2013-08-05T12:19:29-05:00 2012-09-30 263753134 CBIZ TOFIAS 56 EXCHANGE TERRACE PROVIDENCE RI 02903 990 2011-10-01 042105745 SOUTHCOAST VISITING NURSE ASSOCIATION INC SOUT 5089733213 200 MILL ROAD NO 120 FAIRHAVEN MA 02719 SHARON JONES 5089733213 2013-08-05 1 JOHN T WILMOT P00095129 4016263200 2011 2016-02-24 21:20:13Z SHARON JONES 200 MILL ROAD NO 120 FAIRHAVEN MA 02719 33119983 0 X WWW.VNASM.ORG X 1941 MA THE SOUTHCOAST VISITING NURSE ASSOCIATION, INC. IS COMMITTED TO PROVIDING HIGH QUALITY COMPREHENSIVE HEALTH AND HOSPICE SERVICES IN THE HOME SETTING AND COMMUNITY-BASED PROGRAMS WHICH FOSTER IMPROVEMENT AND MAINTENANCE OF HEALTH, PREVENTION OF DISEASE AND DISABILITY AND COMPASSIONATE END-OF-LIFE CARE. 14 10 435 125 0 0 399630 388227 18376874 27010096 220012 1373715 0 0 18996516 28772038 0 0 0 0 14884873 21505110 0 0 6608 5476789 7362627 20361662 28867737 -1365146 -95699 14949116 15926783 6185564 8016902 8763552 7909881 X THE SOUTHCOAST VISITING NURSE ASSOCIATION, INC. IS COMMITTED TO PROVIDING HIGH QUALITY COMPREHENSIVE HEALTH AND HOSPICE SERVICES IN THE HOME SETTING AND COMMUNITY-BASED PROGRAMS WHICH FOSTER IMPROVEMENT AND MAINTENANCE OF HEALTH, PREVENTION OF DISEASE AND DISABILITY AND COMPASSIONATE END-OF-LIFE CARE. 0 0 24356427 27010096 HEALTH CARE - PROVIDES ACUTE HEALTH CARE TO PATIENTS AT HOME, SUPPORTIVE CARE TO THE TERMINALLY ILL, AND GROUP SUPERVISION, ACTIVITIES, AND MEALS FOR PHYSICALLY AND/OR MENTALLY IMPAIRED ADULTS. 24356427 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 37 0 1 435 1 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X JEAN SMITH WHITE 5089733213 200 MILL ROAD SUITE 120 FAIRHAVEN MA 02719 GARY F CONNER 40.00 X X 0 0 0 CYNTHIA C BURKE 1.00 X 0 0 0 DONALD J EMOND 1.00 X 0 0 0 LINDA BODENMANN 40.00 X X 0 624370 179370 RUTH E HURLEY 1.00 X X 0 0 0 REVEREND DONALD S MIER 1.00 X X 0 0 0 EVERETT MOORE 1.00 X 0 0 0 WILLIAM K RILEY 1.00 X 0 0 0 RONALD A SCHWARTZ MD 1.00 X 0 296974 29454 SHARON JONES 40.00 X X 0 221937 13901 KEITH HOVAN 1.00 X 0 1038235 424247 LISA LUNDY-KUSINITZ 1.00 X 0 0 0 JEANNE M LEFFERS 1.00 X 0 0 0 MARIA CARVALHO 1.00 X 0 0 0 JEAN SMITH WHITE 40.00 X 0 0 0 WILLIAM GRIGG 1.00 X 0 582452 105088 JOHN TAYLOR 40.00 X 88056 65733 0 BRETT HAWORTH 40.00 X 102785 0 6195 JOHN DAY 40.00 X 0 773852 183287 190841 3603553 941542 1 1 1 0 CORE MEDICAL GROUP 2 KEEWAYDIN DRIVE SALEM NH 03079 CONTRACT STAFFING 510271 MAS MEDICAL STAFFING 500 HARVEY ROAD SUITE 304 MANCHESTER NH 03103 CONTRACT STAFFING 222878 THERAPY CONSULTING LLC 130 CHAPEL STREET LINCOLN RI 02865 CONTRACT STAFFING 157258 MANAGEMENT RESOURCE SOLUTIONS INC 299 WEST HILLCREST DR 200 THOUSAND OAKS CA 91360 PERSONNEL PLACEMENT