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.") . | 165,090 | 354,500 | 204,000 | 203,000 | 501,406 | 1,427,996 |
| 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 | 11,392,050 | 9,070,037 | 10,191,194 | 10,223,503 | 8,256,165 | 49,132,949 |
| 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 | 11,557,140 | 9,424,537 | 10,395,194 | 10,426,503 | 8,757,571 | 50,560,945 |
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 50,560,945 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 11,557,140 | 9,424,537 | 10,395,194 | 10,426,503 | 8,757,571 | 50,560,945 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 107 | 192 | 539 | 3,199 | 5,531 | 9,568 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 107 | 192 | 539 | 3,199 | 5,531 | 9,568 |
| 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.) .. | 220,803 | 244,199 | 583,123 | 712,016 | 209,229 | 1,969,370 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 11,778,050 | 9,668,928 | 10,978,856 | 11,141,718 | 8,972,331 | 52,539,883 |
| 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: | MANAGEMENT FEES - 2016 AMOUNT: $ 190,750. 2017 AMOUNT: $ 165,000. 2018 AMOUNT: $ 138,000. 2019 AMOUNT: $ 154,000. 2020 AMOUNT: $ 48,000. MISCELLANEOUS - 2016 AMOUNT: $ 24,259. 2017 AMOUNT: $ 780. 2018 AMOUNT: $ 579. 2019 AMOUNT: $ 22,916. 2020 AMOUNT: $ 4,149. MEDICAL RECORDS - 2016 AMOUNT: $ 5,794. 2017 AMOUNT: $ 11,242. 2018 AMOUNT: $ 5,999. 2019 AMOUNT: $ 9,211. 2020 AMOUNT: $ 2,634. REIMBURSEMENTS - 2017 AMOUNT: $ 67,177. 2018 AMOUNT: $ 438,545. 2019 AMOUNT: $ 525,889. 2020 AMOUNT: $ 134,664. INSURANCE REFUNDS - 2020 AMOUNT: $ 19,782. |
| 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 3 | THE ORGANIZATION HAS A MANAGEMENT AGREEMENT WITH RICHMOND UNIVERSITY MEDICAL CENTER, AN UNRELATED ORGANIZATION. THE ORGANIZATION IS IN PROCESS OF MERGING INTO THE CENTER'S SYSTEM, AND AS PART OF THE MERGER PROCESS, THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR THE CENTER TO OVERSEE THE DAY-TO-DAY OPERATIONS OF THE CERTIFIED HOME HEALTH AGENCY. HOPE ILICETO, PRESIDENT/CEO OF VNA, IS PAID BY THE CENTER FOR HER SERVICES AS THE PRESIDENT/CEO OF VNA. IN 2020, SHE WAS RECEIVED A SALARY OF $248,284 AND $81,934 OF FRINGE BENEFITS IN EXCHANGE FOR HER SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION (PARENT) IS THE VISITING NURSE ASSOCIATION OF STATEN ISLAND, INC. (VNASI). |
| FORM 990, PART VI, SECTION A, LINE 7A | WHENEVER DIRECTORS ARE TO BE ELECTED BY THE MEMBERS, THEY SHALL BE ELECTED BY A PLURALITY OF THE VOTES CAST AT A MEETING OF SUCH MEMBERS BY THE MEMBERS ENTITLED TO VOTE IN THE ELECTION. |
| FORM 990, PART VI, SECTION A, LINE 7B | WHENEVER ANY CORPORATE ACTION, OTHER THAN THE ELECTION OF DIRECTORS IS TO BE TAKEN BY VOTE OF THE MEMBERS, IT SHALL, EXCEPT AS OTHERWISE REQUIRED BY LAW, BE AUTHORIZED BY A MAJORITY OF THE VOTES CAST AT A MEETING OF MEMBERS BY THE MEMBERS ENTITLED TO VOTE THEREON. