SERENITY LANE: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- SERENITY LANE (EIN 93-0606316)
- Tax period
- 2017-04-01 to 2018-03-31
- Filed
- 2019-02-11
- IRS object ID
- 201900429349301190
- Schema version
- 2017v2.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-02-11T15:51:39-06:00 | ReturnTs |
| Tax Period End | 2018-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 910189318 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 SW BROADWAY STE 1200 | AddressLine1Txt |
| City | PORTLAND | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97205 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930606316 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SERENITY LANE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SERE | BusinessNameControlTxt |
| Phone | 5414842156 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8549 | AddressLine1Txt |
| City | COBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97408 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE DYER | PersonNm |
| Person Title | PRESIDENT AND CEO | PersonTitleTxt |
| Phone | 5414842156 | PhoneNum |
| Signature | 2019-01-30 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY CAMPOS | PreparerPersonNm |
| PTIN | P00448102 | PTIN |
| Phone | 5032421447 | PhoneNum |
| Preparation | 2019-01-26 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 12.129.7.100 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-01-30 | IPDt |
| IP Tm | 17:27:46 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | CEB32098E0DA78823741A708D31426FEC07C0BDB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MIKE DYER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 8549 | AddressLine1Txt |
| City | COBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97408 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,326,173 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SERENITYLANE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1973 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | TREATMENT OF THE DISEASE OF CHEMICAL DEPENDENCY | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 244 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $2,062 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $19,473 | PYContributionsGrantsAmt |
| CY Contributions Grants | $25,580 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,796,333 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,298,476 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,385 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,117 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $14,822,191 | PYTotalRevenueAmt |
| CY Total Revenue | $14,326,173 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,482,929 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,133,961 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $316,141 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,540,101 | PYOtherExpensesAmt |
| CY Other Expenses | $6,577,501 | CYOtherExpensesAmt |
| PY Total Expenses | $16,023,030 | PYTotalExpensesAmt |
| CY Total Expenses | $15,711,462 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,200,839 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,385,289 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,879,792 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,438,061 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,298,147 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,239,912 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$418,355 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,801,851 | NetAssetsOrFundBalancesEOYAmt |