CONSULTANTS 120370 FAVORITE HEATHCARE STAFFING PO BOX 803356 KANSAS CITY MO 64180 CONTRACT STAFFING 116163 7 23702 14260 350265 388227 HOME HEALTH CARE 621610 27010096 27010096 27010096 54984 54984 5666676 4347945 1318731 1318731 1318731 28772038 27010096 0 1373715 312084 312084 17414494 15427161 1987333 516017 390835 125182 1958558 1483427 475131 1303957 987627 316330 8690 8690 65300 65300 458783 347486 111297 27159 20570 6589 88838 67287 21551 191118 144754 46364 556216 421282 134934 631863 611170 20693 42351 32077 10274 625514 473769 151745 156707 118691 38016 HOSPICE PROGRAM EXPENSE 777445 777445 PERSONNEL/SERVICE EXPEN 629974 477147 152827 REHAB EXPENSES 527054 527054 BAD DEBTS 423999 423999 2151616 1624646 520362 6608 28867737 24356427 4504702 6608 563616 1392156 5923532 7277209 11068 105571 3756895 2080354 2103750 1676541 4581907 0 1765243 5475306 14949116 15926783 1685362 1978494 1046538 1101691 3453664 4936717 6185564 8016902 X 7133502 6072078 61063 106310 1568987 1731493 8763552 7909881 14949116 15926783 X -95699 -757972 X 0 1 1 X 0 X 522783 435323 243481 399630 388227 1989444 15912680 17580419 16154824 18376874 27010096 95034893 16435463 18015742 16398305 18776504 27398323 97024337 0 0 0 97024337 440007 128946 98141 111732 54984 833810 440007 128946 98141 111732 54984 833810 16875470 18144688 16496446 18888236 27453307 97858147 0.99150 0.98760 0.00850 0.01240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 571058 1058992 224707 29366 1825391 605177 -4614 29505 571058 585710 50919 31452 605177 579419 35262 28971 585710 0.00000 0.94860 0.05140 1 0 1049471 309736 739735 2502782 1740255 762527 204642 30363 174279 1676541 ASSETS LIMITED AS TO USE 12413 BENEFICIAL INTEREST IN PERPETUAL TRUST 1221498 DUE FROM AFFILIATES 4241395 5475306 DUE TO AFFILIATES 4936717 4936717 28772038 28867737 -95699 -757972 -757972 -853671 28014066 -757972 -757972 28772038 0 28772038 28867737 0 28867737 0 28867737 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: VNA ACCOUNTS FOR THE EFFECT OF ANY UNCERTAIN TAX POSITIONS BASED ON A "MORE LIKELY THAN NOT" THRESHOLD TO THE RECOGNITION OF THE TAX POSITIONS BEING SUSTAINED BASED ON THE TECHNICAL MERITS OF THE POSITION UNDER SCRUTINY BY THE APPLICABLE TAXING AUTHORITY. IF A TAX POSITION OR POSITIONS ARE DEEMED TO RESULT IN UNCERTAINTIES OF THOSE POSITIONS, THE UNRECOGNIZED TAX BENEFIT IS ESTIMATED BASED ON A "CUMULATIVE PROBABILITY ASSESSMENT" THAT AGGREGATES THE ESTIMATED TAX LIABILITY FOR ALL UNCERTAIN TAX POSITIONS. VNA HAS IDENTIFIED ITS TAX STATUS AS A TAX EXEMPT ENTITY AS A TAX POSITION; HOWEVER, VNA HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. THE VNA IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. ITS FEDERAL INFORMATIONAL RETURNS ARE GENERALLY OPEN FOR EXAMINATION FOR THREE YEARS FOLLOWING THE DATE FILED. 