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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 8,203 | 4,646 | 2,223 | 11,372 | 442,104 | 468,548 |
| 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 | 6,741,568 | 7,277,275 | 7,618,821 | 8,732,336 | 9,234,809 | 39,604,809 |
| 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 | 6,749,771 | 7,281,921 | 7,621,044 | 8,743,708 | 9,676,913 | 40,073,357 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 253,050 | 175,186 | 428,236 | |||
| c | Add lines 7a and 7b.. | 253,050 | 175,186 | 428,236 | |||
| 8 | Public support. (Subtract line 7c from line 6.) | 39,645,121 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 6,749,771 | 7,281,921 | 7,621,044 | 8,743,708 | 9,676,913 | 40,073,357 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 24,664 | 24,664 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 24,664 | 24,664 | ||||
| 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.) .. | 41,273 | 27,508 | 19,797 | 30,282 | 47,162 | 166,022 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 6,815,708 | 7,309,429 | 7,640,841 | 8,773,990 | 9,724,075 | 40,264,043 |
| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 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 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | MEALS REVENUE - 2016 AMOUNT: $ 35,437. 2017 AMOUNT: $ 22,421. 2018 AMOUNT: $ 15,137. 2019 AMOUNT: $ 15,997. 2020 AMOUNT: $ 35,885. BARBER BEAUTY SHOP - 2016 AMOUNT: $ 5,836. 2017 AMOUNT: $ 5,087. 2018 AMOUNT: $ 4,660. 2019 AMOUNT: $ 5,533. 2020 AMOUNT: $ 1,911. LAUNDRY - 2019 AMOUNT: $ 1,469. 2020 AMOUNT: $ 1,218. VENDING - 2019 AMOUNT: $ 2,034. 2020 AMOUNT: $ 1,415. PARKING - 2019 AMOUNT: $ 1,889. 2020 AMOUNT: $ 3,543. OTHER REVENUE - 2019 AMOUNT: $ 3,360. 2020 AMOUNT: $ 3,190. |
| 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 V, LINE 2A AND FORM 990, PART IX, LINE 7 | VILLAGE NORTH DOES NOT ISSUE W-2S. THE MANAGEMENT COMPANY, BETHESDA HEALTH GROUP INC, ISSUES THE W-2S FOR THIS ENTITY. THE AMOUNT LISTED ON FORM 990, PART IX, LINE 7 REPRESENTS THE WAGES THAT BETHESDA HAS PAID TO ITS EMPLOYEES WHO WORK SPECIFICALLY AT THE VILLAGE NORTH COMMUNITY. |
| FORM 990, PART VI, SECTION A, LINE 3 | VNI HAS ENTERED INTO AN AGREEMENT WITH BETHESDA HEALTH GROUP, INC., WHO IS ONE OF THE JOINT MEMBERS OF VNI, TO PROVIDE MANAGEMENT SERVICES FOR THE DAY-TO-DAY OPERATIONS OF VNI. THE MANAGEMENT SERVICES TO BE PROVIDED BY BETHESDA HEALTH GROUP, INC. INCLUDE, WITHOUT LIMITATION, THE FOLLOWING: GENERAL PLANNING SERVICES; BUDGETS; CONTRACT NEGOTIATION; BILLING AND COLLECTION SERVICES; BUSINESS OFFICE SERVICES; PRICING; HUMAN RESOURCE SERVICES; INFORMATION SYSTEMS; ADVERTISING & MARKETING SERVICES; ACCOUNTING SERVICES; REPAIRS & MAINTENANCE; CAPITAL IMPROVEMENTS; ADMISSION & DISCHARGE SERVICES; INSURANCE; RECORD MAINTENANCE; QUALITY CONTROL; RISK MANAGEMENT; POLICIES & COMPLIANCE SERVICES; AND OTHER MANAGEMENT ACTIVITIES. DURING THE 2020 CALENDAR YEAR BETHESDA HEALTH GROUP, INC. COMPENSATED THE FOLLOWING INDIVIDUALS IN TOTAL WAGES: WADE HACHMAN $42,776 FOR SERVING AS VNI'S ADMINSITRATOR; KATIE SMITH $50,007 FOR SERVING AS VNI'S DIRECTOR OF NURSING; RENEE CWIKLOWSKI $67,665 FOR SERVING AS VNI'S ADMINISTRATOR; AND CONSTANCE HARRIS-NEWSON $38,769 FOR SERVING AS VNI'S DIRECTOR OF NURSING. |