| Mission | PROVIDING A HEALING ENVIRONMENT IN WHICH CHEMICALLY DEPENDENT INDIVIDUALS AND THEIR FAMILIES DISCOVER AN ENHANCED QUALITY OF LIFE THROUGH LONG-TERM RECOVERY FROM ADDICTIONS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $15,301,404 | ExpenseAmt |
| Revenue | $14,298,476 | RevenueAmt |
| Desc | TREATMENT OF CHEMICAL DEPENDENCY THROUGH INPATIENT AND RESIDENTIAL SERVICES. | Desc |
| Total Program Service Expenses | $15,301,404 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 39 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 244 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DUSTIN STAPLETON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5412848617 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SERENITY LANE | AddressLine1Txt |
| City | COBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97408 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| JOHN DUNPHY | |||||||||
| CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| JOHN LIPKIN | |||||||||
| VICE CHAIRMAN | 0.50 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MIKE KEHOE | |||||||||
| TREASURER | 0.50 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KATE KLOOS | |||||||||
| SECRETARY | 0.50 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| LARRY OLSON | |||||||||
| MEMBER | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| REV JOHN KERNS | |||||||||
| MEMBER | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| TIM DANFORTH | |||||||||
| MEMBER | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| MARY CHAVIN | |||||||||
| MEMBER | 0.50 | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| MIKE DYER | |||||||||
| PRESIDENT & CEO | 1.00 | 41.00 | Yes (X) | $0 | $177,660 | $22,976 | |||
| DUSTIN STAPLETON | |||||||||
| VP OF FINANCE/ADMINISTRATION | 1.00 | 40.00 | Yes (X) | $0 | $113,782 | $23,054 | |||
| LARRY BRADLEY | |||||||||
| VP OF DEVELOPMENT | 40.00 | 0.50 | Yes (X) | $158,100 | $0 | $4,743 | |||
| ERIC GEISLER | |||||||||
| DIRECTOR OF MEDICAL SERVICES | 40.00 | 0.00 | $188,523 | $0 | $11,794 | Yes (X) | |||
| JOEL BREEN | |||||||||
| PSYCHIATRIST | 40.00 | 0.00 | $200,640 | $0 | $12,157 | Yes (X) | |||
| LINDSAY MAGHAN | |||||||||
| NURSE PRACTIONER | 40.00 | 0.00 | $100,913 | $0 | $22,668 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $648,176 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $291,442 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $97,392 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $25,580 | AllOtherContributionsAmt |
| Total Contributions | $25,580 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICES | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $14,298,476 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,298,476 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,298,476 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,117 | TotalRevenueColumnAmt |
| Exclusion | $2,117 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,326,173 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,298,476 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,117 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,752 | TotalAmt |
| Program Services | $200,278 | ProgramServicesAmt |
| Management And General | $81,737 | ManagementAndGeneralAmt |
| Fundraising | $81,737 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,700,333 | TotalAmt |
| Program Services | $6,540,869 | ProgramServicesAmt |
| Fundraising | $159,464 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,277 | TotalAmt |
| Program Services | $67,621 | ProgramServicesAmt |
| Fundraising | $6,656 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,430,121 | TotalAmt |
| Program Services | $1,406,046 | ProgramServicesAmt |