1 X X X X 0 1 0 0 0 0 0 0 0 LINDA BODENMANN 0 443787 0 84778 0 95805 0 165469 0 13901 0 803740 0 0 RONALD A SCHWARTZ MD 0 296974 0 0 0 0 0 0 0 29454 0 326428 0 0 SHARON JONES 0 195256 0 26681 0 0 0 0 0 13901 0 235838 0 0 KEITH HOVAN 0 756500 0 213469 0 68266 0 407073 0 17174 0 1462482 0 0 WILLIAM GRIGG 0 419260 0 77166 0 86026 0 87914 0 17174 0 687540 0 0 JOHN TAYLOR 88056 65733 0 0 0 0 0 0 0 0 88056 65733 0 0 JOHN DAY 0 0 0 0 0 773852 0 183287 0 0 0 957139 0 0 PART I, LINE 4B OFFICERS, DIRECTORS AND TRUSTEES WHO ARE EMPLOYEES OF SOUTHCOAST HOSPITALS GROUP, INC. (SOUTHCOAST) PARTICIPATE IN SOUTHCOAST'S 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. ONLY UPON TERMINATION OF EMPLOYMENT DO FULLY VESTED PARTICIPANTS RECEIVE DISTRIBUTIONS FROM THE PLAN. THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES THE VESTED PORTION OF CONTRIBUTIONS MADE TO THE PLAN WHICH ARE NO LONGER SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2011 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES: KEITH HOVAN $58,659; WILLIAM GRIGG $76,180; LINDA BODENMANN $89,111. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN THE 457(F) PLAN WHICH IS SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE AND ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THE UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN THE INDIVIDUAL'S 2011 FORM W-2, BOX 5, AS TAXABLE WAGES: KEITH HOVAN $173,173; WILLIAM GRIGG $73,214; LINDA BODENMANN $85,769. ALSO INCLUDED IN COLUMN C BUT NOT INCLUDED IN THE INDIVIDUAL'S FORM W-2, BOX 5, WERE CONTRIBUTIONS MADE TO SERP AGREEMENTS OF $219,200 FOR KEITH HOVAN AND $65,000 FOR LINDA BODENMANN. FORM 990, PART VI, SECTION A, LINE 6 VNA'S PARENT CORPORATION, SOUTHCOAST HEALTH SYSTEM, INC. ("SHS") SERVES AS THE SOLE CORPORATE MEMBER OR SOLE CORPORATE STOCKHOLDER OF EACH OF ITS AFFILIATES. FORM 990, PART VI, SECTION A, LINE 7A VNA'S PARENT CORPORATION, SOUTHCOAST HEALTH SYSTEM, INC. ELECTS THE TRUSTEES OR DIRECTORS OF EACH AFFILIATE AND WITH RESPECT TO CERTAIN OF THE AFFILIATES, EXERCISES SPECIFIED RESERVE POWERS AND IS GOVERNED BY A BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE ROLE OF THE SHS BOARD IS TO MAINTAIN A SYSTEM PERSPECTIVE WITH A REGIONAL EMPHASIS AND A BROAD FOCUS ACROSS ALL ACTIVITIES IN THE ORGANIZATION. PRIMARY FUNCTIONS OF THE SHS BOARD INCLUDE STRATEGIC PLANNING, NETWORK GROWTH AND DEVELOPMENT, AND OVERALL FISCAL RESPONSIBILITIES. EACH AFFILIATE IS EXPECTED TO FOCUS ON ITS OWN ACTIVITIES ADDRESSING COMMUNITY NEEDS WITHIN ITS SCOPE OF SERVICE. FORM 