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)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 892,001 | 1,013,613 | 1,205,105 | 3,531,915 | 827,872 | 7,470,506 |
| 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 | 20,488,339 | 17,772,061 | 18,179,371 | 15,736,726 | 12,249,168 | 84,425,665 |
| 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 | 21,380,340 | 18,785,674 | 19,384,476 | 19,268,641 | 13,077,040 | 91,896,171 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 1,000 | 1,000 | ||||
| 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.. | 1,000 | 1,000 | ||||
| 8 | Public support. (Subtract line 7c from line 6.) | 91,895,171 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 21,380,340 | 18,785,674 | 19,384,476 | 19,268,641 | 13,077,040 | 91,896,171 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 38,037 | 26,621 | 555 | 140 | 5,564 | 70,917 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 38,037 | 26,621 | 555 | 140 | 5,564 | 70,917 |
| 11 | Net income from unrelated business activities not included on 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.).. | 21,418,377 | 18,812,295 | 19,385,031 | 19,268,781 | 13,082,604 | 91,967,088 |
| 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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| 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 VI, SECTION A, LINE 2 | THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER ARE OFFICERS OF AND EMPLOYED BY CARE SYNERGY, A RELATED EXEMPT ORGANIZATION. THESE INDIVIDUALS ARE ALSO OFFICERS OF THE HOSPICE OF METRO DENVER, PIKES PEAK HOSPICE AND PALLIATIVE CARE, AND PATHWAYS HOSPICE. THEREFORE, BUSINESS RELATIONSHIPS EXIST BETWEEN THESE INDIVIDUALS. |
| FORM 990, PART VI, SECTION A, LINE 3 | CARE SYNERGY, A RELATED EXEMPT ORGANIZATION, PERFORMED EXECUTIVE MANAGEMENT SERVICES INCLUDING FINANCE AND ACCOUNTING, PAYROLL, INFORMATION TECHNOLOGY, HUMAN RESOURCES, QUALITY MANAGEMENT, COMPLIANCE, HIGH LEVEL RISK MANAGEMENT, AND GROUP CONTRACTING SERVICES. SEE FORM 990, PART VII FOR COMPENSATION PAID BY THE RELATED MANAGEMENT COMPANY. |
| FORM 990, PART VI, SECTION A, LINE 6 | COLORADO VISITING NURSE ASSOCIATION'S SOLE MEMBER IS CARE SYNERGY, A COLORADO NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER, CARE SYNERGY, HAS THE POWER TO ELECT AND REMOVE DIRECTORS OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS INITIALLY REVIEWED BY THE CONTROLLER AND THE CHIEF FINANCIAL OFFICER. AFTER THE INITIAL REVIEW HAS BEEN COMPLETED, A FINAL COPY IS GIVEN TO THE FULL BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL BOARD MEMBERS AFFIRM THEY ARE COMPLIANT WITH THE CONFLICT OF INTEREST POLICY BY COMPLETING AN INDEPENDENCE QUESTIONNAIRE CERTIFICATION ON AN ANNUAL BASIS. IF ANY CONFLICTS ARISE DURING THE YEAR, THE BOARD MEMBERS RECUSE THEMSELVES ON VOTING ON ANY ACTIONS PERTAINING TO THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PRESIDENT'S COMPENSATION IS SET BY THE BOARD OF DIRECTORS. THE BOARD USED SURVEY DATA FROM OTHER HOMECARE AND HOSPICE ORGANIZATIONS TO DETERMINE THE APPROPRIATE COMPENSATION LEVEL. THE PROCEDURE BY WHICH THE PRESIDENT'S COMPENSATION IS SET IS DOCUMENTED IN AN