| Fundraising | $24,075 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $565,478 | TotalAmt |
| Program Services | $546,413 | ProgramServicesAmt |
| Management And General | $6,560 | ManagementAndGeneralAmt |
| Fundraising | $12,505 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,300,000 | TotalAmt |
| Program Services | $1,300,000 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,620 | TotalAmt |
| Management And General | $5,620 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,182 | TotalAmt |
| Program Services | $253,927 | ProgramServicesAmt |
| Fundraising | $10,255 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $478,224 | TotalAmt |
| Program Services | $478,224 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $767,596 | TotalAmt |
| Program Services | $756,138 | ProgramServicesAmt |
| Fundraising | $11,458 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,655,019 | TotalAmt |
| Program Services | $1,655,019 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,057 | TotalAmt |
| Program Services | $107,967 | ProgramServicesAmt |
| Fundraising | $1,090 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,307 | TotalAmt |
| Program Services | $22,330 | ProgramServicesAmt |
| Fundraising | $1,977 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | FundraisingFundraisingAmt |
|---|---|---|---|
| CHARITY CARE | $508,951 | $508,951 | |
| DIETARY SUPPLIES | $429,685 | $429,685 | |
| BAD DEBT EXPENSE | $322,555 | $322,555 | |
| TAXES AND LICENSES | $219,187 | $215,313 | $3,874 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $493,118 | TotalAmt |
| Program Services | $490,068 | ProgramServicesAmt |
| Fundraising | $3,050 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,711,462 | TotalAmt |
| Program Services | $15,301,404 | ProgramServicesAmt |
| Management And General | $93,917 | ManagementAndGeneralAmt |
| Fundraising | $316,141 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $345,351 | BOYAmt |
| EOY | $412,892 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $470,054 | BOYAmt |
| EOY | $250,333 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,661,307 | BOYAmt |
| EOY | $2,383,836 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,080 | BOYAmt |
| EOY | $391,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,879,792 | BOYAmt |
| EOY | $3,438,061 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,298,147 | BOYAmt |
| EOY | $5,239,912 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,298,147 | BOYAmt |
| EOY | $5,239,912 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$418,355 | BOYAmt |
| EOY | -$1,801,851 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$418,355 | BOYAmt |
| EOY | -$1,801,851 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,879,792 | BOYAmt |
| EOY | $3,438,061 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,385,289 | ReconcilationRevenueExpnssAmt |
| Donated Services And Use Fclts | $1,793 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | SERENITY LANE HEALTH SERVICES, SERENITY LANE, AND SERENITY LANE HEALTH SERVICES FOUNDATION ARE NOT-FOR-PROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES. SERENITY LANE HEALTH SERVICES, SERENITY LANE, AND SERENITY LANE HEALTH SERVICES FOUNDATION HAVE ALSO BEEN CLASSIFIED AS ENTITIES THAT ARE NOT PRIVATE FOUNDATIONS WITHIN THE MEANING OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES IN THE CONSOLIDATED FINANCIAL STATEMENTS PURSUANT TO ASC 740, INCOME TAXES. THE ORGANIZATION GENERALLY EVALUATES ANY UNCERTAIN TAX POSITIONS CONSISTENT WITH THE ACCOUNTING AND DISCLOSURE REQUIREMENTS OF ASC 450, CONTINGENCIES. THE ORGANIZATION DID NOT HAVE ANY UNCERTAIN TAX POSITIONS IN CONNECTION WITH THESE CONSOLIDATED STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 308 | PersonsServedCnt |
