CARERESOURCE HAWAII: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CARERESOURCE HAWAII (EIN 99-0250062)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-09
IRS object ID
201321299349302887
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-09T20:34:08-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14370 LA JOLLA VILLAGE DRIVE STE 500AddressLine1
CitySAN DIEGOCity
StateCAState
ZIP Code92122ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN990250062EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CARERESOURCE HAWAIIBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% Thad WakasugiInCareOfName
Name ControlCARENameControl
Phone8085994999Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1680 IWILEI ROADAddressLine1
CityHONOLULUCity
StateHIState
ZIP Code968175392ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTHAD K WAKASUGIName
TitleCONTROLLERTitle
Date Signed2013-05-08DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8585357200Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCONSTANCE BLACKNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1680 IWILEI ROAD SUITE 600AddressLine1
CityHONOLULUCity
StateHIState
ZIP Code968175392ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13320698GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CARERESOURCEHAWAII.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1996YearFormation
State Legal DomicileHIStateLegalDomicile
Activity Or Mission DescriptionPROVIDE AND MAINTAIN A NONPROFIT HOME HEALTH CARE SERVICE TO PROVIDE MEDICAL SERVICES FOR MEMBERS OF THE PUBLIC IN THEIR HOMES AND THEREBY PROMOTE THE HEALTH OF THE COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees435TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year10000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13193976ProgramServiceRevenuePriorYear
Program Service Revenue CY13310698ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year13193976TotalRevenuePriorYear
Total Revenue Current Year13320698TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11520654SalariesEtcPriorYear
Salaries Etc Current Year11389725SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1683781OtherExpensePriorYear
Other Expenses Current Year1766136OtherExpensesCurrentYear
Total Expenses Prior Year13204435TotalExpensesPriorYear
Total Expenses Current Year13155861TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-10459RevenuesLessExpensesPriorYear
Revenues Less Expenses CY164837RevenuesLessExpensesCY
Total Assets BOY4046312TotalAssetsBOY
Total Assets EOY3843974TotalAssetsEOY
Total Liabilities BOY1457777TotalLiabilitiesBOY
Total Liabilities EOY1274414TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2588535NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2569560NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSEE SCHEDULE OMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense11290421Expense
Grants0Grants
Revenue13310698Revenue
DescriptionCARERESOURCE HAWAII PROVIDED 285,274 HOURS OF NURSING, HOME HEALTH AIDE, AND HOME COMPANION SERVICE AND PROVIDED 20,673 VISITS BY REGISTERED NURSES, LICENSED THERAPISTS, HOME HEALTH AIDES, AND OTHER HEALTH PROFESSIONALS IN PATIENTS' HOMES DURING THIS REPORTING PERIOD.Description
Total Program Service Expense11290421TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees435NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonThad WakasugiNamePerson
Telephone Number8085994999TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1680 Iwilei Road Suite 660AddressLine1
CityHonoluluCity
StateHIState
ZIP Code96817ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
CONSTANCE BLACK
CHAIRPERSON2.0XX000
MARK YAMAKAWA
PRESIDENT1.0XX000
GREGG OISHI
SECRETARY / TREASURER1.0XX000
GARY KAJIWARA
DIRECTOR1.0X000
CYNTHIA KAMIKAWA
DIRECTOR1.0X000
QUIN OGAWA
DIRECTOR1.0X000
JANICE LUKE LOO
DIRECTOR1.0X000
EMILIE SMITH
ADMINISTRATOR40.0X12094209773
THAD WAKASUGI
CONTROLLER40.0X9760304875
CYNTHIA IWATA
MEDICARE SERVICES MANAGER40.010550709930X
JOAN LIU
BRANCH MANAGER40.010226804017X
VIVIAN PILBROW
MED CERT RN40.0101642018544X
SHAWN MEDEIROS
BRANCH MANAGER40.010118503033X
FieldValueIRS element (for citing)
Total Reportable Comp From Org629147TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation50172TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions10000AllOtherContributions
Total Contributions10000TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPatient servicesDescription
Business Code621610BusinessCode
Total Revenue Column13310698TotalRevenueColumn
Related Or Exempt Function Income13310698RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue13310698TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column13320698TotalRevenueColumn
Related Or Exempt Function Income13310698RelatedOrExemptFunctionIncome

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total231597Total
Management And General231597ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9182972Total
Program Services8578938ProgramServices
Management And General604034ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1264586Total
Program Services1166152ProgramServices
Management And General98434ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total710570Total
Program Services649989ProgramServices
Management And General60581ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total20270Total
Program Services19802ProgramServices
Management And General468ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total13445Total
Management And General13445ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total118002Total
Program Services109380ProgramServices
Management And General8622ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3775Total
Program Services577ProgramServices
Management And General3198ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total122427Total
Program Services50561ProgramServices
Management And General71866ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total206093Total
Program Services90748ProgramServices
Management And General115345ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total345442Total
Program Services67420ProgramServices
Management And General278022ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total111960Total
Program Services111960ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total39727Total
Program Services24713ProgramServices
Management And General15014ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total178179Total
Program Services144678ProgramServices
Management And General33501ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total233623Total
Program Services43204ProgramServices
Management And General190419ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Communication1477786596281816
Bad debt expense7640076400
Medical supplies5018550185
All other expenses988303975259078

