HAZELDEN NEW YORK: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- HAZELDEN NEW YORK (EIN 13-3673215)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-07-26
- IRS object ID
- 201722079349300742
- Schema version
- 2016v3.0
- 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 | 2017-07-26T13:54:26-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Suite 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 133673215 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hazelden New York | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HAZE | BusinessNameControlTxt |
| Phone | 6512134006 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 11 | AddressLine1Txt |
| City | Center City | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55012 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James Blaha | PersonNm |
| Person Title | Treasurer | PersonTitleTxt |
| Phone | 6512134006 | PhoneNum |
| Signature | 2017-07-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2017-07-24 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 198.135.125.113 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-07-24 | IPDt |
| IP Tm | 08:13:01 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C7C8DB9543014370B6E09D707AD0C123D6D8C430 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 3F9C168A740BFE5F5D76151F12AACC9E0EB7B57C | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Mark Mishek | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 11 | AddressLine1Txt |
| City | Center City | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55012 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,568,258 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.hazeldenbettyford.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | NY | LegalDomicileStateCd |
| Activity Or Mission | Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 54 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $337,413 | PYContributionsGrantsAmt |
| CY Contributions Grants | $296,189 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,830,662 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,248,509 | CYProgramServiceRevenueAmt |
| PY Investment Income | $6,410 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,424 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | -$6,435 | CYOtherRevenueAmt |
| PY Total Revenue | $4,174,485 | PYTotalRevenueAmt |
| CY Total Revenue | $4,544,687 | 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 | $2,317,019 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,204,223 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $326,720 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,162,124 | PYOtherExpensesAmt |
| CY Other Expenses | $4,031,787 | CYOtherExpensesAmt |
| PY Total Expenses | $5,479,143 | PYTotalExpensesAmt |
| CY Total Expenses | $6,236,010 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,304,658 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,691,323 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,852,118 | TotalAssetsBOYAmt |
| Total Assets EOY | $30,137,809 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $36,061,337 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $42,029,042 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$10,209,219 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$11,891,233 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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, West Los Angeles and San Diego, California; Irving, Texas; and Aurora, Colorado. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,370,429 | ExpenseAmt |
| Revenue | $4,248,509 | RevenueAmt |
| Desc | Recovery ServicesCaring experts at Hazelden New York deliver a wide array of recovery services to men and women needing treatment for alcohol and other drug addiction. 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'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 2016, the following number of people directly benefited from recovery services at Hazelden New York: Outpatient Treatment Adult: 493 Outpatient Treatment Young Adult: 193Recovery Housing: 10 TOTAL PATIENTS SERVED 696Hazelden 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. | Desc |
| Total Program Service Expenses | $4,370,429 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| 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 |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 54 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| 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 | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | 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 | Yes (1) | 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 | NY | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James Blaha VP Chief Financial & Administrative Officer | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6512134006 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15251 Pleasant Valley Road | AddressLine1Txt |
| City | Center City | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55012 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| William Paulsen | ||||||||
| Chair - served part year | 5.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Mark Mishek | ||||||||
| President & CEO/Chair | 5.00 | 55.00 | Yes (X) | Yes (X) | $0 | $596,474 | $80,424 | |
| James Blaha | ||||||||
| Treasurer | 5.00 | 55.00 | Yes (X) | Yes (X) | $0 | $331,247 | $48,712 | |
| Jennifer Lohse | ||||||||
| Secretary | 5.00 | 55.00 | Yes (X) | Yes (X) | $0 | $196,668 | $43,708 | |
| Judy Collins | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Valery Craane | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Paul Gossling | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Margaret Brennan Hassett | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Leonard Holzer | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Robert Manocherian | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Judith Davidson Moyers | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Brooke Picotte | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Charlie Rubenstein | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Thomas Bradley | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ronald Importico | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Frank Greenagel Jr | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| John Murphy | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Madeline Redstone | ||||||||
| Member - served part year | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Barbara Littman | ||||||||
| Member - served part year | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kimberly Hoppes | ||||||||
| Dir. Clinical Services | 50.00 | 0.00 | $122,188 | $0 | $4,238 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $122,188 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,124,389 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $177,082 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | 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 |
| Fundraising | $75,244 | FundraisingAmt |
| All Other Contributions | $220,945 | AllOtherContributionsAmt |
| Total Contributions | $296,189 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Recovery Services | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $4,248,509 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,248,509 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,248,509 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,424 | TotalRevenueColumnAmt |
| Exclusion | $6,424 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $17,136 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $75,244 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $23,571 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,435 | TotalRevenueColumnAmt |
| Exclusion | -$6,435 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,544,687 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,248,509 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$11 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,684,611 | TotalAmt |
| Program Services | $1,684,611 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,841 | TotalAmt |
| Program Services | $86,841 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $302,734 | TotalAmt |
| Program Services | $302,734 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,037 | TotalAmt |
| Program Services | $130,037 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,346 | TotalAmt |
| Program Services | $428,346 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,216 | TotalAmt |
| Program Services | $136,216 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $424,157 | TotalAmt |
| Program Services | $424,157 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,808 | TotalAmt |
| Program Services | $40,808 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,400 | TotalAmt |
| Program Services | $1,400 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $640,747 | TotalAmt |
| Program Services | $640,747 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|---|
| Corporate Support Manag | $1,865,581 | $1,538,861 | $326,720 | |
| Provision for Bad Debt | $274,147 | $274,147 | ||
| Lab Work | $113,901 | $113,901 | ||
| Resident Services | $36,752 | $36,752 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,732 | TotalAmt |
| Program Services | $69,732 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,236,010 | TotalAmt |
| Program Services | $4,370,429 | ProgramServicesAmt |
| Management And General | $1,538,861 | ManagementAndGeneralAmt |
| Fundraising | $326,720 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,041 | BOYAmt |
| EOY | $90,088 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,895 | BOYAmt |