| Total Community Benefit Expns | $537,913 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $537,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 308 | PersonsServedCnt |
| Total Community Benefit Expns | $537,913 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $537,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03570 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 109 | ActivitiesOrProgramsCnt |
| Persons Served | 3751 | PersonsServedCnt |
| Total Community Benefit Expns | $153,416 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $153,416 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $83,550 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $83,550 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00550 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 110 | ActivitiesOrProgramsCnt |
| Persons Served | 3751 | PersonsServedCnt |
| Total Community Benefit Expns | $236,966 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $236,966 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01570 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 110 | ActivitiesOrProgramsCnt |
| Persons Served | 4059 | PersonsServedCnt |
| Total Community Benefit Expns | $774,879 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $774,879 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05140 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $322,555 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SERENITY LANE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 SERENITY LANE | AddressLine1Txt |
| City | COBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97408 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SERENITYLANE.ORG | WebsiteAddressTxt |
| State License | 40-0992 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | SPECIAL INPATIENT CARE FACILITY | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SERENITY LANE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SERENITYLANE.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SERENITYLANE.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE LINE 16J STATEMENT | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE LINE 16J STATEMENT | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE LINE 16J STATEMENT | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SERENITY LANE | PART V, SECTION B, LINE 5: THE HOSPITAL CONSULTED WITH RESPECTED COMMUNITY MEMBERS AND INCLUDED THEIR COMMENTARY IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL CONSULTED WITH CANDACE LANGHOUSE, HUMAN RESOURCES AT SACRED HEART MEDICAL CENTER; EDWIN SCHNEIDER, RPH, PROFESSIONAL RECOVERY NETWORK PRESIDENT, AND CHRISTOPER J. HAMILTON, PHD, MPA, MONITORING PROGRAMS, PROGRAM DIRECTOR, AT RELIANT BEHAVIORAL HEALTH. |
| SERENITY LANE | PART V, SECTION B, LINE 11: PRIORITIZATION OF HEALTH NEEDS AND SERVICES IN THE COMMUNITY. |
| SERENITY LANE | PART V, SECTION B, LINE 16J: THE FAP, FAP APPLICATION, AND FAP PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT HTTPS://SERENITYLANE.ORG/ADMISSIONS/COSTS-AND-INSURANCE-INFO/FINANCIAL-ASSISTANCE-POLICY/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 8 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SERENITY LANE | ||||
| 1050 PRICE ROAD | ALBANY | OR | 97322 | OUTPATIENT REHAB FACILITY |
| 2 - SERENITY LANE | ||||
| 4305 NE THURSTON WAY STE E | VANCOUVER | WA | 98662 | OUTPATIENT REHAB FACILITY |
| 3 - SERENITY LANE | ||||
| 601 NW HARMON BOULEVARD | BEND | OR | 97701 | OUTPATIENT REHAB FACILITY |
| 4 - SERENITY LANE | ||||
| 10920 BARBUR BOULEVARD | PORTLAND | OR | 97219 | OUTPATIENT REHAB FACILITY |
| 5 - SERENITY LANE | ||||