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13155861Total
Program Services11290421ProgramServices
Management And General1865440ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2081237BOY
EOY1730934EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1449892BOY
EOY1773807EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY68006BOY
EOY59043EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1747840LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1471427LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY443400BOY
EOY276413EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3777BOY
EOY3777EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4046312BOY
EOY3843974EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1207764BOY
EOY840589EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY250013BOY
EOY433825EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1457777BOY
EOY1274414EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2588535BOY
EOY2569560EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2588535BOY
EOY2569560EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4046312BOY
EOY3843974EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses164837ReconcilationRevenueExpenses
Reconcilation Other Changes-183812ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedfalseFSAudited
Audit CommitteefalseAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years820CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years45CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year10000CurrentTaxYear
Total10865Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13034716CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13961877CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13778602CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13193976CurrentTaxYearMinus1Year
Current Tax Year13310698CurrentTaxYear
Total67279869Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13034716CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13962697CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13778647CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13193976CurrentTaxYearMinus1Year
Current Tax Year13320698CurrentTaxYear
Total67290734Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years192115CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years138285CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years68914CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year82901CurrentTaxYearMinus1Year
Current Tax Year84690CurrentTaxYear
Total566905Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years192115CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years138285CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years68914CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year82901CurrentTaxYearMinus1Year
Current Tax Year84690CurrentTaxYear
Total566905Total
FieldValueIRS element (for citing)
Public Support Total50966723829PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years49928CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10088CurrentTaxYearMinus3Years
Total60016Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years49928CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10088CurrentTaxYearMinus3Years
Total60016Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years13084644CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13972785CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13778647CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13193976CurrentTaxYearMinus1Year
Current Tax Year13320698CurrentTaxYear
Total67350750Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99069PublicSupportPercentage509
Prior Year Support Percentage0.98970PriorYearSupportPercentage
Investment Income Percentage0.00089InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00200PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
LandLand
BuildingsBuildings

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis138051OtherCostOrOtherBasis
Depreciation122051Depreciation
Book Value16000BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1609789OtherCostOrOtherBasis
Depreciation1349376Depreciation
Book Value260413BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings276413TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPension liabilityDescription
Amount$433,825Amount
FieldValueIRS element (for citing)
Total Of Amounts433825TotalOfAmounts

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONPART III, LINE 1TO OPERATE AND MAINTAIN A NONPROFIT HOME HEALTH CARE SERVICE TO PROVIDE SKILLED NURSING SERVICES AND OTHER DIAGNOSTIC, THERAPEUTIC AND SUPPORTIVE MEDICAL SERVICES FOR MEMBERS OF THE PUBLIC IN THEIR HOMES AND THEREBY TO PROMOTE THE HEALTH OF THE COMMUNITY AND COST EFFECTIVE AND EFFICIENT HEALTH CARE.
DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990FORM 990 PART VI, LINE 11BTHE FORM 990 WILL BE REVIEWED WITH THE SECRETARY / TREASURER OF THE BOARD BY THE CONTROLLER AND THE CONTROLLER WILL DISCUSS THE FORM IN SUMMARY WITH THE WHOLE BOARD AT THE NEXT SCHEDULED QUARTERLY BOARD MEETING. THE COMPLETED COPY WILL BE PRESENTED TO THE BOARD AFTER THE FILING DEADLINE.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTERESTFORM 990, PART VI, LINE 12CA CONFLICT OF INTEREST DISCLOSURE FORM IS MAILED TO ALL BOARD MEMBERS AND MANAGERS OF THE COMPANY ANNUALLY FOR COMPLETION. FORMS ARE REVIEWED BY CORPORATE COMPLIANCE OFFICER AND QUEEN'S LEGAL DEPARTMENT. ANY POTENTIAL CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE ADMINISTRATOR AND BOARD, IF NECESSARY, FOR FOLLOW-UP ACTION WITH INDIVIDUALS, RESULTING IN EITHER RELINQUISHING OF CONFLICTED ACTIVITIES OR RESIGNATION OF POSITION.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLICFORM 990, PART VI, QUESTION 19THESE DOCUMENTS ARE AVAILABLE AT OUR HOME OFFICE, UPON REQUEST.
OVERSIGHT OR SELECTION PROCESSFORM 990, PART XI, QUESTION 2CTHE COMPANY IS NOT REQUIRED TO HAVE AN AUDITED FINANCIAL STATEMENT AT THIS TIME. AN INDEPENDENT FINANCIAL REVIEW WAS COMPLETED FOR FISCAL YEAR ENDED JUNE 30, 2012.
OTHER CHANGES IN NET ASSETS OR FUND BALANCESFORM 990, PART XI, LINE 5PENSION ADJUSTMENT - $(183,812)

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