| EOY | $1,500 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $304,682 | BOYAmt |
| EOY | $448,669 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,379 | BOYAmt |
| EOY | $49,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $13,683,855 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,348,415 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,957,308 | BOYAmt |
| EOY | $10,335,440 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,466,813 | BOYAmt |
| EOY | $19,212,365 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,852,118 | BOYAmt |
| EOY | $30,137,809 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $254,989 | BOYAmt |
| EOY | $225,505 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,806,348 | BOYAmt |
| EOY | $41,803,537 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,061,337 | BOYAmt |
| EOY | $42,029,042 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$10,636,419 | BOYAmt |
| EOY | -$12,214,660 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,987 | BOYAmt |
| EOY | $187,214 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,213 | BOYAmt |
| EOY | $136,213 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$10,209,219 | BOYAmt |
| EOY | -$11,891,233 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,852,118 | BOYAmt |
| EOY | $30,137,809 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,691,323 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $9,309 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $71,030 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $76,206 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $258,987 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $337,413 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $296,189 | CurrentTaxYearAmt |
| Total | $1,039,825 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,559,052 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,897,207 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,595,540 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,830,662 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,248,509 | CurrentTaxYearAmt |
| Total | $17,130,970 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,630,082 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,973,413 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,854,527 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,168,075 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,544,698 | CurrentTaxYearAmt |
| Total | $18,170,795 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $50,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $30,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $40,000 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $67,713 | CurrentTaxYearAmt |
| Total | $197,713 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $164,358 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $170,406 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $95,682 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $84,002 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $20,467 | CurrentTaxYearAmt |
| Total | $534,915 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $214,358 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $180,406 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $125,682 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $124,002 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $88,180 | CurrentTaxYearAmt |
| Total | $732,628 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $17,438,167 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,439 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,749 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,183 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,410 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,424 | CurrentTaxYearAmt |
| Total | $30,205 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $5,439 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,749 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,183 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,410 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,424 | CurrentTaxYearAmt |
| Total | $30,205 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,635,521 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,979,162 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,860,710 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,174,485 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,551,122 | CurrentTaxYearAmt |
| Total | $18,201,000 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.95810 | PublicSupportCY509Pct |
| Public Support PY509 | 0.95260 | PublicSupportPY509Pct |
| Investment Income CY | 0.00170 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00190 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $123,692 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $9,167 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,424 | OtherExpendituresAmt |
| End Year Balance | $126,435 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $134,597 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$4,495 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,410 | OtherExpendituresAmt |
| End Year Balance | $123,692 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $135,464 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $5,316 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $6,183 | OtherExpendituresAmt |
| End Year Balance | $134,597 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $120,641 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $20,572 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,749 | OtherExpendituresAmt |
| End Year Balance | $135,464 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $109,949 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $16,131 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $5,439 | OtherExpendituresAmt |
| End Year Balance | $120,641 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,574,415 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,497,985 | DepreciationAmt |
| Book Value | $10,076,430 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,109,440 | OtherCostOrOtherBasisAmt |
| Depreciation | $850,430 | DepreciationAmt |
| Book Value | $259,010 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,335,440 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Intercompany Receivables | Desc |
| Book Value | $19,212,365 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $19,212,365 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Intercompany Payables | Desc |
| Amt | $41,803,537 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $41,803,537 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | Earnings from the endowment funds are used to provide financial aid to qualified patients. |
| Part X, Line 2: | In accordance with the accounting standard on Accounting for Uncertainty in Income Taxes, 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 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, 2016 and 2015. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | Golf Tournament | Event1Nm |
| Gross Receipts Event1 | $92,380 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $75,244 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $17,136 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $8,140 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $9,124 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $6,307 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $92,380 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $75,244 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $17,136 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $8,140 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $9,124 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $6,307 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $23,571 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$6,435 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mark Mishek | ||||||||||||||
| President & CEO/Chair | $0 | $552,541 | $0 | $32,465 | $0 | $11,468 | $0 | $56,809 | $0 | $26,434 | $0 | $679,717 | $0 | $0 |
| James Blaha | ||||||||||||||
| Treasurer | $0 | $315,424 | $0 | $12,536 | $0 | $3,287 | $0 | $28,576 | $0 | $22,279 | $0 | $382,102 | $0 | $0 |
| Jennifer Lohse | ||||||||||||||
| Secretary | $0 | $191,624 | $0 | $4,768 | $0 | $276 | $0 | $12,176 | $0 | $32,968 | $0 | $241,812 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $22,909. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2 | Officers are employed by Hazelden Betty Ford Foundation, a related exempt organization. Certain members of the board are also board members of Hazelden Betty Ford Foundation. Therefore, business relationships exist between these individuals. This only applies from January - September 2016 when the bylaws were changed. |
| Form 990, Part VI, Section A, line 4 | The Bylaws of Hazelden New York were amended in September, 2016 to modify the reserve powers granted to Hazelden New York from its wholly-owned parent, Hazelden Betty Ford Foundation. Three of the current board members are officers of Hazelden Betty Ford Foundation. |
| 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 February of 2017. The compensation review for other officers and key employees will be completed in July 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 9,309. |
| 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. |
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | Hazelden Betty Ford Foundation | |
| 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 | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | 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 |