2018-08-09T15:20:30-05:00 2017-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Suite 1300 Minneapolis MN 554027033 990 2017-01-01 133673215 Hazelden New York HAZE 6512134006 PO Box 11 Center City MN 55012 James Blaha Treasurer 6512134006 2018-08-09 1 Kim Hunwardsen CPA P00484560 6122536500 2018-08-09 2017 2022-09-23 18:48:47Z Mark Mishek PO Box 11 Center City MN 55012 3522019 0 X www.hazeldenbettyford.org X 1992 NY Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. 3 0 46 6 0 0 296189 436296 4248509 3070401 6424 6516 -6435 -18991 4544687 3494222 0 0 0 0 2204223 2065908 0 0 168989 4031787 3582786 6236010 5648694 -1691323 -2154472 30137809 33391372 42029042 47420496 -11891233 -14029124 X Hazelden New York (in the Tribeca and Chelsea neighborhoods) is a vital affiliated entity of the Hazelden Betty Ford Foundation with its mission to be a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. This is accomplished through a commitment to treatment, publishing, education, research, public education and advocacy, and shared learning with other organizations. Hazelden New York provides addiction recovery services, including outpatient programs, sober residence, and continuing care services for addicted people and their families in New York City, New York; and has affiliated entities in Center City, Chaska, Maple Grove, Plymouth, and St. Paul, Minnesota; Chicago, Illinois; Naples, Florida; Beaverton and Springbrook, Oregon; Newton, Massachusetts; and the Betty Ford Center in Rancho Mirage, Los Angeles and San Diego, California; Dallas, Texas; and Denver, Colorado. 0 0 3974991 3070401 Recovery ServicesCaring experts at Hazelden New York deliver a wide array of recovery services to men and women needing treatment for addiction to alcohol and other drugs. Hazelden New York offers outpatient treatment services, including assessment and evaluation, adult nonresidential day treatment, continuing care programs, family programs, sober living facilities and alumni services. The facility is the center for Hazelden Betty Ford's programs and services in the greater New York City area, while also serving as an access point to all of Hazelden Betty Ford's resources.University students face one of the biggest obstacles to recovery of any group: finding like-minded peers who are willing to take the clean and sober route through their college careers. To help form the bridge to a new life, Hazelden opened Tribeca Twelve, a collegiate recovery residence in New York City's vibrant Tribeca neighborhood, for 18- to 29-year-olds who attend or plan to attend college. Students find a supportive environment that fosters friendships for life with peers who understand the struggles of recovery and are eager to celebrate their successes. In 2017, the following number of people directly benefited from recovery services at Hazelden New York: Outpatient Treatment Adult: 426 Outpatient Treatment Young Adult: 121Mental Health Services Adult: 118Mental Health Services Young Adult: 35Recovery Housing: 14 TOTAL PATIENTS SERVED 714Hazelden New York also hosted alumni events and related services and made its facility available for groups to hold recovery-related meetings. The facility is used by other groups for networking and educational opportunities. A non-governance "council" was organized in 2016, named Hazelden Betty Ford New York Council, comprised of former board members and other community members to advise on recovery events, community needs, alumni relations, and philanthropic opportunities in the community served by Hazelden New York. 3974991 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 10 0 1 46 1 0 0 0 0 0 1 1 0 0 0 0 X 3 0 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 NY X James Blaha VP Chief Financial & Administrative Officer 6512134006 15251 Pleasant Valley Road Center City MN 55012 Mark Mishek President and CEO/Chair 5.00 55.00 X X 0 589217 67759 James Blaha Treasurer 5.00 55.00 X X 0 320451 50817 Jennifer Lohse Secretary 5.00 55.00 X X 0 197186 44605 Christopher Yadron Executive Director, New York 50.00 45.00 X 150958 51859 57552 150958 1158713 220733 1 0 1 0 0 81819 354477 436296 Recovery Services 621400 3070401 3070401 3070401 6516 6516 8806 81819 27797 -18991 -18991 3494222 3070401 0 -12475 188147 188147 1428483 1428483 71438 71438 262773 262773 115067 115067 450217 450217 82792 82792 438041 438041 24486 24486 572208 572208 Corporate Support Manag 1673703 1504714 168989 Bad Debt 133342 133342 Lab Work 91616 91616 Program/Client Supplies 37480 37480 78901 78901 5648694 3974991 1504714 168989 90088 95050 1500 448669 280433 49747 49747 13683855 3920622 10335440 9763233 19212365 23202909 30137809 33391372 225505 387462 41803537 47033034 42029042 47420496 X -12214660 -14439362 187214 274025 136213 136213 -11891233 -14029124 30137809 33391372 X -2154472 16581 X X 0 1 X 0 0 X 76206 258987 337413 296189 436296 1405091 2897207 3595540 3830662 4248509 3070401 17642319 2973413 3854527 4168075 4544698 3506697 19047410 10000 30000 40000 67713 35000 182713 170406 95682 84002 20467 21566 392123 180406 125682 124002 88180 56566 574836 18472574 5749 6183 6410 6424 6516 31282 5749 6183 6410 6424 6516 31282 2979162 3860710 4174485 4551122 3513213 19078692 0.96820 0.95810 0.00160 0.00170 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 126435 12943 6520 132858 123692 9167 6424 126435 134597 -4495 6410 123692 135464 5316 6183 134597 120641 20572 5749 135464 0.00000 1.00000 0.00000 0 1 1 12574415 3018712 9555703 1109440 901910 207530 9763233 Intercompany receivables 23202909 23202909 Intercompany payables 47033034 47033034 X Part V, Line 4: Earnings from the endowment funds are used to provide financial aid to qualified patients. Part X, Line 2: In accounting for uncertain tax positions, the Foundation addresses the determination of whether tax benefits claimed on a tax