Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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 | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 461,999 | 629,195 | 838,170 | 548,033 | 1,569,428 | 4,046,825 |
| 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 | 29,945,411 | 32,703,281 | 32,194,737 | 32,145,012 | 31,878,337 | 158,866,778 |
| 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 | 30,407,410 | 33,332,476 | 33,032,907 | 32,693,045 | 33,447,765 | 162,913,603 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 10,000 | 11,000 | 10,000 | 11,000 | 42,000 | |
| 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.. | 10,000 | 11,000 | 10,000 | 11,000 | 42,000 | |
| 8 | Public support. (Subtract line 7c from line 6.) | 162,871,603 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 30,407,410 | 33,332,476 | 33,032,907 | 32,693,045 | 33,447,765 | 162,913,603 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 477,495 | 408,153 | 553,130 | 559,632 | 559,411 | 2,557,821 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 477,495 | 408,153 | 553,130 | 559,632 | 559,411 | 2,557,821 |
| 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.).. | 30,884,905 | 33,740,629 | 33,586,037 | 33,252,677 | 34,007,176 | 165,471,424 |
| 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) |
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| 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): |
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| 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 |
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| 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 |
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| 9 Distributable amount for 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. 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 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part I, Line 1 Description of Organization Mission (Cont'd): | The agency's service area includes Merrimack County and portions of Hillsborough County, representing more than 44 communities in central New Hampshire. Concord Regional VNA serves over 7,200 patients annually and provides approximately 132,552 homecare visits and more than 50,000 hospice days annually, including a 10-bed Hospice House. Patients who are uninsured, underinsured, or otherwise unable to pay the published fees for services are provided charity care. In the Fiscal Year 2020, the CRVNA Home Care Program provided care to 6,209 patients. Fourteen percent (14%) of the patients served in the Home Care Program were uninsured or received funding from Medicaid. In addition, 65% of the Home Care patients had Medicare or Medicare replacement plans as their insurance plan. The Hospice program provided care to 849 patients. Ninety four percent (94%) of the Hospice patients had Medicare and 4% of the patients were uninsured or received funding from Medicaid. We are a 501(c)(3) non-profit agency and a subsidiary of Capital Region Health Care. Concord Regional VNA is a Medicare and Medicaid Certified Home Health and Hospice Provider and is licensed by the State of New Hampshire Bureau of Health Care Facilities. In addition, Concord Regional VNA's Hospice House, an inpatient setting providing care and comfort for the terminally ill, is licensed by the State of New Hampshire as a Supportive Residential Care Facility. |
| Form 990, Part VI, Section A, line 6 | Capital Region HealthCare Corporation is the sole member of the Concord Regional VNA. |
| Form 990, Part VI, Section A, line 7a | Capital Region HealthCare Corporation accepts any changes made to the bylaws by the governing body. |
| Form 990, Part VI, Section B, line 11b | The role of Concord Regional Visiting Nurse Association's Audit Committee has expanded to include review of the agency's 990. The Audit Committee engages the auditors and receives the audit and the 990 Report. The Audit Committee receives a complete copy of the 990 including all schedules. The initial presentation of the FY2020 audit and the 990 Form will occur at the November 18, 2020 meeting of the Audit/Finance Committee meeting. Subsequent Audit Committee meetings will occur if necessary to complete the review. The Audit Committee will report to the Board of Trustees that a review of the 990 has occurred. The Board of Trustees accepts the Audit Committee reports, the audit, and the 990 documents. All members of the Board will have access to the reports. The Form 990 is available to the public upon request. |
| Form 990, Part VI, Section B, line 12c | The Conflict of Interest, Statement of Conflict of Interest with Respect to a Relationship, Transaction and/or Financial Interest form was revised by the Audit Committee in February 2010 and approved by the Board in March 2010. The form was revised to ensure compliance with the State of NH Pecuniary Benefit Law (Chapter 7: RSA 7:19a) and the revised IRS 990 disclosure requirements. The Board Chair and Chief Executive Officer/President reviewed the form and the regulation requirements at the March 10, 2020 Board Meeting. Trustees at the meeting were requested to complete the forms and return them to management. The Executive Assistant worked with Board members to ensure each member had returned the Conflict of Interest Forms. In FY2020, 100% of the Board of Trustees returned the signed conflict of interest forms. The Audit Committee at its May 6, 2020 meeting reviewed the forms for those Trustees that reported a conflict of interest. The Audit Committee reported to the full Board the conflict of interest transactions that had been disclosed on the conflict of interest forms. The Board at its May 12, 2020 meeting approved the conflict of interest disclosures. The approved transactions over $5,000 were reported as required by law to the State of New Hampshire's Director of Charitable Trust at the Attorney General's office and a notice was published in the Concord Monitor. In addition to the annual completion of the form, Trustees were asked at every Board meeting during Fiscal Year 2020, if there were any conflicts that they have identified that should be reported to Management and the Board. |
| Form 990, Part VI, Section B, line 15 | The Board at its May 8, 2018 meeting adopted an Executive Compensation policy for the CEO/CFO positions. The Executive Committee's compensation philosophy is to pay the CEO and CFO at the appropriate level of compensation based on market data and surveys. The compensation will be performance based using the salary information available. The Executive Committee commissions a bi-annual review by an independent consulting firm to evaluate the organization's executive compensation program against the competitive market. The evaluation is intended to ensure that the compensation program falls within a reasonable range of competitive practices for comparable positions among similarly situated organizations. |
| Form 990, Part VI, Section C, line 19 | The Organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Concord Regional Visiting Nurse Association, Inc. 30 Pillsbury Street Concord, NH 03301 EIN 02-0222122 Concord Regional Visiting Nurse Association, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n). |
| Form 990, Part XI, line 9: | Change in Fair Value of Beneficial Interest in Perpetual Trusts 3,276. |
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