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS PREPARED BY OUR INDEPENDENT ACCOUNTANTS FROM INFORMATION GATHERED AS PART OF THEIR AUDIT AND FROM OTHER INFORMATION SUPPLIED BY THE AGENCY. A DRAFT OF THE 990 IS REVIEWED BY MANAGEMENT. AFTER THEIR REVIEW, THE FORM 990 IS ELECTRONICALLY SENT TO THE BOARD FOR THEIR REVIEW BEFORE BEING ELECTRONICALLY FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION CURRENTLY HAS IN PLACE A CONFLICT OF INTEREST POLICY WHICH IT ANNUALLY MONITORS AND ENFORCES. THE BOARD CURRENTLY MANDATES THAT ALL MEMBERS OF MANAGEMENT AND THE GOVERNING BODY ANNUALLY SIGN A CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS THAT MAY EXIST. THE SIGNED CONFLICT OF INTEREST POLICY IS SUBMITTED TO THE CORPORATE COMPLIANCE OFFICER WHO REVIEWS THE SIGNED ATTESTATIONS FOR POTENTIAL OR ACTUAL CONFLICTS. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS, THE CORPORATE COMPLIANCE OFFICER WILL NOTIFY A MEMBER OF MANAGEMENT OR THE GOVERNING BODY ABOUT SUCH CONFLICT AND INVESTIGATE THE CONFLICT. THE RESULTS OF THE INVESTIGATION WILL BE SUMMARIZED AND DOCUMENTED BY THE CORPORATE COMPLIANCE OFFICER AND BE REPORTED TO THE GOVERNING BODY. IF THE CORPORATE COMPLIANCE OFFICER ESTABLISHES THAT AN ACTUAL CONFLICT EXISTS, THE MEMBER OF MANAGEMENT OR THE GOVERNING BODY WILL BE NOTIFIED IMMEDIATELY AND WILL NOT BE ALLOWED TO VOTE OR BE A PART OF ANY DECISIONS ABOUT ANY SUCH TRANSACTIONS THAT HAVE TO DO WITH THE CONFLICT UNTIL SUCH TIME THERE IS NO LONGER A CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE, CONSISTING OF PERSONS WITHOUT CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT, ESTABLISHES THE CEO'S COMPENSATION USING COMPARABLE DATA AND DETERMINES THAT THE SALARY IS REASONABLE. THE EXECUTIVE COMMITTEE'S DECISION ON THE AMOUNT OF COMPENSATION PAID IS REQUIRED TO BE DOCUMENTED IN A WRITTEN FORMAT INCLUDING THE DATE OF THE DECISION. THE COMPENSATION REVIEW PROCESS FOR THE CEO WAS LAST UNDERTAKEN IN 2019. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ASSOCIATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE ASSOCIATION'S FORM 990 IS AVAILABLE ON WWW.GUIDESTAR.ORG AND OTHER SIMILAR TYPE S OF WEBSITES. |
| FORM 990, PART VII: | CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES ARE PAID BY THE ORGANIZATION BUT SPEND A PERCENTAGE OF THEIR TIME WORKING FOR VISITING NURSE ASSOCIATION OF STATEN ISLAND (VNASI) AND VISITING NURSE PLUS (VNP). |
| FORM 990, PART IX, LINE 11G | CONSULTANTS: PROGRAM SERVICE EXPENSES 102,019. MANAGEMENT AND GENERAL EXPENSES 12,747. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,766. CONTRACT HEALTH WORKERS: PROGRAM SERVICE EXPENSES 591,633. MANAGEMENT AND GENERAL EXPENSES 73,922. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 665,555. RNS, LPNS AND PHYSICIANS: PROGRAM SERVICE EXPENSES 129,025. MANAGEMENT AND GENERAL EXPENSES 16,121. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 145,146. BILLING SERVICES: PROGRAM SERVICE EXPENSES 397,086. MANAGEMENT AND GENERAL EXPENSES 49,614. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 446,700. CONTRACT THERAPISTS: PROGRAM SERVICE EXPENSES 1,357,320. MANAGEMENT AND GENERAL EXPENSES 110,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,468,101. |
| FORM 990, PART XII, LINE 2C: | THE ASSOCIATION HAS A FINANCE COMMITTEE WHICH FUNCTIONS AS AN AUDIT COMMITTEE AND WHICH ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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| Software Version: |