| 2575 NW KLINE STREET | ROSEBURG | OR | 97471 | OUTPATIENT REHAB FACILITY |
| 6 - SERENITY LANE | ||||
| 4211 WEST 11TH AVENUE | EUGENE | OR | 97402 | OUTPATIENT REHAB FACILITY |
| 7 - SERENITY LANE | ||||
| 960 LIBERTY STREET SE STE 120 | SALEM | OR | 97302 | OUTPATIENT REHAB FACILITY |
| 8 - SERENITY LANE | ||||
| 12662 SE STARK STREET STE A | PORTLAND | OR | 97233 | OUTPATIENT REHAB FACILITY |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | AS REPORTED ON SCHEDULE H, PART V, LINE 13, THE ORGANIZATION ALSO USES INSURANCE STATUS TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| PART I, LINE 7: | CHARITY CARE COST IS ESTIMATED BASED UPON A PRO-RATA PERCENTAGE OF TOTAL PATIENT SERVICE COSTS TO TOTAL PATIENT SERVICE REVENUES.COMMUNITY SERVICES AND EDUCATION ARE TRACKED BY EVENT OR ACTIVITY WITH DIRECT COST BEING ACCUMULATED. |
| PART I, LN 7 COL(F): | ESTIMATED AT GROSS REVENUES PRIOR TO DISCOUNTS AND PAYMENTS. |
| PART III, LINE 2: | ESTIMATED AT 1-2% OF GROSS REVENUES, LESS PRIOR ACCOUNTS WRITTEN-OFF BUT COLLECTED IN THE CURRENT PERIOD. |
| PART III, LINE 3: | IF PATIENT APPLIES FOR FINANCIAL ASSISTANCE AND PROVIDES PROPER DOCUMENTATION, THEN BALANCES ARE WRITTEN-OFF TO CHARITY CARE (NOT BAD-DEBT EXPENSE) WHICH IS NETTED WITH GROSS REVENUES. NO DETERMINATION OF THOSE WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE IS MADE UNLESS PROPER INFORMATION IS SUPPLIED AND ASSISTANCE IS REQUESTED. |
| PART III, LINE 4: | ACCOUNTS RECEIVABLE ARE CARRIED AT THEIR ESTIMATED COLLECTIBLE AMOUNTS. IN THE NORMAL COURSE OF BUSINESS, THE ORGANIZATION EXTENDS UNSECURED CREDIT TO THIRD PARTY PAYORS AND PRIVATE PARTIES. THE ORGANIZATION PROVIDES FOR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS THAT IS BASED UPON REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, EXISTING ECONOMIC CONDITIONS, AND CONTRACT RATES WITH THIRD PARTY PAYORS. ACCOUNTS RECEIVABLE WITH THIRD PARTY PAYORS ARE GENERALLY DUE BASED UPON SUBMISSION OF THE CLAIM. THE MAJORITY OF RECEIVABLES FROM PRIVATE PARTIES ARE FINANCED OVER 18-36 MONTHS AS DETERMINED AT THE TIME OF DISCHARGE. NO NONCURRENT PORTION IS SEGREGATED AS ESTIMATION IS DIFFICULT AND NOT RELIABLE. IF THE NONCURRENT PORTION COULD BE REASONABLY ESTIMATED, SUCH CLASSIFICATION MAY HAVE A MATERIAL EFFECT ON THE CURRENT PORTION OF ASSETS; HOWEVER, IT WOULD NOT CHANGE THE OVERALL FINANCIAL POSITION OF THE ORGANIZATION. FINANCE CHARGES ARE CALCULATED AT 18% PER ANNUM AND SECURITY ARRANGEMENTS, IF ANY, VARY WITH THE FINANCIAL CIRCUMSTANCES OF THE PRIVATE PARTIES. MANAGEMENT DETERMINES NONACCRUAL OF INTEREST ON DELINQUENT ACCOUNTS RECEIVABLE ON AN ACCOUNT-BY-ACCOUNT BASIS BASED UPON HISTORICAL COLLECTION INFORMATION AND FINANCIAL CIRCUMSTANCES OF THE PRIVATE PARTY. MANAGEMENT DETERMINES AND EVALUATES PAST DUE BALANCES ON AN ACCOUNT-BY-ACCOUNT BASIS, AND IF AMOUNTS BECOME UNCOLLECTIBLE, THEY WILL BE WRITTEN-OFF WHEN THE DETERMINATION IS MADE.THERE WAS NO CHANGE IN THE METHODOLOGY USED BY THE ORGANIZATION TO ESTIMATE THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS IN THE CURRENT YEAR. |
| PART III, LINE 9B: | IF THE PATIENT REQUESTS CONSIDERATION AND PROVIDES THE REQUESTED AND APPROPRIATE SUPPORT, FINANCIAL ASSISTANCE IS PROVIDED. |
