2013-11-13T12:01:52-06:00 2012-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2012-01-01 470690286 VISITING NURSE HEALTH SERVICES VISI 4023425566 12565 WEST CENTER ROAD NO 100 OMAHA NE 68144 DAVID VANLANDINGHAM 4029304064 2013-11-12 1 BARBARA J FAJEN P00400874 4023302660 2012 2016-02-24 21:20:13Z DAVID VANLANDINGHAM 12565 WEST CENTER ROAD NO 100 OMAHA NE 68144 5442528 0 X WWW.THEVNACARES.ORG X 1986 NE TO PROVIDE HEALTH SERVICES TO VULNERABLE, LOW INCOME INDIVIDUALS AND FAMILIES IN THE COMMUNITY, WHEREVER THEY CALL HOME. 26 25 179 100 0 0 2444690 2716709 2900950 2725819 0 0 0 0 5345640 5442528 65995 126888 0 0 3388417 3611516 0 0 71720 1657033 1501572 5111445 5239976 234195 202552 1208557 1385693 176392 150976 1032165 1234717 X THE MISSION OF THE VISITING NURSE HEALTH SERVICES IS TO FOSTER THE DIGNITY AND WELL-BEING OF THE RESIDENTS OF OUR COMMUNITIES BY DELIVERING THE HIGHEST QUALITY HOME AND COMMUNITY-BASED HEALTH CARE SERVICES THAT PROVIDE PEACE OF MIND, QUALITY OF LIFE, AND INDEPENDENCE. 0 0 2674662 1403900 FAMILY SUPPORT WHICH INCLUDES MULTIDISCIPLINARY (PUBLIC HEALTH NURSING, SOCIAL WORK, FAMILY SUPPORT) HOME VISITATION SERVICES TO VULNERABLE AND AT-RISK FAMILIES (FOCUSED ON PREGNANT TEENS, WOMEN WITH INFANTS AND YOUNG CHILDREN). CARE MAY BE PROVIDED IN HOMES, HOMELESS SHELTERS, OR WHEREVER THE FAMILY RESIDES. 1744489 126888 1000726 CONTRACT/PRIVATE PAY WHICH INCLUDES COMMUNITY-BASED SERVICES THAT SERVE A SPECIFIC POPULATION WITH A FOCUS ON PREVENTIVE HEALTH ACTIVITIES. INCLUDES SCHOOL HEALTH, ANNUAL COMMUNITY FLU CAMPAIGN, HOMEMAKER AND HOMEMAKER AIDE SERVICES TO SENIORS AND LIFELINE AND MEDICATION ADMINISTRATION EQUIPMENT. 578753 321193 HOME CARE WHICH INCLUDES BOTH SKILLED SERVICES (NURSING, THERAPIES, SOCIAL WORK) AND NON-SKILLED (HOME HEALTH AIDE AND HOMEMAKER) PROVIDED TO THE POOR FRAIL ELDERLY AND DISABLED WHO ARE NOT ELIGIBLE FOR COVERED SERVICES (MEDICARE, ETC) BUT NEED ASSISTANCE WITH DAILY ACTIVITIES IN ORDER REGAIN HEALTH AND/OR STAY SAFE AND WELL IN THEIR HOMES. 4997904 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 13 0 1 179 1 0 0 0 0 0 0 0 0 0 0 X 26 25 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X DAVID E VANLANDINGHAM VP & CFO 4023425566 12565 WEST CENTER ROAD SUITE 100 OMAHA NE 68144 X MIKE WEINBERG 1.00 4.00 X X 0 0 0 NEIL FORTKAMP 1.00 0.00 X X 0 0 0 DANIEL PADILLA 1.00 4.00 X X 0 0 0 RAY STOUPA 1.00 4.00 X X 0 0 0 JAMES SUMMERFELT 5.00 50.00 X X 0 208188 23280 JOSIE ABBOUD 1.00 0.00 X 0 0 0 SCOTT BELT 1.00 0.00 X 0 0 0 JANIS M BERRY 1.00 0.00 X 0 0 0 DEANNA BOESE 1.00 0.00 X 0 0 0 MARY ANN BORGESON 1.00 0.00 X 0 0 0 JACKIE BORYCA 1.00 0.00 X 0 0 0 MARY M BROCKELSBY 1.00 0.00 X 0 0 0 TAINA BROOKS 1.00 0.00 X 0 0 0 MARCEL DEVETTEN MD 1.00 0.00 X 0 0 0 THERESA FRANCO 1.00 0.00 X 0 0 0 MARGARITE GOODENOW 1.00 0.00 X 0 0 0 MARGARET KAISER 1.00 0.00 X 0 0 0 MIKALA HOLTZ 1.00 0.00 X 0 0 0 GEORGE KLEINE 1.00 0.00 X 0 0 0 RANDY LENHOFF 1.00 0.00 X 0 0 0 SHAWN MOORE 1.00 0.00 X 0 0 0 WES NEUHAUS 1.00 0.00 X 0 0 0 PAM STENE HAGGE 1.00 0.00 X 0 0 0 EMMET TINLEY III 1.00 0.00 X 0 0 0 TERRI TIPTON 1.00 0.00 X 0 0 0 AURA WHITNEY-JACKSON 