990, PART VI, SECTION B, LINE 11 THE GOVERNING BOARD OF THE ASSOCIATION'S NOT-FOR-PROFIT PARENT, SOUTHCOAST HEALTH SYSTEM, INC., REVIEWS THE FORM 990 AND ALL OF ITS RELATED SCHEDULES PRIOR TO FILING. THE REVIEW IS PERFORMED BY THE GOVERNING BOARD AS IT PROVIDES OVERSIGHT FOR COMPENSATION AND CONFLICT OF INTEREST MATTERS ON ITS OWN BEHALF AND ON BEHALF OF ITS AFFILIATES ON A SYSTEM WIDE BASIS. A COMPLETE COPY OF THE FORM 990 AND ITS SCHEDULES ARE POSTED TO THE SOUTHCOAST HEALTH SYSTEMS, INC. BOARD'S WEBSITE FOR ALL BOARD MEMBERS TO REVIEW, MAKE INQUIRIES, AND HAVE ANY ADJUSTMENTS MADE PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C SHS HAS CONFLICT OF INTEREST, LEGAL COMPLIANCE, AND CODE OF CONDUCT POLICIES THAT APPLY TO ALL TRUSTEES, OFFICERS, EMPLOYEES AND VOLUNTEERS (REFERRED TO AS "MEMBERS"). THE PRESIDENT OF SHS IS RESPONSIBLE FOR INFORMING ALL MEMBERS OF THIS POLICY. THE CHAIRMAN OF SHS'S BOARD IS RESPONSIBLE FOR MAKING AN INITIAL DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS WITH RESPECT TO ANY TRUSTEE, OFFICER OR DIRECTOR OF SHS OR ANY OF ITS AFFILIATES. THE PRESIDENT OF SHS IS RESPONSIBLE FOR MAKING AN INITIAL DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS AS TO ANY MEMBER OTHER THAN A TRUSTEE OR DIRECTOR. IN THE EVENT OF A POTENTIAL CONFLICT RELATING TO THE CHAIRMAN OF SHS, THE MATTER WOULD BE REPORTED TO THE PRESIDENT OF SHS AND REFERRED AUTOMATICALLY TO THE SYSTEM'S GOVERNANCE COMMITTEE FOR DETERMINATION AS TO WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. IN THE EVENT THE AFFECTED MEMBER DISAGREES WITH THE INITIAL DETERMINATION OF THE CHAIRMAN OR PRESIDENT, AS APPLICABLE, THEN UPON REQUEST, HE OR SHE MAY BE AFFORDED THE OPPORTUNITY TO DISCUSS THE ISSUE WITH THE SHS GOVERNANCE COMMITTEE WHICH HAS FINAL AUTHORITY IN ITS SOLE DISCRETION TO DETERMINE WHETHER A POTENTIAL CONFLICT OF INTEREST EXISTS. THE AFFECTED MEMBER, IF A MEMBER OF THE GOVERNANCE COMMITTEE, MUST REMOVE HIMSELF FROM THE ROOM DURING ANY DISCUSSION OF THE MATTER (AFTER HIS INITIAL PRESENTATION) AND REFRAIN FROM PARTICIPATING IN ANY VOTE OR OTHER DECISION MAKING IN REGARD TO THE MATTER. THE MINUTES OF THE MEETING WOULD REFLECT THAT A FULL AND ACCURATE DISCLOSURE WAS MADE, THAT THE MEMBER ABSTAINED FROM VOTING OR DECISION MAKING AND THAT A QUORUM WAS OTHERWISE PRESENT. VIOLATION OF THIS POLICY MAY RESULT IN DISCIPLINARY ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR REMOVAL FROM OFFICE. THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD. THE BOARD IS ADVISED OF THE POLICY PRIOR TO SELECTION AS A MEMBER AND IS REQUIRED TO FILE WITHIN 30 DAYS THEREAFTER THE CONFLICT OF INTEREST DISCLOSURE STATEMENT OR