| PART VI, LINE 2: | IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT SERENITY LANE DOES THE FOLLOWING TO ADDRESS THE HEALTH CARE NEEDS OF THE COMMUNITY:1. THE BOARD IS MADE UP OF HIGHLY RESPECTED MEMBERS OF THE COMMUNITY REPRESENTING DIFFERENT ASPECTS, SUCH AS DOCTORS, HUMAN RESOURCE DIRECTORS, PRIESTS, ETC...2. SERENITY LANE STAYS IN CONTACT WITH NUMEROUS REPRESENTATIVES OF THE COMMUNITY, SUCH AS POLICE OFFICERS AND ELECTED REPRESENTATIVES. THE ORGANIZATION ALSO MAINTAINS CONTACT WITH OTHER PROFESSIONALS SERVICING THE ALCOHOL AND DRUG ABUSE ARENA INCLUDING AN ANNUAL AWARDS BANQUET SPONSORED AND ORGANIZED BY SERENITY LANE THAT RECOGNIZES OTHERS IN THE COMMUNITY THAT HAVE A SIGNIFICANT IMPACT IN THIS ARENA.3. SERENITY LANE HAS AN INTERNAL QUALITY ASSURANCE LICENSED STAFF TO PERFORM ROUTINE INSPECTIONS OF OTHER SIMILAR FACILITIES TO ENSURE THE ORGANIZATION IS UP TO DATE WITH THE LATEST PROCESSES AND TECHNOLOGY.4. SERENITY LANE PERFORMS ANNUAL PATIENT SURVEYS.5. SERENITY LANE ACCUMULATES PATIENT DATA BY GEOGRAPHICAL LOCATION WHICH HELPS ALIGN SERVICES WITH THE CURRENT NEED. |
| PART VI, LINE 3: | PATIENTS WITHOUT ADEQUATE RESOURCES ARE DIRECTED TO THE BUSINESS OFFICE TO APPLY FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | NEARLY ALL COMMUNITIES IN THE STATE OF OREGON AND VANCOUVER, WA. CONSTITUENTS SERVED ARE THE WORKING MEN AND WOMEN AND THEIR FAMILIES. |
| PART VI, LINE 5: | PROVIDING COMMUNITY EDUCATION AND RESOURCES REGARDING THE DISEASE OF CHEMICAL DEPENDENCY. THIS IS DONE THROUGH PARTICIPATION IN CONFERENCES, EDUCATING EMPLOYERS, NEWS ARTICLES AND OTHER COMMUNITY OUTREACH PRACTICES. |
| SCHEDULE H PART VI 501(R) DISCLOSURE | PURSUANT TO REV. PROC. 2015-21, SERENITY LANE (THE HOSPITAL) IS DISCLOSING THE FOLLOWING INFORMATION FOR FAILURES TO COMPLY WITH REGARD TO INTERNAL REVENUE CODE SECTION 501(R). TIMING OF DISCOVERY AND CORRECTION OF DEFICIENCIES: THE FOLLOWING FOUR ERRORS OR OMISSIONS WITH RESPECT TO SECTION 501(R) AND THE RELATED REGULATIONS WERE DISCOVERED AS A RESULT OF AN EXAMINATION WITH THE IRS FOR THE TAX YEAR ENDED MARCH 31, 2015. THE HOSPITAL RECEIVED INFORMATION DOCUMENT REQUESTS IN APRIL OF 2017 WITH RESPECT TO THE FORM 990 FILED FOR THE TAX YEAR ENDED MARCH 31, 2015. AT THE CLOSE OF THE EXAM ON DECEMBER 29, 2017 THE TAX RETURN WAS ACCEPTED AS FILED. CORRECTIONS WERE MADE BY FEBRUARY 2018 TO ADDRESS THE DEFICIENCIES NOTED.A) FINANCIAL ASSISTANCE POLICY (FAP)(1) DESCRIPTION OF FAILURE: THE HOSPITAL'S FAP DID NOT CONTAIN ADEQUATE PROVISIONS PURSUANT TO REGULATION 1.501(R)-4(B)(2) REGARDING: A) THE ELIGIBILITY REQUIREMENTS FOR FINANCIAL ASSISTANCE, B) THE METHOD AND FORMULA USED TO DETERMINE THE AMOUNT GENERALLY BILLED (AGB) FOR FAP ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, AND C) THE AGB CHARGE LIMITATION FOR FAP ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THIS FAILURE OCCURRED DUE TO THE ORGANIZATIONS LACK OF CLARITY, UNDERSTANDING, AND APPLICABILITY OF THE REGULATIONS TO THE ORGANIZATION.(2) DESCRIPTION OF CORRECTION: THE FAP WAS REVISED TO INCLUDE THE APPLICABLE PROVISIONS EFFECTIVE JANUARY 29, 2018. THE ORGANIZATION IS NOT AWARE OF ANY INDIVIDUALS WHO WERE AFFECTED BY THE DEFICIENCIES. THE FAP WAS REVISED AND IMPLEMENTED ON A PROSPECTIVE BASIS.(3) ESTABLISHMENT OR REVISION OF PRACTICES OR PROCEDURES: ALL REQUIREMENTS OF SECTION 501(R) AND THE RELATED REGULATIONS ARE NOW BEING MET, AND COMPLIANCE WILL BE MONITORED ON AN ONGOING BASIS AND WHENEVER CHANGES TO DOCUMENTS OCCUR.B) EMERGENCY MEDICAL CARE POLICY(1) DESCRIPTION OF FAILURE: THE HOSPITAL DID NOT HAVE A WRITTEN EMERGENCY MEDICAL CARE POLICY THAT MET THE REQUIREMENTS OF REGULATION 1.501(R)-4(C). THIS FAILURE OCCURRED DUE TO THE ORGANIZATIONS LACK OF CLARITY, UNDERSTANDING, AND APPLICABILITY OF THE REGULATIONS TO THE ORGANIZATION.(2) DESCRIPTION OF CORRECTION: THE EMERGENCY MEDICAL CARE POLICY WAS CREATED EFFECTIVE JANUARY 29, 2018. THE ORGANIZATION IS NOT AWARE OF ANY INDIVIDUALS WHO WERE AFFECTED BY THE DEFICIENCIES. THE EMERGENCY MEDICAL CARE POLICY WAS IMPLEMENTED ON A PROSPECTIVE BASIS.