1.00 0.00 X 0 0 0 DAVID VANLANDINGHAM 5.00 45.00 X 0 105446 8354 BRIDGET YOUNG 40.00 0.00 X 0 115505 9318 JOANIE KUSH 40.00 0.00 X 0 0 0 BRIDGET CANIGLIA 40.00 0.00 X 0 0 0 MICHAEL ALSTON 40.00 0.00 X 0 0 0 ELIZABETH CERNECH 20.00 20.00 X 103302 0 3195 103302 429139 44147 1 0 1 0 0 677363 22034 498676 1518636 2716709 HOME HEALTH CARE SVCS 621610 1936177 1936177 MANAGEMENT SERVICES 561000 763689 763689 MEDICARE/MEDICAID PAYM 621610 25953 25953 2725819 5442528 2725819 0 0 126888 126888 106497 53249 53248 3014212 2950835 59377 4000 59137 58929 208 198942 169993 18631 10318 232728 220286 8288 4154 858604 858604 206072 188638 17434 103625 100751 2874 107 107 116399 114753 1646 3466 2941 525 20 20 MEDICAL SUPPLIES 194694 187358 7336 BAD DEBTS 15200 15200 MISCELLANEOUS 1409 760 649 PUBLIC RELATIONS 1306 1191 115 670 670 5239976 4997904 170352 71720 150 1400 203981 262946 514444 523984 174798 247580 23461 12136 12820 12820 20 0 291703 337647 1208557 1385693 176392 150976 176392 150976 X 255742 366634 776423 868083 1032165 1234717 1208557 1385693 202552 0 X X 0 1 X 1 1 1 X 3302640 2394386 2157430 2444690 2716709 13015855 3302640 2394386 2157430 2444690 2716709 13015855 1093536 11922319 809 200 1009 33081 39354 44387 52234 169056 13185920 12420692 0.90420 0.93580 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 578908 20300 16453 3847 578908 578908 8569 4737 3832 578908 578908 67258 63228 4030 578908 578908 138706 126740 11966 578908 578908 16038 15850 188 578908 0.00000 1.00000 0.00000 0 1 1 12820 12820 0 0 INTERCOMPANY RECEIVABLE 337647 337647 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT IS HELD BY VISITING NURSE FOUNDATION, AN AFFILIATE THAT WAS FORMED TO FURTHER THE MISSION OF VISITING NURSE HEALTH SERVICES AND VISITING NURSE ASSOCIATION OF THE MIDLANDS. THE ENDOWMENT IS MAINTAINED IN PERPETUITY TO GENERATE INCOME TO SUPPORT THE OPERATIONS OF VISITING NURSE HEALTH SERVICES AND VISITING NURSE ASSOCIATION OF THE MIDLANDS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ENTITIES OF THE ASSOCIATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE ALL OF THE AFFILIATED ENTITIES TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE ASSOCIATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ASSOCIATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2012 AND 2011, THE ASSOCIATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE ASSOCIATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY U.S. FEDERAL, STATE OR LOCAL AUTHORITIES FOR YEARS BEFORE 2009. 1 VISITING NURSE ASSOCIATION OF THE MIDLANDS 12565 WEST CENTER ROAD SUITE 200 OMAHA NE 68144 470690207 501(C)(3) 89537 TO AID IN THE PROGRAMS AND SERVICES INCLUDING HOME HEALTH CARE AND HOSPICE. VISITING NURSE FOUNDATION 12565 WEST CENTER ROAD SUITE 200 OMAHA NE 68144 470690846 501(C)(3) 36811 TO AID IN THE PROGRAMS AND SERVICES INCLUDING HOME HEALTH CARE AND HOSPICE. 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AS THE VISITING NURSE HEALTH SERVICES GAVE FUNDING TO A RELATED ORGANIZATION, VNHS IS ABLE TO MONITOR THE USE AND MAINTAIN RECORDS THAT SUBSTANTIATE THE ASSISTANCE. 