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.") . | 1,460,971 | 674,564 | 1,363,734 | 1,106,319 | 1,993,189 | 6,598,777 |
| 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 | 20,088,308 | 11,028,227 | 22,006,616 | 22,096,588 | 21,576,058 | 96,795,797 |
| 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 | 21,549,279 | 11,702,791 | 23,370,350 | 23,202,907 | 23,569,247 | 103,394,574 |
| 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.) | 103,394,574 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 21,549,279 | 11,702,791 | 23,370,350 | 23,202,907 | 23,569,247 | 103,394,574 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 322,018 | 167,990 | 410,160 | 524,396 | 562,121 | 1,986,685 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 322,018 | 167,990 | 410,160 | 524,396 | 562,121 | 1,986,685 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 7,389 | 0 | 7,389 | |||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 1,181,471 | 1,181,471 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 21,871,297 | 11,870,781 | 23,780,510 | 23,734,692 | 25,312,839 | 106,570,119 |
| 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) |
||||
| 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 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 |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12, Explanation of Other Income: | Stimulus Funding - 2019 Amount: $ 1,181,471. |
| 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 2 | Dartmouth-Hitchcock Health owns For-Profit subsidiaries that provide services and support the mission of the Organization. As a result, some officers of Visiting Nurse Association and Hospice of Vermont and New Hampshire may also be officers of related non-profit and for-profit entities. |
| Form 990, Part VI, Section A, line 6 | Dartmouth-Hitchcock Health, a New Hampshire non-profit corporation, is the sole corporate member of the Visiting Nurse Association and Hospice of Vermont and New Hampshire. D-HH has the power to appoint 1/3 of the members of the Visiting Nurse Association and Hospice of Vermont and New Hampshire's board of trustees. |
| Form 990, Part VI, Section A, line 7a | Dartmouth-Hitchcock Health, a New Hampshire non-profit corporation, is the sole corporate member of the Visiting Nurse Association and Hospice of Vermont and New Hampshire. D-HH has the power to appoint 1/3 of the members of the Visiting Nurse Association and Hospice of Vermont and New Hampshire's board of trustees. |
| Form 990, Part VI, Section A, line 7b | The sole member has the right to ratify the Visiting Nurse Association and Hospice of Vermont and New Hampshire's nomination of 2/3 of the members of the Board of Trustees; remove trustees after consultation with the chairperson of the board; approve the dissolution or liquidation of the Visiting Nurse Association and Hospice of Vermont and New Hampshire; appoint, evaluate, terminate, and approve the compensation of the President and CEO; and other governance decisions. |
| Form 990, Part VI, Section B, line 11b | The Chief Financial Officer will first review the form 990 in its entirety. The executive committee reviews and approves the process for the form 990 review and appoints a finance committee member as well as another member of the board of trustees to review the form 990. Questions and comments are brought to the attention of the executive committee and are resolved prior to submission of the form 990. A copy of the form 990 is posted on the Trustees domain on the VNH website and the board of trustees is given instructions to access and review the form 990 prior to submission. |
| Form 990, Part VI, Section B, line 12c | The Visiting Nurse Association and Hospice of VT & NH Board of Trustees approved a policy concerning a voluntary self-disclosure of any potential conflict of interest. Per the policy, any conflicts or otherwise perceived conflicts are required to be addressed by the Board of Trustees on an ongoing basis. In the event a conflict arises, the individual may be removed from participating in any decision making regarding the identified conflict and/or its corresponding transactions. If the board or committee has reasonable cause to believe that an interested person has failed to disclose actual or possible conflicts of interest, it shall inform such person on the basis for such belief and afford him/her an opportunity to explain the alleged failure to disclose. If, after hearing the response of the interested person and making such further investigation as may be warranted in the circumstances, the board or committee determines that such person has in fact failed to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. |
| Form 990, Part VI, Section B, line 15 | The compensation for the President/CEO is determined by a related Organization (Mary Hitchcock Memorial Hospital) through an evaluation by an independent third party firm for reasonableness and national data benchmarking. The talent development and compensation committee, along with independent trustees, approve the final compensation in consideration with the independent third party firm's recommendations and suggestions. This process was contemporaneously documented and last undertaken in 2020. |
| Form 990, Part VI, Section C, line 19 | By request. |
| Form 990, Part IX, line 11g | Temporary Staffing: Program service expenses 2,177,604. Management and general expenses 330,975. Fundraising expenses 0. Total expenses 2,508,579. Purchased Services: Program service expenses 1,497,811. Management and general expenses 227,653. Fundraising expenses 0. Total expenses 1,725,464. Other Contract Services: Program service expenses 14,021. Management and general expenses 2,132. Fundraising expenses 0. Total expenses 16,153. |
| Form 990, Part X, Line 10: Land, Buildings, and Equipment | Section 1.263(a)-3(n) Election: Visiting Nurse Associatoin and Hospice of Vermont and New Hampshire, Inc. 88 Prospect Street White River Junction, VT 05001 EIN 03-6006494 Visiting Nurse Association and Hospice of Vermont and New Hampshire, Inc. is electing to capitalize repair and maintenance costs under Regulation Section1.263(a)-3(n). |
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