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 | |||||
| (A)
AVOW HOSPICE INC |
592201250 | 9 | Yes | 0 | 0 | |
| (B)
AVOW CARE SERVICES INC |
274127864 | 9 | Yes | 0 | 0 | |
| Total 2 | 0 | 0 | ||||
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.") . | ||||||
| 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 IV, Section D, Line 3 Supp. Org. Have Significant Voice In Investment Policies | All of the individuals that served on Avow Hospice, Inc. Board of Directors also served on the Board of Directors of the Corporation. A significant number of the individuals who served on Avow Care Services, Inc. board of directors also serve on the Board of Directors of the Corporation. As a result of the board overlap between the Corporation and its supported organizations, the supported organizations have a significant voice in how the Corporation managed and used its assets. |
| Schedule A, Part IV, Section E, Line 3a Power To Appoint/Elect Majority of Officer/Director/Trustee | The Corporation served as parent organization of the supported organizations having the power to appoint and remove the directors and officers of the supported organizations. |
| Schedule A, Part IV, Section E, Line 3b Substantial Direction Over Policies/Programs/Activities | The Corporation has the power to approve the strategic plan, operating and capital plans and budgets, and other significant transactions of the supported organizations, per the Bylaws of each supported organization. |
| 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 VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL | COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS IS PAID BY AVOW HOSPICE, INC., A RELATED TAX EXEMPT ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS COMPENSATION OF THE PRESIDENT & CEO TO ENSURE COMPENSATION IS REASONABLE AND THEN RECOMMENDS ANY CHANGES IN COMPENSATION TO THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE USES COMPARABILITY DATA IN THEIR DETERMINATION. THE FULL BOARD THEN APPROVES THE COMPENSATION OF THE PRESIDENT & CEO. THE PROCESS IS DOCUMENTED IN THE BOARD AND EXECUTIVE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN DURING 2015. BECAUSE THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS ARE NOT PAID BY THE FILING ORGANIZATION, THE FORM 990 INSTRUCTIONS REQUIRE THIS TO BE ANSWERED "NO". |
| Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER EMPLOYEES | COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS IS PAID BY AVOW HOSPICE, INC., A RELATED TAX EXEMPT ORGANIZATION. THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS COMPENSATION OF THE PRESIDENT & CEO TO ENSURE COMPENSATION IS REASONABLE AND THEN RECOMMENDS ANY CHANGES IN COMPENSATION TO THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE USES COMPARABILITY DATA IN THEIR DETERMINATION. THE FULL BOARD THEN APPROVES THE COMPENSATION OF THE PRESIDENT & CEO. THE PROCESS IS DOCUMENTED IN THE BOARD AND EXECUTIVE COMMITTEE MINUTES. THIS PROCESS WAS LAST UNDERTAKEN DURING 2015. BECAUSE THE ORGANIZATION'S PRESIDENT AND OTHER OFFICERS ARE NOT PAID BY THE FILING ORGANIZATION, THE FORM 990 INSTRUCTIONS REQUIRE THIS TO BE ANSWERED "NO". |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | The executive committee shall consist of the board officers and President & CEO, as well as up to two other directors who will serve at the discretion of the chairperson. The Executive Committee shall monitor all, and may intervene in any, matters pertaining to the management of the corporation and be the only committee empowered to exercise the full authority of the board. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | Janice Gazdic & Thomas Gazdic - Family relationship, Phyllis Hall & Thomas Gazdic - Business relationship |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | The reinstated bylaws now have adopted an investment committee, governance committee, and Ad Hoc committee, all of which the board shall retain final authority over all matters. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The Form 990 is reviewed by the Chief Executive Officer and the Chief Financial Officer in detail. A copy of the Form 990 is provided to every member of the governing body prior to filing. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ANNUALLY, THE CORPORATE COMPLIANCE OFFICER PROVIDES A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH BOARD DIRECTOR AND OFFICER , TO COMPLETE AND RETURN. THE CORPORATE COMPLIANCE OFFICER THEN REVIEWS THESE QUESTIONNAIRES TO DETERMINE WHAT CONFLICTS, REAL OR PERCEIVED, EXIST. IF A BOARD DIRETOR OR OFFICER HAS A CONFLICT OF INTEREST, S/HE DISCLOSES THE CONFLICT. THE BOARD DIRECTOR OR OFFICER WITH THE CONFLICT IS ALLOWED TO REMAIN IN THE MEETING TO ANSWER ANY QUESTION THE CONFLICTED BOARD DIRECTOR OR OFFICER MAY NEED TO ANSWER AND THEN THE CONFLICTED BOARD DIRECTOR OR OFFICER IS EXCUSED FROM THE MEETING. THE REMAINING BOARD DIRECTORS OR OFFICER CAN THEN DISCUSS THE MATTER FURTHER AND ACTION IS TAKEN ON THE MATTER. THE CONFLICTED BOARD DIRECTOR OR OFICER IS THEN INVITED BACK INTO THE MEETING. CONFLICTED TRUSTEES MAY ALSO BE ASKED, IN RARE SITUATIONS, TO RESIGN THEIR POSITION ON THE BOARD. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM THE ORGANIZATION. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Net Income from Affiliated Entities - 104925; |
| Software ID: | 15000238 |
| Software Version: | 2015v2.1 |