0 1 0 0 0 0 0 0 0 JAMES SUMMERFELT 0 208188 0 0 0 0 0 6324 0 16956 0 231468 0 0 PART I, LINE 3 VISITING NURSE HEALTH SERVICES (VNHS) DOES NOT PAY COMPENSATION TO A CEO OR EXECUTIVE DIRECTOR. VISITING NURSE ASSOCIATION OF THE MIDLANDS PAYS THE COMPENSATION OF JAMES SUMMERFELT WHO SERVES AS THE TOP MANAGEMENT OFFICIAL OF THE VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, VISITING NURSE ASSOCIATION OF THE MIDLANDS, AND VISITING NURSE FOUNDATION. VNAM UTILIZED THE FOLLOWING FOR DETERMINING HIS COMPENSATION: FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY AND APPROVAL BY THE BOARD. PART I, LINE 4B VISITING NURSE ASSOCIATION OF THE MIDLANDS (VNAM), AN AFFILIATE, SPONSORS A 457(F) PLAN FOR CERTAIN EXECUTIVES OF THE ORGANIZATION. JAMES SUMMERFELT, BRIDGET YOUNG, JOANIE KUSH, AND BRIDGET CANIGLIA PARTICIPATED IN THE PLAN DURING 2012. VNAM DID NOT MAKE ANY CONTRIBUTIONS TO THE PLAN DURING 2012. FORM 990, PART VI, SECTION A, LINE 2 EMMETT TINLEY, III, DIRECTOR, AND SUSAN TINLEY, DIRECTOR, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 VNHS WILL SHARE THE FORM 990 WITH THE GOVERNING BODY PRIOR TO SUBMISSION. IF A REGULARLY SCHEDULED MEETING DOES NOT OCCUR BEFORE THE FORM 990 DEADLINE FOR SUBMISSION, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WILL MEET, REVIEW THE FORM 990, AND RELAY INFORMATION TO THE GOVERNING BODY AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. THE CFO PREPARES THE FORM 990 AND A FINAL COPY OF THE 2012 FORM 990 WILL BE PROVIDED TO ALL BOARD MEMBERS WHO REQUEST IT. THE PRESIDENT / CEO AND THE VICE PRESIDENT FINANCE / CFO WILL PROVIDE FORM 990 TO THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS, OFFICERS AND KEY EMPLOYEES COMPLETE AND SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. THESE ARE KEPT IN THE ADMINISTRATIVE OFFICE. ELECTRONIC COPIES ONLY ARE KEPT. MEMBERS OF THE BOARD OF DIRECTORS ARE AWARE OF THE POLICY AND EXCUSE THEMSELVES FROM ANY VOTES WHEN APPROPRIATE. THE CONFLICT OF INTEREST POLICY STATEMENTS ARE REVIEWED BY THE PRESIDENT AND CEO WHO MAKES HIMSELF AWARE OF ANY POTENTIAL CONFLICTS THAT MAY ARISE. ALL MEMBERS OF THE BOARD OF DIRECTORS AND LEADERSHIP TEAM COMPLETE AND SIGN CONFLICT OF INTEREST STATEMENTS. BOARD MEMBERS ARE REQUIRED BY THE ORGANIZATION'S BYLAWS TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST OR CONFLICT OF INTEREST TRANSACTIONS TO BE APPROVED BY BOARD VOTE. FORM 990, PART VI, SECTION B, LINE 15A THE CEO IS COMPENSATED THROUGH VISITING NURSE ASSOCIATION OF THE MIDLANDS (VNAM), AN AFFILIATE OF VISITING NURSE HEALTH SERVICES. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE COMPENSATION FOR THE CEO. SALARY COMPARISONS ARE CONDUCTED WHEN DETERMINED NECESSARY BY THE COMMITTEE; A PAID COMPARABILITY STUDY AND REVIEW OF COMPARABLE COMPANY 990S HAVE BEEN DONE IN THE PAST, THE MOST RECENT IN 2012. A PERFORMANCE EVALUATION PROCESS IS COMPLETED ANNUALLY BY THE BOARD OF DIRECTORS AND THE EXECUTIVE COMMITTEE MAKES THE FINAL DETERMINATION ON THE CEO'S SALARY BASED ON THE EVALUATION PROCESS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. INTERCOMPANY MANAGEMENT FEES: FORM 990, PART VII, SECTION