION FOR THEIR DIRECTOR DUTIES. MICHAEL CALLAHAN, JASON TRONETTI AND KALLIOPI NESTOR ARE COMPENSATED BY COLE MEMORIAL, A RELATED ORGANIZATION, AS PHYSICIANS. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS: $173,765 TRANSFER FROM COLE MEMORIAL |
| FORM 990, PART XII, LINE 2C | GOVERNANCE OVERSIGHT COMMITTEE: A GOVERNANCE OVERSIGHT COMMITTEE WAS FORMED IN FEBRUARY 2015. THIS COMMITTEE IS COMPRISED OF AT LEAST FIVE VOTING MEMBERS OF THE BOARD WITH THE VICE CHAIR OF THE BOARD SERVING AS CHAIR OF THE COMMITTEE. THE COMMITTEE IS RESPONSIBLE FOR, AMONG OTHER FUNCTIONS: -OVERSEEING AUDIT AND FINANCE FUNCTIONS. -PROVIDING INDEPENDENT JUDGMENT AND SERVING AS AN OBJECTIVE BODY TO MONITOR THE CORPORATION'S FINANCIAL REPORTING PROCESS AND INTERNAL AND EXTERNAL AUDITING PROCESSES. -REVIEWING AND EVALUATING THE AUDIT EFFORTS OF THE CORPORATION'S INDEPENDENT ACCOUNTANTS. |
| Software ID: | |
| Software Version: |