2011-12-20T11:51:39-06:00 2011-09-30 Berry Dunn McNeil & Parker LLC 1000 Elm Street 15th Floor Manchester NH 03101 990 2010-10-01 020222122 Concord Regional Visiting Nurse Association Inc CONC 6032244093 30 Pillsbury Street Concord NH 03301 Mary B Deveau 6032244093 2011-12-13 1 Rachel Williamson CPA 6036697337 2011-11-22 2010 2016-02-24 21:20:13Z Mary B Deveau 30 Pillsbury Street Concord NH 03301 26879699 0 X www.crvna.org X 1899 NH Concord Regional Visiting Nurse Association, incorporated in 1899, is a home health and hospice care provider, offering both preventive and supportive health care services. Our mission is to provide and facilitate comprehensive care in the home and community to optimize health, well-being and independence. Our services include: Skilled Nursing; Physical Therapy, Occupational Therapy, & Speech Therapy; Homemaking; Maternal/Child Health; Social Work; Hospice Care; Personal Home Services; Pediatric Care; Nutritional Counseling; Senior Health Clinics; Flu Immunization Clinics; Immunization Clinics; Blood Pressure Clinics; and Community Education. 18 16 392 143 0 0 594292 661035 22575714 21986458 -80350 626888 -26432 -20918 23063224 23253463 0 0 0 0 15719466 17166781 0 0 26082 6388468 4821805 22107934 21988586 955290 1264877 22570849 22771611 2795152 2418190 19775697 20353421 X The Organization provides and facilitates comprehensive care in the home and community to optimize health, well-being and independence. 0 0 10222881 13460676 Home Health Care - provides skilled care services to patients who qualify for care in their home. Services were rendered to 4,157 patients including 85,832 chargable visits and 17,457 additional service hours for indigent patients. Charity care is provided to individuals who are uninsured, underinsured, or otherwise unable to pay the published fee for service. 4754867 6861560 Hospice - supportive care for the terminally ill on a 24 hour basis. Services were rendered to 656 patients providing 35,006 hospice care days. Charity care is provided to individuals who are uninsured, underinsured, or otherwise unable to pay the published fee for services. 1627728 1430913 Personal Care Services - Provides care and support primarily to frail elders who need assistance to stay living independently in their own homes. 794795 233309 Community Health Services - provides community based health care services in individual homes and clinic setting including Parent Friend Program (a mentoring program for at risk families), senior health clinics, immunization clinics, children dental clinics, head lice services and community health education. Funding for services is subsidized by agency and community funding. 794795 233309 17400271 1 1 0 1 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 14 0 1 392 1 0 0 0 0 0 0 0 0 0 0 X 18 16 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NH X Violet Rounds 6032244093 30 Pillsbury Street Concord NH 03301 Mary B Deveau 50.00 X X 225969 0 47823 Richard Holden 1.00 X X 0 0 0 Steven Lauwers Esq 1.00 X X 0 0 0 Christopher Parkinson 1.00 X X 0 0 0 Kathleen Ames 1.00 X X 0 0 0 Mark T Broth Esq 1.00 X 0 0 0 Vera Buck 1.00 X 0 0 0 Charles J Fanaras RPh 1.00 X 0 0 0 Marianne Fleischman MD 1.00 X X 0 0 0 Susan Heinecke 1.00 X 0 0 0 Brian LaRoche 1.00 X 0 0 0 Marcia M Matthews 1.00 X 0 0 0 Leslie K Melby 1.00 X 0 0 0 Jessica S Pollack APRN 1.00 X 0 0 0 Douglas Sampson 1.00 X 0 0 0 Douglas Black MD 1.00 X 0 0 0 Melvin J Severance CFP 1.00 X 0 0 0 Michael L Timm 1.00 X 0 0 0 Deacon Winton DeRosia 1.00 X 0 0 0 Andrew B Eills Esq 1.00 X 0 0 0 Violet Rounds 50.00 X 159249 0 17803 Lois Ferguson 45.00 X 109232 0 12706 Linda Flewelling 45.00 X 105313 0 5740 Deborah Mullen 45.00 X 104990 0 12417 Arthur Savage 55.00 X 103964 0 4159 808717 0 100648 6 0 1 0 0 198546 145359 317130 2037 661035 Home Care Revenue 621610 13460676 13460676 Hospice Revenue 623000 6861560 6861560 Personal Home Services 621610 1430913 1430913 Community Services Rev 621990 233309 233309 21986458 400809 400809 3831397 3605318 226079 226079 226079 0 198546 20918 -20918 -20918 23253463 21986458 0 605970 420043 395744 24299 13380017 11319459 2060558 459932 390001 69931 1882254 1618001 264253 1024535 842497 180255 1783 21167 21167 58775 58775 81492 81492 613191 570920 42271 1885997 1488879 397118 361837 361837 515489 193870 321619 601573 584383 17190 124234 124234 338805 257988 80817 64600 64600 Bad Debt Expense 85000 85000 Dues & Subscriptions 69645 49273 20372 21988586 17400271 4562233 26082 1040582 150120 6422126 6088168 24921 54451 2672770 2737440 108195 130972 2524542 1257336 1328796 1267206 9554417 11003471 1419042 1339783 22570849 22771611 2041261 1678799 753891 739391 2795152 2418190 X 15526893 16295663 1020344 908557 3228460 3149201 19775697 20353421 22570849 22771611 X 1264877 -687153 X X 0 1 1 X 0 X 1050938 1726440 650949 594292 661035 4683654 15498108 17033058 21208606 22575714 24570961 100886447 16549046 18759498 21859555 23170006 25231996 105570101 17014 7500 8250 32764 0 17014 7500 8250 32764 105537337 422074 462707 335538 304370 397473 1922162 422074 462707 335538 304370 397473 1922162 10971 13599 24570 16982091 19235804 22195093 23474376 25629469 107516833 0.98160 0.98100 0.01790 0.01820 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5972 5972 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The Organization pays dues to various organizations, some to which a portion of the dues are attributable to lobbying expenses. 