| FORM 990, PART VI, SECTION A, LINE 6 | BETHESDA HEALTH GROUP, INC. AND CHRISTIAN HEALTH SERVICES DEVELOPMENT CORPORATION, TWO UNRELATED CHARITABLE TAX-EXEMPT ORGANIZATIONS DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3), ARE VNI'S TWO MEMBERS, WITH EACH HAVING 50% CONTROL OF ITS BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH OF THE ORGANIZATION'S TWO MEMBERS, BETHESDA HEALTH GROUP, INC. AND CHRISTIAN HEALTH SERVICES DEVELOPMENT CORPORATION, HAVE THE POWER TO APPOINT TWO MEMBERS TO VNI'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 WILL BE DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW, COMMENT AND APPROVAL PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | VNI HAS ADOPTED A WRITTEN CONFLICT OF INTEREST POLICY (POLICY) THAT REQUIRES OFFICERS, DIRECTORS, KEY EMPLOYEES, AND OTHER COVERED INDIVIDUALS TO DISCLOSE BUSINESS OR OTHER INTERESTS THAT MAY GIVE RISE TO CONFLICTS. VNI REGULARLY AND CONSISTENTLY MONITORS COMPLIANCE WITH THE POLICY BY ISSUING ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE REMINDING COVERED INDIVIDUALS OF THEIR OBLIGATION TO DISCLOSE POTENTIAL CONFLICTS AND REQUIRES THE INDIVIDUAL TO ATTEST TO THEIR CONTINUING OBLIGATION TO DISCLOSE SAID CONFLICTS SHOULD THE NEED ARISE. THE RESULTS OF THE CONFLICTS QUESTIONNAIRE ARE REVIEWED BY A CENTRALIZED COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN AS NECESSARY. IN ACCORDANCE WITH THE POLICY, INDIVIDUALS DISCLOSING SUCH CONFLICTS RECUSE THEMSELVES FROM ANY AND ALL DISCUSSIONS RELATED TO SUCH BUSINESS TRANSACTIONS. SUCH RELATIONSHIPS ARE REVIEWED TO ENSURE THAT ANY PAYMENTS RECEIVED OR AMOUNTS PAID DO NOT EXCEED THE FAIR MARKET VALUE OF THE GOODS AND SERVICES RECEIVED BY VNI. |
| FORM 990, PART VI, SECTION B, LINE 15 | PER POLICIES OF THE MANAGEMENT SERVICES PROVIDER, BETHESDA HEALTH GROUP, AN INDEPENDENT COMPENSATION CONSULTANT IS REGULARLY ENGAGED TO REVIEW AND ANALYZE THE COMPENSATION AND BENEFITS OF OUR EXECUTIVES COMPARED TO THEIR PEERS IN THE BUSINESS COMMUNITY. THE RESULTS ARE REVIEWED AND APPROVED, WHEN APPROPRIATE, BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | PER THE POLICIES OF THE MANAGEMENT SERVICES PROVIDER, THE ORGANIZATION DOES NOT MAKE COPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART VII, SECTION B AND PART IX | ALTHOUGH THE ORGANIZATION PAID BETHESDA APPROXIMATELY $695,984 FOR THE CALENDAR YEAR, ONLY $382,248 OF THAT IS CONSIDERED TO BE MANAGEMENT FEES. THE OTHER $313,736 IS REIMBURSEMENT FOR MISCELLANEOUS FEES AND TECHNOLOGY INCURRED BY THE MANAGEMENT COMPANY. THESE AMOUNTS ARE SPLIT BETWEEN THE APPROPRIATE CATEGORIES ON REPORTED ACCORDINGLY ON PAGE 10. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,933,104. MANAGEMENT AND GENERAL EXPENSES 41,826. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,974,930. TEMP AGENCIES: PROGRAM SERVICE EXPENSES 52,625. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,625. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 219,951. MANAGEMENT AND GENERAL EXPENSES 360,576. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 580,527. |
| FORM 990, PART XI, LINE 9: | ADDITIONAL PAID IN CAPITAL BY MEMBERS 300,001. |
| Software ID: | |
| Software Version: |