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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 169,139 | 47,000 | 773,046 | 47,735 | 329,040 | 1,365,960 |
| 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 | 15,588,449 | 16,751,695 | 15,507,943 | 16,004,914 | 15,625,938 | 79,478,939 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 15,757,588 | 16,798,695 | 16,280,989 | 16,052,649 | 15,954,978 | 80,844,899 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | 0 | 0 | 0 | 0 | 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 | 0 | 0 | 0 | 126,635 | 126,635 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 126,635 | 126,635 |
| 8 | Public support. (Subtract line 7c from line 6.) | 80,718,264 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 15,757,588 | 16,798,695 | 16,280,989 | 16,052,649 | 15,954,978 | 80,844,899 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 30,826 | 34,218 | 78,560 | 21,933 | 35,246 | 200,783 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 30,826 | 34,218 | 78,560 | 21,933 | 35,246 | 200,783 |
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 14,663 | 2,861 | 3,492 | 1,569 | 309 | 22,894 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 15,803,077 | 16,835,774 | 16,363,041 | 16,076,151 | 15,990,533 | 81,068,576 |
| 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12 Other Income | DESCRIPTION - MISCELLANEOUS INCOME, COLUMN A - 14663.0, COLUMN B - 2861.0, COLUMN C - 3492.0, COLUMN D - 1569.0, COLUMN E - 309.0, COLUMN F - 22894.0; |
| Software ID: | 21014044 |
| Software Version: | 2021v4.2 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 14 DOCUMENT RETENTION | The organization's parent, Western Connecticut Health Network (WCHN) has a written document retention and destruction policy, which is followed by the organization. The policy was approved by the audit committee of the parent organization. |
| Form 990, Part VI, Line 12a Conflict of Interest Policy | The organization's parent, Western Connecticut Health Network (WCHN) has a written conflict of interest policy, which is followed by the organization. The policy was approved by the board of the parent organization. |
| Form 990, Part VI, Line 13 Whistleblower Policy | The organization's parent, Western Connecticut Health Network (WCHN) has a written whistleblower policy, which is followed by the organization. The policy was approved by the board of the parent organization. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | The organization's sole member is Western Connecticut Health Network |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Western Connecticut Health Network must approve the election of the directors of the organization, as well as the removal of a director. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | CERTAIN DECISIONS OF THE BOARD OF DIRECTORS ARE SUBJECT TO APPROVAL BY WESTERN CONNECTICUT HEALTH NETWORK, THE SOLE MEMBER OF WESTERN CONNECTICUT HOME CARE, INC. THESE DECISIONS INCLUDE: (1) WESTERN CONNECTICUT HOME CARE'S ANNUAL OPERATING AND CAPITAL BUDGET, (2) PROPOSED ANNUAL FUNDRAISING PROGRAMS, (3) PROPOSED SIGNIFICANT PROGRAMS AND EXPENDITURES, (4) PURCHASE OR SALE OF SIGNIFICANT CAPITAL OR OPERATING ASSETS, (5) ACQUISITION OF INDEBTEDNESS FOR BORROWED MONEY, (6) ELECTION OR REMOVAL OF A MEMBER OF THE BOARD OF DIRECTORS, Officers and Managers, (7) DEVELOPMENT, IMPLEMENTATION, REVIEW, AND MONITORING OF INVESTMENT POLICY, (8) SETTING THE MAXIMUM AND MINIMUM NUMBER OF THE BOARD OF DIRECTORS, (9) AMENDMENT OF ORGANIZATIONAL DOCUMENTS, (10) ADOPTION OF OR AMENDMENT TO QUALIFIED AND NON-QUALIFIED BENEFIT PLANS, (11) APPROVAL OF ALL AUDITED FINANCIAL STATEMENTS, (12) REPLACEMENT OF A DIRECTOR DUE TO DEATH, RESIGNATION, OR OTHERWISE, AND (13) ANY OTHER MATTERS ON WHICH MEMBERS ARE ENTITLED TO VOTE UNDER THE NONSTOCK CORPORATION ACT OF THE STATE OF CONNECTICUT. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The Form 990 is prepared by Western Connecticut Home Care, Inc.'s management, reviewed by the Accounting Firm engaged for the tax return filing and then a draft Form 990 is reviewed by the Western Connecticut Home Care, Inc.'s Board of Directors and internal management. A complete draft is then posted to an internet site for Nuvance board members, the ultimate parent of the organization, to review prior to filing. The Form 990 is then signed and filed with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The Organization's Process for Monitoring and Enforcing Conflicts of Interest: Nuvance Health & Western Connecticut Health Network and its affiliates' (The Network) Conflict of Interest Policy