QUESTIONNAIRE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR ALL VICE PRESIDENTS AND HIGHER LEVEL EXECUTIVES IS ESTABLISHED USING THE FOLLOWING PROCEDURE: 1. REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE OF SOUTHCOAST HEALTH SYSTEM, WITHOUT THE INVOLVEMENT OF PERSONS WITH A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE. 2. USE OF DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED POSITIONS. THE COMPENSATION COMMITTEE ENGAGED THE SERVICES OF AN INDEPENDENT HUMAN RESOURCE CONSULTING FIRM ("CONSULTANT") TO PROVIDE UPDATED COMPENSATION DATA AND ASSESS THE REASONABLENESS OF THE TOTAL COMPENSATION PROVIDED TO SHS'S EXECUTIVES. THIS INCLUDED RELEVENT COMPETITIVE MARKET PRACTICE INFORMATION FOR THE NORTHEAST REGION MARKET OBTAINED FROM TWO HEALTHCARE EXECUTIVE COMPENSATION SURVEYS THAT WERE PREPARED BY INDEPENDENT FIRMS. THE CONSULTANT ALSO COMPILED NATIONAL MARKET DATA FROM THREE COMMERCIALLY-AVAILABLE HEALTHCARE EXECUTIVE COMPENSATION SURVEYS PREPARED BY INDEPENDENT FIRMS, AND 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE PROVIDED UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -757,972. SCHEDULE B, PART I, NO,6 CONTRIBUTIONS FROM SOUTHCOAST HOSPITALS GROUP RELATES TO DONATIONS MADE TO BENEFIT THE HOMECARE/HOSPICE DEPARTMENT OF THE HOSPITAL PRIOR TO MERGING WITH THE VNA. AFTER THE MERGER THESE DONATIONS WERE TRANSFERRED TO THE VNA. CONTRIBUTIONS SCHEDULE D, PART V, LINE 1B THE ORGANIZATION HAS A BENEFICIAL INTEREST IN A PERPETUAL TRUST THAT WAS NOT INCLUDED IN ENDOWMENT FUNDS IN PRIOR YEARS. SOUTHCOAST HEALTH SYSTEM INC 101 PAGE STREET NEW BEDFORD MA 02740 042794625 SUPPORT RELATED ENTITIES MA 501(C)(3) LINE 11A, I N/A 0 SOUTHCOAST HOSPITAL GROUP INC 101 PAGE STREET NEW BEDFORD MA 02740 222592333 ACUTE CARE HOSPITAL MA 501(C)(3) LINE 3 N/A 0 CHARLTON LONG TERM CARE SERVICES INC 363 HIGHLAND AVENUE FALL RIVER MA 02720 043109579 SUPPORT SOUTHCOAST HOSPITAL MA 501(C)(3) LINE 11A, I N/A 0 SOUTHCOAST VENTURES INC 101 PAGE STREET NEW BEDFORD MA 02740 043003172 PHYSICIAN SVCS/HEALTH CARE MA 501(C)(3) LINE 11A, I N/A 0 ST LUKES NURSING HOME INC 101 PAGE STREET NEW BEDFORD MA 02740 042984542 INACTIVE MA 501(C)(3) LINE 11A, I N/A 0 SOUTHCOAST PHYSICIANS GROUP INC 200 MILL ROAD FAIRHAVEN MA 02719 222703314 PHYSICIAN SERVICES MA 501(C)(3) LINE 9 N/A 0 COASTLINE PROFESSIONAL ASSURANCE CORP LTD PO BOX 10 GRAND CAYMAN CJ 980445031 INSURANCE CJ N/A C SOUTHCOAST PHYSICIANS NETWORK INC 101 PAGE STREET NEW BEDFORD MA 02740 450568782 PHYSICIAN NETWORK SERVICES MA N/A C HEALTH MANAGEMENT INITIATIVE INC 363 HIGHLAND AVENUE FALL RIVER MA 02702 042998712 COMMERCIAL RENTALS MA N/A C 0 0 0 0 1 0 0 0 0 1 0 1 0 0 1 1 0 0