INTERNAL COMPENSATION POLICY AND ANY FUTURE ADJUSTMENTS TO THE PRESIDENT'S COMPENSATION WILL BE IN ACCORDANCE WITH THE POLICY. THE ORGANIZATION HAS MAINTAINED THE APPROPRIATE DOCUMENTATION WITH RESPECT TO THE COMPENSATION ARRANGEMENT. THE COMPENSATION LEVELS FOR OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE ALSO SET IN ACCORDANCE WITH THIS POLICY. SALARY RANGES ARE ESTABLISHED BY A COMPENSATION COMMITTEE, WHICH INCLUDES APPROVAL BY THE PRESIDENT. THE SALARY RANGES ARE BASED ON SURVEY DATA FROM SIMILARLY SITUATED ORGANIZATIONS. THE ORGANIZATION HAS MAINTAINED THE APPROPRIATE DOCUMENTATION WITH RESPECT TO THE COMPENSATION ARRANGEMENTS FOR ITS OTHER EMPLOYEES. COMPENSATION LEVELS OF OFFICERS WHO ARE PAID BY A RELATED TAX-EXEMPT ORGANIZATION, IS DETERMINED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS FOR CARE SYNERGY, THE RELATED TAX-EXEMPT ORGANIZATION, WHO FUNCTIONS AS THE COMPENSATION COMMITTEE TO DETERMINE COMPENSATION LEVELS OF THOSE OFFICERS AND KEY EMPLOYEES. THEY ENGAGE AN INDEPENDENT THIRD-PARTY COMPENSATION AND BENEFITS CONSULTANT TO CONDUCT A MARKET ANALYSIS OF COMPENSATION AND BENEFITS FOR ALL TOP MANAGEMENT AND TOP FINANCIAL OFFICIALS OF THE ORGANIZATION. THE ANALYSIS INCLUDES COMPARISONS OF SIMILARLY SIZED HOSPICE AND OTHER HEALTHCARE ORGANIZATIONS. THE CONSULTING FIRM ALSO EVALUATES THE REASONABLENESS OF EXECUTIVE COMPENSATION FROM AN INTERMEDIATE SANCTIONS PERSPECTIVE. ANY COMPENSATION OR BENEFIT CHANGES FOR TOP MANAGEMENT AND FINANCIAL OFFICIALS ARE APPROVED BY THE EXECUTIVE COMMITTEE OF THE CARE SYNERGY BOARD OF DIRECTORS AND DOCUMENTED IN THE COMMITTEE MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, SECTION A: | THE COMPENSATION PAID TO THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCIAL OFFICER IS PAID FOR BY CARE SYNERGY, A RELATED TAX-EXEMPT ORGANIZATION. IN ADDITION TO PROVIDING SERVICES TO COLORADO VISITING NURSE ASSOCIATION, TOP MANAGEMENT OFFICIALS LISTED ABOVE ALSO PROVIDE SERVICES IN THEIR RESPECTIVE POSITIONS TO OTHER RELATED TAX-EXEMPT ORGANIZATIONS. THE AMOUNTS REPORTED ON FORM 990, PART VII, SECTION A REPRESENT COMPENSATION AND BENEFITS PAID TO THESE INDIVIDUALS FOR THEIR SERVICES TO THE FILING ORGANIZATION AS WELL AS OTHER TAX-EXEMPT ORGANIZATIONS. |
| FORM 990, PART IX, LINE 24B: | CARE SYNERGY MAINTAINS AN OPERATING RESERVE (THE RESERVE) TO SUPPORT THE STRATEGIC GOALS AND OPERATIONAL PLANS OF CARE SYNERGY AND ITS AFFILIATES. THE RESERVE WAS FUNDED BY AFFILIATES WITH AVAILABLE CASH FLOW BASED ON THEIR PROPORTIONATE SHARE OF PATIENT SERVICE REVENUE. FUNDING REQUIREMENTS OF THE RESERVE ARE DETERMINED ON AN ANNUAL BASIS. THE USE OF THE RESERVE IS TO SUPPORT UNFORESEEN FINANCIAL NEEDS OR CERTAIN STRATEGIC INITIATIVES OF CARE SYNERGY AND ITS AFFILIATES. THE RESERVE IS NOT INTENDED FOR CAPITAL PROJECTS, TO REPLACE A PERMANENT LOSS OF FUNDS OR ELIMINATE AN ONGOING BUDGET GAP OR SHORTFALL. UTILIZATION OF THE RESERVE REQUIRES THE EXPRESS APPROVAL OF THE CARE SYNERGY BOARD OF DIRECTORS. DURING THE YEAR ENDED DECEMBER 31, 2022, THE ASSOCIATION CONTRIBUTED $622,000 TO THE RESERVE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION -16,000. |
| Software ID: | |
| Software Version: |