Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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)
VISITING NURSE ASSOCIATION OF THE MIDLANDS |
470690207 | 7 | Yes | 1,055 | 0 | |
| (B)
VISITING NURSE HEALTH SERVICES |
470690286 | 7 | No | 78,962 | 0 | |
| (C)
THE VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY IOWA |
420681048 | 7 | No | 0 | 0 | |
| (D)
EASTER SEAL SOCIETY OF NEBRASKA INC |
470457872 | 7 | No | 0 | 0 | |
| (E)
VNA HOSPICE OF SOUTHWEST IOWA |
470733773 | 10 | No | 0 | 0 | |
|
Total 5
|
80,017 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART IV, SECTION A, LINE 1: | THE ARTICLES OF INCORPORATION STATE THAT VISITING NURSE FOUNDATION SUPPORTS THE VISITING NURSE ASSOCIATION OF OMAHA, ENTITIES AFFILIATED WITH THE VISITING NURSE ASSOCIATION OF OMAHA, AND ENTITIES AFFILIATED WITH THE VISITING NURSE FOUNDATION. THE VISITING NURSE ASSOCIATION OF OMAHA HAS CHANGED ITS NAME TO VISITING NURSE ASSOCIATION OF THE MIDLANDS (VNAM). ENTITIES AFFILIATED WITH VNAM AND WITH THE VISITING NURSE FOUNDATION INCLUDE VISITING NURSE HEALTH SERVICES, VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, EASTER SEAL SOCIETY OF NEBRASKA, INC AND VNA HOSPICE OF SOUTHWEST IOWA. |
| SCHEDULE A, PART IV, SECTION A, LINE 5A: | DURING THE YEAR, VNA HOSPICE OF SOUTHWEST IOWA, EIN: 47-0733773, WAS ADDED AS AN AFFILIATE OF VISITING NURSE HEALTH SERVICES (VNHS), AND THUS BECAME A SUPPORTED ORGANIZATION OF THE FOUNDATION. THIS DECISION WAS VOTED ON AND APPROVED BY THE BOARD OF DIRECTORS OF VNHS. AS THE FOUNDATION'S ARTICLES OF INCORPORATION STATE THAT THE FOUNDATION SUPPORTS ENTITIES AFFILIATED WITH THE VISITING NURSE ASSOCIATION OF OMAHA (SEE ABOVE), NO FURTHER AMENDMENTS TO THE ORGANIZING DOCUMENTS WERE NECESSARY. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | VISITING NURSE FOUNDATION BOARD MEMBERS ARE SELECTED BY THE VISITING NURSE HEALTH SERVICES BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BYLAWS MAY BE AMENDED UPON A TWO-THIRDS VOTE OF THE VISITING NURSE FOUNDATION'S BOARD OF DIRECTORS. ALL AMENDMENTS MUST BE REVIEWED AND APPROVED BY THE VISITING NURSE HEALTH SERVICES' BOARD OF DIRECTORS BEFORE THE AMENDMENTS BECOME EFFECTIVE. |
| FORM 990, PART VI, SECTION B, LINE 11B | VISITING NURSE FOUNDATION WILL SHARE THE FORM 990 WITH THE GOVERNING BODY PRIOR TO SUBMISSION. IF A REGULARLY SCHEDULED MEETING DOES NOT OCCUR BEFORE THE FORM 990 DEADLINE FOR SUBMISSION, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WILL MEET, REVIEW THE FORM 990, AND RELAY INFORMATION TO THE GOVERNING BODY AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. THE VP FINANCE/CFO COORDINATES THE PREPARATION OF FORM 990 WITH AN OUTSIDE ACCOUNTING FIRM, AND REVIEWS A DRAFT COPY. THE PRESIDENT/CEO AND THE VP FINANCE/CFO WILL PROVIDE THE FORM 990 TO THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS, OFFICERS AND KEY EMPLOYEES COMPLETE AND SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. ELECTRONIC COPIES ARE KEPT IN THE ADMINISTRATIVE OFFICE. MEMBERS OF THE BOARD OF DIRECTORS ARE AWARE OF THE POLICY AND EXCUSE THEMSELVES FROM THE VOTE WHEN APPROPRIATE. THE CONFLICT OF INTEREST POLICY STATEMENTS ARE REVIEWED BY THE PRESIDENT AND CEO, WHO MAKES HIMSELF AWARE OF ANY POTENTIAL CONFLICTS THAT MAY ARISE. ALL MEMBERS OF THE BOARD OF DIRECTORS AND LEADERSHIP TEAM COMPLETE AND SIGN CONFLICT OF INTEREST STATEMENTS. BOARD MEMBERS ARE REQUIRED BY THE ORGANIZATION'S BYLAWS TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST OR CONFLICT OF INTEREST TRANSACTIONS TO BE APPROVED BY BOARD VOTE. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE COMPENSATION FOR THE CEO. SALARY COMPARISONS ARE CONDUCTED WHEN DETERMINED NECESSARY BY THE COMMITTEE; A PAID COMPARABILITY STUDY HAS BEEN USED, AND REVIEWS OF COMPARABLE ORGANIZATIONS' FORMS 990 HAVE BEEN DONE IN THE PAST, THE MOST RECENT IN 2016. A PERFORMANCE EVALUATION PROCESS IS COMPLETED ANNUALLY BY THE BOARD OF DIRECTORS AND THE EXECUTIVE COMMITTEE MAKES THE FINAL DETERMINATION ON THE CEO'S SALARY BASED ON THE EVALUATION PROCESS. ALL DISCUSSIONS ARE RECORDED IN COMMITTEE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, SECTION B; FORM 990 PART VIII; AND FORM 990 PART IX: | VISITING NURSE FOUNDATION (VNF) SHARES ITS FACILITY, ITS EMPLOYEES AND OTHER EXPENSES WITH FIVE RELATED ORGANIZATIONS: VISITING NURSE ASSOCIATION OF THE MIDLANDS, VISITING NURSE HEALTH SERVICES, VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, EASTER SEAL SOCIETY OF NEBRASKA, INC., AND VNA HOSPICE OF SOUTHWEST IOWA. VNF PAYS MANAGEMENT FEES TO THOSE ORGANIZATIONS. FEES PAID ARE REPORTED ON PART IX, LINE 11A. AS THE FEES ARE PAID TO A RELATED OPERATING CHARITABLE ENTITY, THE MANAGEMENT FEES PAID ARE NOT REPORTED AS AN INDEPENDENT CONTRACTOR PAYMENT ON PART VII, SECTION B. |
| FORM 990, PART XI, LINE 2C: | THE FINANCE AND AUDIT COMMITTEE IS RESPONSIBLE FOR EVALUATION AND OVERSIGHT OF THE FINANCIAL NEEDS AND STATUS OF THE VNA AND FOR THE ESTABLISHMENT AND REVIEW OF POLICIES DESIGNED TO MEET SUCH NEEDS. THE COMMITTEE REVIEWS AND RECOMMENDS APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS, REVIEWS AND RECOMMENDS APPROVAL TO THE VNA BOARD OF MONTHLY FINANCIAL PROGRESS TOWARD ANNUAL BUDGET PLANS AS REPORTED BY STAFF, ENSURES ACCURACY OF FINANCIAL REPORTING INCLUDING MONITORING OF INTERNAL CONTROLS, OVERSEES THE ACCOUNTING AND FINANCIAL REPORTING PROCESS AND THE INDEPENDENT AUDIT OF THE FINANCIAL STATEMENTS AND SELECTS, OVERSEES AND COMPENSATES THE EXTERNAL AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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| Software Version: |