provides that annually, its Representatives shall sign a statement affirming that they disclosed all potential conflicts, as documented in the Conflict of Interest Policy. In addition, General Counsel is part of the routine contracts review process and watches for potential conflicts with any of The Network's Representatives. Who Is Covered By the Policy: The Network's Conflict of Interest Policy covers each director, officer and manager of The Network, also referred to as "Representatives". Level At Which Determinations of Whether There Is a Conflict: In connection with any actual or possible conflict of interest, an interested person must disclose the facts of the conflict. The Compliance Officer and the Audit Committee review and evaluate each disclosure to determine if there is a conflict of interest. After presentation of a potential transaction or arrangement is made by an interested person, the remaining disinterested Board or Committee members shall decide if a conflict of interest exist. Level That Reviews and Determines What To Do If There Is a Conflict: After exercising due diligence the full Board would determine what actions should be taken for all conflicts by Officers and Directors. Any conflicts occurring by a manager are reviewed by the Compliance Committee to determine what further action should be taken. Restrictions on the Conflicted Person: No director having a conflict of interest on any matter shall vote on that matter or be counted in determining the quorum for the meeting at which the vote is taken, even when permitted by law. No Representative having a conflict of interest on any matter shall use his or her personal influence on the matter. If the Board of Directors, in its sole discretion, determines that any Representative has conflicts of interest sufficient in number and/or importance that the effectiveness of such individual on behalf of The Network may be significantly impaired, the Board may ask the individual to resign |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | IN ORDER TO ACHIEVE ITS MISSION AND ITS OVERALL PERFORMANCE OBJECTIVES, NUVANCE HEALTH EMPLOYS A PERFORMANCE-BASED TOTAL COMPENSATION PROGRAM THAT IS MARKET COMPETITIVE, COMPLIANT WITH REGULATORY GUIDELINES, AND REPRESENTATIVE OF BEST PRACTICES. TO MEET NUVANCE HEALTH'S TOTAL COMPENSATION OBJECTIVES: - BLEND OF NATIONAL CONFIDENTIAL SOURCE, INTEGRATED HEALTH STRATEGIES (IHS), MERCER, SULLIVAN COTTER, TITLE MATCH DATA CUTS SELECTED BASED ON REVENUE SIZE. NUVANCE HEALTH WILL UTILIZE A WEIGHTED BLEND OF BOTH NATIONAL COMPARABLY-SIZED HEALTH CARE PROVIDER MARKET DATA WITH A +25% GEOGRAPHIC DIFFERENTIAL APPLIED (DIFFERENTIAL TO BE VALIDATED ON A PERIODIC BASIS) AT TWO-THIRDS WEIGHT, AND NATIONAL COMPARABLY-SIZED GENERAL INDUSTRY DATA, FOR IDENTIFIED ROLES WHERE SKILL SETS OVERLAP AT ONE-THIRD WEIGHT. - NUVANCE HEALTH TARGETS CASH COMPENSATION AT MARKET COMPETITIVE LEVELS. BASE SALARY PLUS SHORT-TERM (ANNUAL) INCENTIVE AWARDS (TOTAL CASH) AT 62.5 PERCENTILE FOR TOTAL CASH COMPENSATION. PERFORMANCE IS EXPECTED TO MEET OR EXCEED PREDETERMINED OPERATIONAL AND FINANCIAL METRICS. - OTHER FACTORS, SUCH AS COMPETITIVE MARKET FORCES, JOB PERFORMANCE, UNIQUE QUALIFICATIONS, AND/OR INDIVIDUAL JOB RESPONSIBILITIES ARE ALSO CONSIDERED IN NUVANCE HEALTH'S COMPENSATION DECISIONS. ROLE OF THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF NUVANCE HEALTH: - THE EXECUTIVE COMPENSATION COMMITTEE WITH THE NUVANCE HEALTH PRESIDENT & CEO AND THE CHIEF OF HUMAN RESOURCES SELECTS THE OUTSIDE COMPENSATION CONSULTANTS. THE CURRENT CONSULTANT IS WILLIS TOWERS WATSON, WHOSE PURPOSE IS TO PROVIDE A VALID INDEPENDENT ASSESSMENT OF THE RELEVANT MARKET RATES AND PAY PRACTICES. - THE EXECUTIVE COMPENSATION COMMITTEE DETERMINES THE EXECUTIVES' SALARY BASED ON OVERALL PERFORMANCE AND MARKET DATA SUPPLIED BY THE OUTSIDE MARKET CONSULTANT. LAST ASSESSMENT WAS DONE IN THE FALL 2021. |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. INFORMATION IS MAINTAINED BY THE AGENCY'S MANAGEMENT. |
| Form 990, Part XII, Line 2c Change of oversight process or selection process | PRIOR TO FY2022, THE ORGANIZATION'S FINANCIAL STATEMENTS WERE AUDITED SEPARATELY AND ON A CONSOLIDATED BASIS. STARTING IN FY2022, SINCE THE CONSOLIDATED AUDIT INCLUDES THE ORGANIZATION, THE ORGANIZATION NO LONGER ENGAGES FOR A SEPARATE AUDIT. THE CONSOLIDATED AUDIT IS ATTACHED TO THE RETURN. |
| FORM 990, PART VI, LINE 15b COMPENSATION REVIEW AND APPROVAL PROCESS | COMPENSATION REVIEW AND APPROVAL PROCESS IS IDENTICAL TO THE PROCESS FOR THE EXECUTIVE DIRECTOR NOTED IN 15A ABOVE. |
| Software ID: | 21014044 |
| Software Version: | 2021v4.2 |