2073418 37759 37759 2073418 2068241 5177 2073418 1987202 81039 2068241 1.00000 0 0 1014853 370550 644303 1459229 847140 612089 50460 39646 10814 1267206 Beneficial Interest in Perpetual Trust 1075783 Deposits - Worker's Compensation 264000 1339783 23253463 21988586 1264877 -607894 -79259 -687153 577724 22587228 -607894 20918 -586976 23174204 79259 79259 23253463 22009504 20918 20918 21988586 0 21988586 Description of Intended Use of Endowment Funds: Part V, Line 4: The Endowment funds are used to subsidize charitable care, support community programs that have no outside funding, provide seed money for program expansion and new programs and to make capital improvements to the Hospice House. Programs and Services supported by the Agency's funds include a Parent Child Mentoring program for at risk children, health clinics for seniors that provide screenings, foot care, ear wax removal, and other related services, head lice prevention and screening and immunization clinics. In addition, the Hospice Program and the Hospice House are supported through charitable funds to provide subsidized or free services; bereavement support groups, Hospice volunteer training and community education. Funds also would be used to support CRVNA's Home Care Program's Telehealth Program and to subsidize charitable care for patients that are uninsured or underinsured in the Home Care Program. Part XI, Line 8 - Other Adjustments: Change in market value of perpetual trust -79,259. Part XII, Line 2d - Other Adjustments: Fundraising Expenses 20,918. Part XII, Line 4b - Other Adjustments: Change in Market Value of Perpetual Trusts 79,259. Part XIII, Line 2d - Other Adjustments: Fundraising Expenses 20,918. Lights of Life 67635 67635 8591 Annual Appeal 68820 68820 4362 1 62091 62091 7965 198546 198546 20918 20918 -20918 X X X X X 0 0 0 0 0 0 0 0 0 Mary B Deveau 201219 0 19950 0 4800 0 8777 30801 8245 0 242991 30801 0 0 Violet Rounds 144516 0 9933 0 4800 0 5559 0 12244 0 177052 0 0 0 Supplemental Information Part III Mary B. Deveau, President, participates in the Concord Hospital Cash Balance plan. Concord Hospital is a related organization through CRVNA's sole corporate member, Capital Region HealthCare Corporation. The deferred tax benefit received totalled $30,801, as reported on Schedule J, page 2, column (C)(ii). The Prescription Center and Northeast Pharmacy Vendor of Organization 500797 Charles Fanares, a member of the Board of Trustees of the Organization is the sole owner of The Prescription Center and Northeast Pharmacy. Douglas Sampson is an officer of The Prescription Center and serves as a Trustee of the Organization. The Organization purchases prescriptions from this organization. All transactions are at arm's length. 0 Form 990, Part VI, Section A, line 2 Douglas Sampson, a trustee of the Organization, is an employee of The Prescription Center, an entity owned 100% by Charles J. Fanares, a trustee of the Organization. Form 990, Part VI, Section A, line 6 Capital Region HealthCare Corporation is the sole member of the Concord Regional VNA. Form 990, Part VI, Section A, line 7a Capital Region HealthCare Corporation accepts any changes made to the bylaws by the governing body. Form 990, Part VI, Section B, line 11 The role of Concord Regional Visiting Nurse Association's Audit Committee has expanded to include review of the agency's 990. The auditing firm of Berry, Dunn, McNeil and Parker presented the 990 to the Audit Committee prior to filing the form. The Audit Committee engages the auditors and receives the audit and the 990 Report. The Audit Committee receives a complete copy of the 990 including all schedules. The initial presentation of the FY2011 audit and the 990 Form will occur at the November 22, 2011 meeting of the Audit/Finance Committee meeting. Subsequent Audit Committee meetings will occur if necessary to complete the review. The Audit Committee will report to the Board of Trustees that the 990 review has occurred. The Board of Trustees accepts the Audit Committee reports, the audit, and the 990 documents. All members of the Board will have access to the reports. The Form 990 is available to the public upon request. Form 990, Part VI, Section B, line 12c The Conflict of Interest, Statement of Conflict of Interest with Respect to a Relationship, Transaction and/or Financial Interest form was revised by the Audit Committee