return should be recorded in the financial statements. Under this guidance, the Foundation may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merit of the position. Examples of tax positions include the tax-exempt status of the Foundation and various tax positions related to the potential sources of unrelated business taxable income. There were no unrecognized tax benefits identified or recorded as liabilities, as of December 31, 2017 and 2016. Golf Tournament 90625 81819 8806 13441 8364 5992 90625 81819 8806 13441 8364 5992 27797 -18991 0 1 0 0 0 0 0 0 0 Mark Mishek President and CEO/Chair 0 582542 0 0 0 6675 0 43338 0 24421 0 656976 0 0 James Blaha Treasurer 0 317068 0 0 0 3383 0 26040 0 24777 0 371268 0 0 Jennifer Lohse Secretary 0 196914 0 0 0 272 0 12552 0 32053 0 241791 0 0 Christopher Yadron Executive Director, New York 130647 45673 20000 0 311 6186 12268 0 26255 19029 189481 70888 0 0 Part I, Line 3 Hazelden New York relies on a related entity, Hazelden Betty Ford Foundation, to determine the compensation of the CEO. Part I, Line 4b Mark Mishek, President and CEO, participated in a nonqualified retirement plan in the amount of $9,138. Form 990, Part VI, Section A, Line 1b: Board members are employees of Hazelden Betty Ford Foundation and therefore are not independent. However, the Hazelden Betty Ford Foundation Board of Trustees is comprised of only independent board members and the board appoints the members of the New York board and provides oversight of their activities. Form 990, Part VI, Section A, line 6 Hazelden Betty Ford Foundation is the sole member of Hazelden New York. Form 990, Part VI, Section A, line 7a As the sole member, Hazelden Betty Ford Foundation will elect all members of the governing body of Hazelden New York. Form 990, Part VI, Section A, line 8b Hazelden New York has no committee that has authority to act on behalf of its Board of Trustees. Form 990, Part VI, Section B, line 11b Hazelden New York sent its Form 990 via email to Board members for review and questions prior to filing. Form 990, Part VI, Section B, line 12c Hazelden Betty Ford Foundation, the sole member of Hazelden New York, monitors and enforces compliance with the conflict of interest policy. If a board member does disclose a potential conflict, that person excuses him or herself from voting on a particular issue. All new board members are provided conflict of interest education and periodic training throughout their term. All board members sign an annual conflict of interest disclosure form. Form 990, Part VI, Section B, line 15 Hazelden Betty Ford Foundation has an established process for determining the compensation of the President and CEO, other officers and key employees. The Hazelden Betty Ford Foundation by-laws delegate responsibility for determining compensation for the President and CEO, other officers and key employees to the Executive Committee of the Board of Trustees. The Executive Committee develops, reviews, and modifies, as necessary, the compensation philosophy for Hazelden Betty Ford Foundation. Each year the Board members complete a conflict of interest disclosure. The documents are reviewed by Hazelden Betty Ford's General Counsel and if a Board member has a conflict of interest they are not involved in any compensation decisions. The Executive Committee engages the use of an outside independent compensation consultant to identify comparable market data for comparable positions for the President and CEO and other disqualified individuals consistent with the approved compensation philosophy. Generally the market analysis includes competitive data from published survey sources, supplemented with compensation data from custom 990 analyses. Where possible, competitive data are pulled from similarly sized organizations. The compensation consultant analyzes the pay packages of the President and CEO and other disqualified individuals by reviewing base salary, total cash compensation (salary plus annual incentive at both target and actual levels) and total direct compensation (salary plus annual and long-term incentive). In addition, every two to three years the Executive Committee reviews the total compensation package of the President and CEO and other disqualified individuals. The total compensation package includes total direct compensation plus severance, employee benefits, perquisites and any other pay. Comparable market data are reviewed and discussed by the Executive Committee and minutes record those discussions and any resulting compensation decisions. A compensation review for the President and CEO was most recently done in March of 2018. The compensation review for other officers and key employees was completed in August 2017. Form 990, Part VI, Section C, line 19 Hazelden Betty Ford Foundation, the sole member of Hazelden New York, makes its annual report available to the public via its website at www.hazeldenbettyford.org. The governing documents and conflict of interest policy are not available for public inspection. Form 990, Part XI, line 9: Net assets released-intercompany transactions 16,581. Form 990, Part XII, Line 2c: Hazelden New York does not have a committee that assumes responsibility for oversight of the audit. However, as the sole member, Hazelden Betty Ford Foundation's audit committee assumes the oversight responsibility for the consolidated audit of the Foundation and its related entities and the selection of the independent accounting firm. Hazelden Betty Ford Foundation PO Box 11 Center City MN 55012 410682405 Recovery services, publishing, higher education and training MN 501(c)3 3 N/A 0 Hazelden Chicago PO Box 11 Center City MN 55012 364099403 Addiction recovery services, including outpatient, sober residence IL 501(c)3 3 Hazelden Betty Ford Foundation 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0