(3) ESTABLISHMENT OR REVISION OF PRACTICES OR PROCEDURES: ALL REQUIREMENTS OF SECTION 501(R) AND THE RELATED REGULATIONS ARE NOW BEING MET, AND COMPLIANCE WILL BE MONITORED ON AN ONGOING BASIS AND WHENEVER CHANGES TO DOCUMENTS OCCUR.C) WIDELY PUBLICIZING FAP DOCUMENTS(1) DESCRIPTION OF FAILURE: THE FAP OR CHARITY CARE POLICY, APPLICATION FORM, PLAIN LANGUAGE SUMMARY AND WRITE-OFF OF BAD DEBT POLICY WERE NOT AVAILABLE FOR FREE DOWNLOAD ON THE HOSPITAL'S WEBSITE. THIS FAILURE OCCURRED DUE TO THE ORGANIZATIONS LACK OF CLARITY, UNDERSTANDING, AND APPLICABILITY OF THE REGULATIONS TO THE ORGANIZATION.(2) DESCRIPTION OF CORRECTION: ALL APPLICABLE DOCUMENTS WERE MADE AVAILABLE ON THE HOSPITAL'S WEBSITE EFFECTIVE FEBRUARY 2018. THE ORGANIZATION IS NOT AWARE OF ANY INDIVIDUALS WHO WERE AFFECTED BY THE DEFICIENCIES. (3) ESTABLISHMENT OR REVISION OF PRACTICES OR PROCEDURES: ALL REQUIREMENTS OF SECTION 501(R) AND THE RELATED REGULATIONS ARE NOW BEING MET, AND COMPLIANCE WILL BE MONITORED ON AN ONGOING BASIS AND WHENEVER CHANGES TO DOCUMENTS OCCUR.D) WRITE-OFF OF BAD DEBT POLICY(1) DESCRIPTION OF FAILURE: THE WRITE-OFF OF BAD DEBT POLICY DID NOT INCLUDE ADEQUATE PROCESS AND TIME FRAME REQUIREMENTS PURSUANT TO REGULATION 1.501(R)-4(B)(4)(I)(B). THIS FAILURE OCCURRED DUE TO THE ORGANIZATIONS LACK OF CLARITY, UNDERSTANDING, AND APPLICABILITY OF THE REGULATIONS TO THE ORGANIZATION.(2) DESCRIPTION OF CORRECTION: THE WRITE-OFF OF BAD DEBT POLICY WAS REVISED TO INCLUDE THE APPLICABLE PROVISIONS EFFECTIVE JANUARY 29, 2018. THE ORGANIZATION IS NOT AWARE OF ANY INDIVIDUALS WHO WERE AFFECTED BY THE DEFICIENCIES. THE WRITE-OFF OF BAD DEBT POLICY WAS REVISED AND IMPLEMENTED ON A PROSPECTIVE BASIS.(3) ESTABLISHMENT OR REVISION OF PRACTICES OR PROCEDURES: ALL REQUIREMENTS OF SECTION 501(R) AND THE RELATED REGULATIONS ARE NOW BEING MET, AND COMPLIANCE WILL BE MONITORED ON AN ONGOING BASIS AND WHENEVER CHANGES TO DOCUMENTS OCCUR. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MIKE DYER | ||||||||||||||
| PRESIDENT & CEO | $0 | $177,660 | $0 | $0 | $0 | $0 | $0 | $5,330 | $0 | $17,646 | $0 | $200,636 | $0 | $0 |
| LARRY BRADLEY | ||||||||||||||
| VP OF DEVELOPMENT | $158,100 | $0 | $0 | $0 | $0 | $0 | $4,743 | $0 | $0 | $0 | $162,843 | $0 | $0 | $0 |
| ERIC GEISLER | ||||||||||||||
| DIRECTOR OF MEDICAL SERVICES | $188,523 | $0 | $0 | $0 | $0 | $0 | $5,656 | $0 | $6,138 | $0 | $200,317 | $0 | $0 | $0 |
| JOEL BREEN | ||||||||||||||
| PSYCHIATRIST | $200,640 | $0 | $0 | $0 | $0 | $0 | $6,019 | $0 | $6,138 | $0 | $212,797 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE PRESIDENT/CEO, VP OF FINANCE/ADMINISTRATION AND THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY REQUIRES A STATEMENT FILLED OUT AND SIGNED PERIODICALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | PRESIDENT/CEO COMPENSATION IS SET BY THE BOARD OF DIRECTORS USING DATA FROM COMPARABLE ORGANIZATIONS. VICE PRESIDENT COMPENSATION IS SET BY THE PRESIDENT/CEO USING USING DATA FROM COMPARABLE ORGANIZATIONS. COMPENSATION WAS LAST DETERMINED IN 2016. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SERENITY LANE HEALTH SERVICES | |||||||||||
| PO BOX 8549 | COBURG | OR | 97408 | 943113708 | ADMINISTRATIVE SUPPORT FOR SERENITY LANE | OR | 501(C)(3) | LINE 12A, I | N/A | 0 | |
| SERENITY LANE HEALTH SERVICES FOUNDATION | |||||||||||
| PO BOX 8549 | COBURG | OR | 97408 | 461684147 | FINANCIAL SUPPORT FOR SERENITY LANE | OR | 501(C)(3) | LINE 12A, I | 0 | SERENITY LANE HEALTH SERVICES | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| SERENITY LANE HEALTH SERVICES | ||
| D | $12,975,113 | CASH |
| SERENITY LANE HEALTH SERVICES | ||
| E | $1,000,000 | CASH |
| SERENITY LANE HEALTH SERVICES | ||
| K | $1,061,757 | CASH |
| SERENITY LANE HEALTH SERVICES | ||
| M | $1,300,000 | CASH |