in February 2010 and approved by the Board in March 2010. The form was revised to ensure compliance with the State of NH Pecuniary Benefit Law (Chapter 7: RSA 7:19a) and the revised IRS 990 disclosure requirements. The Chief Executive Officer/President reviewed the form and the regulation requirements at the March 8, 2011 Board Meeting. Trustees at the meeting were requested to complete the forms and return them to management. The Executive Administrative Manager worked with Board members to ensure each member had returned the Conflict of Interest Forms. In FY2011, 100% of the Board of Trustees returned the signed conflict of interest forms. The Audit Committee at its April 28, 2011 meeting reviewed the forms for those Trustees that reported a conflict of interest. The Audit Committee reported to the full Board the conflict of interest transactions that had been disclosed on the conflict of interest forms. The Board at its May 10, 2011 meeting approved the conflict of interest disclosures. The approved transactions over $5,000 were reported as required by law to the State of New Hampshire's Director of Charitable Trust at the Attorney General's office and a notice was published in the Concord Monitor. In addition to the annual completion of the form, Trustees are asked at every Board meeting beginning with the June 2010, if there are any conflicts that they have identified that should be reported to Management and the Board. Form 990, Part VI, Section B, line 15 In August 2009, the Executive Committee in collaboration with other VNAs affiliated with the Visiting Nurse Association Health System of Northern New England engaged Skeates Consulting, LLC and Olney/HR Advantage to complete an executive compensation analysis/review that would be used to determine the compensation for the Chief Executive Officer and the Chief Financial Officer. The results of this report were presented to the CRVNA Executive Committee on September 3, 2009. The Executive committee members decided at this meeting to accept the report as the appropriate tool to use to set the compensation for the CEO and CFO positions. The Board at its November 10, 2009 meeting adopted an Executive Compensation policy for the CEO/CFO positions. The Executive Committee's compensation philosophy is to pay the CEO and CFO at the appropriate level of compensation based on market data and surveys such as the compensation report noted above. The compensation will be performance based using the salary information available. The Executive Committee of the Board of Trustees recommended the annual compensation for the CEO and CFO at the December 14, 2010 Board meeting. The Board unanimously approved the compensation recommendation. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -607,894. Change in market value of perpetual trust -79,259. Total to Form 990, Part XI, Line 5: -687,153. Form 990, Part XII, Line 2c The organization has not changed its oversight or selection process during the tax year. Description of Organization Mission, continued Form 990, Part I, Line 1 The agency's service area includes Merrimack County and portions of Hillsborough County, representing more than 30 communities in central New Hampshire. Concord Regional VNA serves 7,000 patients annually and provides 150,000 homecare hours and more than 35,000 hospice days annually, including a 10-bed Hospice House. Patients who are uninsured, underinsured, or otherwise unable to pay the published fees for services are provided charity care. In the Fiscal Year 2011, the CRVNA Home Care Program provided care to 4,157 patients. Thirteen percent (13%) of the patients served in the Home Care Program were uninsured or received funding from Medicaid or low income grants. In addition, 68% of the Home Care patients had Medicare or Medicare replacement plans as their insurance plan. We are a 501(c)(3) non-profit agency and a subsidiary of Capital Region Health Care. Concord Regional VNA is a Medicare and Medicaid Certified Home Health and Hospice Provider and is licensed by the State of New Hampshire Bureau of Health Care Facilities. In addition, Concord Regional VNA's Hospice House, an inpatient setting providing care and comfort for the terminally ill, is licensed by the State of New Hampshire as a Supportive Residential Care Facility. Capital Region Health Care Corporation 250 Pleasant Street Concord NH 03301 020222123 Health Care Services NH 501(c)(3) Line 11a, I N/A 0 Concord Hospital Inc 250 Pleasant Street Concord NH 03301 222594672 Patient Care Services NH 501(c)(3) Line 3 N/A 0 Riverbend Community Mental Health Inc 3-5 North State Street PO Box 2032 Concord NH 03302 020264383 Mental Health Services NH 501(c)(3) Line 7 N/A 0 Capital Region Health Care Development Corporation 250 Pleasant Street Concord NH 03301 020429749 Management of Real Estate Holdings NH 501(c)(2) N/A 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0