B; FORM 990 PART VIII; AND FORM 990 PART IX: VISITING NURSE HEALTH SERVICES (VNHS) SHARES ITS FACILITY, ITS EMPLOYEES AND OTHER EXPENSES WITH FOUR RELATED ORGANIZATIONS: VISITING NURSE ASSOCIATION OF THE MIDLANDS, VISITING NURSE FOUNDATION, VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY AND EASTER SEAL SOCIETY OF NEBRASKA, INC. VNHS RECEIVES MANAGEMENT FEES AND EXPENSE SHARING FEES FROM THOSE ORGANIZATIONS AND ALSO PAYS MANAGEMENT FEES TO THOSE ORGANIZATIONS. FEES RECEIVED ARE REPORTED ON PART VIII, LINE 2 AND FEES PAID ARE REPORTED ON PART IX, LINE 11A. AS THE FEES ARE PAID TO A RELATED OPERATING CHARITABLE ENTITY, THE MANAGEMENT FEES PAID ARE NOT REPORTED AS AN INDEPENDENT CONTRACTOR PAYMENT ON PART VII, SECTION B. FORM 990, PART XI, LINE 2C: THE FINANCE AND AUDIT COMMITTEE IS RESPONSIBLE FOR EVALUATION AND OVERSIGHT OF THE FINANCIAL NEEDS AND STATUS OF THE VNA AND FOR THE ESTABLISHMENT AND REVIEW OF POLICIES DESIGNED TO MEET SUCH NEEDS. THE COMMITTEE REVIEWS AND RECOMMENDS APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS, REVIEWS AND RECOMMENDS APPROVAL TO THE VNA BOARD MONTHLY FINANCIAL PROGRESS AS REPORTED BY STAFF TOWARDS ANNUAL BUDGET PLANS, ENSURES ACCURACY OF FINANCIAL REPORTING INCLUDING MONITORING OF INTERNAL CONTROLS, OVERSEES THE ACCOUNTING AND FINANCIAL REPORTING PROCESS AND THE INDEPENDENT AUDIT OF THE FINANCIAL STATEMENTS AND SELECTS, OVERSEES AND COMPENSATES THE EXTERNAL AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. VISITING NURSE ASSOCIATION OF THE MIDLANDS 12565 WEST CENTER ROAD STE 100 OMAHA NE 68144 470690207 HOME CARE, HOSPICE, PHARMACY NE 501(C)(3) 7 VISITING NURSE HEALTH SERVICES 1 VISITING NURSE FOUNDATION 12565 WEST CENTER ROAD STE 100 OMAHA NE 68144 470690846 FUNDRAISING, INVESTMENTS NE 501(C)(3) 11A TYPE I VISITING NURSE HEALTH SERVICES 1 VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY 822 S MAIN STE 102 COUNCIL BLUFFS IA 51503 420681048 HOME CARE, PUBLIC HEALTH IA 501(C)(3) 7 VISITING NURSE HEALTH SERVICES 1 EASTER SEAL SOCIETY OF NEBRASKA INC 12565 WEST CENTER ROAD STE 100 OMAHA NE 68144 470457872 DISABILITY ASSISTANCE NE 501(C)(3) 7 VISITING NURSE HEALTH SERVICES 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 VISITING NURSE ASSOCIATION OF THE MIDLANDS O 557913 FAIR MARKET VALUE VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY O 136831 FAIR MARKET VALUE VISITING NURSE FOUNDATION O 68944 FAIR MARKET VALUE VISITING NURSE ASSOCIATION OF THE MIDLANDS Q 607422 FAIR MARKET VALUE VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY Q 232337 FAIR MARKET VALUE VISITING NURSE FOUNDATION Q 131077 FAIR MARKET VALUE VISITING NURSE ASSOCIATION OF THE MIDLANDS B 89537 FAIR MARKET VALUE SCHEDULE R, PAGE 3, PART V, LINE 2 VISITING NURSE HEALTH SERVICES SHARES ITS FACILITY WITH FOUR AFFILIATES, VISITING NURSE ASSOCIATION OF THE MIDLANDS, VISITING NURSE FOUNDATION, VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY AND EASTER SEAL SOCIETY OF NEBRASKA, INC. USE OF THE FACILITY BY THE FOUR ORGANIZATIONS OVERLAPS. THEREFORE, IT IS DIFFICULT TO QUANTIFY THE COST OF THE PORTION USED BY EACH ORGANIZATION.