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)
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(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.") . | 13,569 | 316,847 | 21,297 | 22,120 | 10,776 | 384,609 |
| 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 | 6,578,990 | 6,280,246 | 6,590,743 | 4,412,818 | 5,516,381 | 29,379,178 |
| 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 | 6,592,559 | 6,597,093 | 6,612,040 | 4,434,938 | 5,527,157 | 29,763,787 |
| 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.) | 29,763,787 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 6,592,559 | 6,597,093 | 6,612,040 | 4,434,938 | 5,527,157 | 29,763,787 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 63,897 | 39,756 | 47,677 | 81,515 | 74,244 | 307,089 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 63,897 | 39,756 | 47,677 | 81,515 | 74,244 | 307,089 |
| 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.).. | 6,656,456 | 6,636,849 | 6,659,717 | 4,516,453 | 5,601,401 | 30,070,876 |
| 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 3 | Starting in May of 2021, the roles and control of the Holyoke Visiting Nurse Association's (the "VNA") and the Community Health Foundation of Western Massachusetts' (the "Foundation") Executive Director and the Finance Director positions were outsourced and delegated to the public accounting and financial services firm BerryDunn; Brad Borbidge, CPA, is the Principal with BerryDunn who was assigned to supervise and overview these managerial responsibilities once they were delegated to BerryDunn. During the period covered by this Form 990, Brad Borbidge retired from BerryDunn but continued to perform his role as an outsourced Finance Director for the VNA as an independent consultant. While Brad Borbidge occupied these outsourced roles on behalf of both the Foundation and VNA, any compensation paid and transactions agreed to pursuant to this engagements were effectuated by the VNA. As per this arrangement, Brad Borbidge maintained control and responsibilities over duties customarily performed by officers or key management personnel. Therefore, in accordance with IRS Instructions, Brad Borbidge has been named as an Officer on this Form 990, Part VII, Section A. While Brad Borbidge likely received compensation from BerryDunn during this Form 990 reporting period, neither the VNA nor the Foundation is able to verify the amount of reportable or other compensation he received from BerryDunn, if any, paid specifically in return for providing services to the VNA or the Foundation. Accordingly, the only amount of compensation reported to Brad Borbidge on this Form 990, Part VII, Section A is $24,788, which represents the fees paid directly to Brad Borbidge after his retirement from BerryDunn and subsequent to the VNA's and Foundation's engagement with him as an independent consultant. Such amounts were paid either directly to Brad Borbidge as an individual ($7,500) or to his Borbidge Consulting practice ($17,288) by the VNA. While the VNA cannot determine the amount of compensation Brad Borbidge personally received from BerryDunn for services rendered on behalf of the VNA, BerryDunn as an entity is one of the VNA's top-five highest paid independent contractors for this tax period. $322,483, the total amount of compensation paid to BerryDunn during this reporting period, has therefore been reported on the VNA's Form 990, Part VII, Section B, as well as on the VNA's Schedule L. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Corporation shall be Valley Health Systems, Inc. acting through its Board of Directors. Any membership action or vote required or permitted by law shall be taken by the Board of Directors of the Member. |
| Form 990, Part VI, Section A, line 7a | The Member shall be required to approve the appointment of the Executive Director; The Executive Director is subject to the discretionary appointment and removal by the President of the Member. The Executive Director is selected, appointed and subject to removal solely by the President of the Member. In addition, the President of the Member, or his designee, shall be an ex-officio member of the Board of Directors. The Board of Directors of the Member may fill vacancies in the Corporation's Board of Directors. Any office (other than the Executive Director) that becomes vacant may be filled by the Board of Directors of the Member and each such successor shall hold office for the unexpired term or until he or she sooner dies, resigns, is removed or becomes disqualified. Any vacancy in the office of the Executive Director shall be appointed by the President of the Member. A Director may be removed with or without cause by vote of at least two-thirds (2/3) of the Board of Directors of the Member at any regular meeting or at any special meeting called for such purpose. The officers of the Corporation, chosen from among the members of its Board of Directors, shall be a Chair, a Vice Chair, a Treasurer, a Clerk, and such other officers as the Board of Directors of the Member may authorize. The officers shall be elected by the Board of Directors of the Member at the Annual Meeting of the Member. The Nominating Committee shall consist of such Directors as the Chair may designate. The Committee shall make nominations and submit them to the President of the Member for consideration and approval. |
| Form 990, Part VI, Section A, line 7b | The Member shall be required to approve the following decisions or actions of the Corporation: (a) Approval of the annual operating and capital budget for the next fiscal year; (b) Selection of the independent public accounting firm engaged to conduct and report upon the annual audit of the Corporation's books of account; (c) Sale, assignment, transfer or exchange of any property, assets and real property, of the Corporation in excess of $10,000; (d) Merger or consolidation with or acquisition of another corporation, organization, or other similar entity; (e) Borrowings or financings in excess of $50,000; (f) Changes in the strategic focus or purpose of the Corporation; (g) Changes in the Articles of Organization or the Bylaws of the Corporation; (h) All other decisions or actions of the Board that the Member determines in its reasonable discretion affect the overall efficiency and effectiveness of the integrated health care delivery system of which the Corporation is a part. In no event shall the Board of Directors take any action that restricts, reduces or eliminates the authority of the Member or the President and CEO of the Member. In all cases of disputed authority or uncertainty as to the meaning of the Bylaws of the Corporation the Board of Directors of the Member shall rule and such ruling shall be sought at the next meeting of the Board. The Finance and Investment Committee shall meet annually with representatives of the Member-approved independent certified public accounting firm to review such firm's audit and recommendations as necessary. The Corporation's bylaws may be altered, amended or repealed in whole or in part only by action of the Member. |
| Form 990, Part VI, Section B, line 11b | A copy of the VNA's Form 990 was provided to each voting member of the governing body prior to its filing with the Internal Revenue Service. The Form 990 was prepared with the assistance of an independent public accounting firm and thoroughly reviewed by the Senior Vice President of Finance and CFO and key financial staff of the Hospital prior to distibuting it to the governing body for review. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy of the Holyoke Visiting Nurse Association (VNA) is monitored and enforced as part of the Valley Health Systems, Inc. System and is reviewed annually by the System's conflict of interest committee. VNA board members and officers complete and sign a conflict of interest questionnaire annually. All signed questionnaires are then submitted to VNA and to Valley Health Systems, Inc. (parent) for review and monitoring. |
| Form 990, Part VI, Section B, line 15 | The compensation committee of the Valley Health System, Inc. utilizes a market compensation survey to recommend to the Board the approval of its determination of the appropriate compensation of the Chief Executive Officer. During that process, the Committee also reviews the compensation levels of other senior management and key employees of the System. These individuals are not members of the compensation committee and do not participate in this process. The CEO, as a member of the Board of VHS, does not participate in the approval process of that officer's compensation. |
| Form 990, Part VI, Section C, line 19 | Available upon written request. |
| Form 990, Part XI, line 9: | Change in Market Value of Beneficial Interest in Perpetual Trust 12,289. |
| Form 990, Part XII, Line 2c: | The audit process has not changed from the prior year. |
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