2015-01-26T15:57:44-06:00 2014-03-31 910189318 MOSS ADAMS LLP 975 OAK STREET SUITE 500 EUGENE OR 97401 990 2013-04-01 930606316 SERENITY LANE SERE 5414842156 2133 CENTENNIAL PLAZA EUGENE OR 97401 MIKE DYER PRESIDENT AND CEO 5414842156 2015-01-15 1 WENDY CAMPOS P00448102 5416861040 2013 2016-02-25 16:41:14Z MIKE DYER 2133 CENTENNIAL PLAZA EUGENE OR 97401 13065819 0 X WWW.SERENITYLANE.ORG X 1973 OR TREATMENT OF THE DISEASE OF CHEMICAL DEPENDENCY 8 8 185 8 0 0 6534 5975 12757441 13057459 2448 2385 122786 0 12889209 13065819 0 0 0 0 7866902 8266577 0 0 336665 4977612 4877524 12844514 13144101 44695 -78282 4502173 4800783 3494678 3871570 1007495 929213 PROVIDING A HEALING ENVIRONMENT IN WHICH CHEMICALLY DEPENDENT INDIVIDUALS AND THEIR FAMILIES DISCOVER AN ENHANCED QUALITY OF LIFE THROUGH LONG-TERM RECOVERY FROM ADDICTIONS. 0 0 12580652 13057459 TREATMENT OF CHEMICAL DEPENDENCY THROUGH INPATIENT AND RESIDENTIAL SERVICES. 12580652 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 43 0 1 185 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X DUSTIN STAPLETON 5412848617 2133 CENTENNIAL PLAZA EUGENE OR 97401 JOHN DUNPHY CHAIRMAN 1.00 1.00 X X 0 0 0 JOHN LIPKIN VICE CHAIRMAN 0.50 0.50 X X 0 0 0 MIKE KEHOE TREASURER 0.50 0.50 X X 0 0 0 KATE KLOOS SECRETARY 0.50 0.50 X X 0 0 0 LARRY OLSEN MEMBER 0.50 0.50 X 0 0 0 REV JOHN KERNS MEMBER 0.50 0.50 X 0 0 0 TIM DANFORTH MEMBER 0.50 0.50 X 0 0 0 CINDY WEINHOLD MEMBER 0.50 0.50 X 0 0 0 MIKE DYER PRESIDENT & CEO 1.00 40.00 X 0 137742 24224 KAREN WILLOCK VP OF CLINICAL SERVICES 1.00 40.00 X 0 93046 4652 PETER ASMUTH FORMER PRESIDENT & CEO 0.50 40.00 X 0 176792 48010 RONALD SCHWERZLER MEDICAL DIRECTOR 40.00 0.00 X 189733 0 26213 MICHAEL SCHWARTZ DOCTOR 40.00 0.00 X 174691 0 25461 JOSH BOLTON CHIEF INFORMATION OFFICER 40.00 0.00 X 103288 0 5164 467712 407580 133724 3 0 1 0 0 5975 5975 MEDICAL TREATMENT FOR 621400 12928828 12928828 FINANCE CHARGE 621400 128631 128631 13057459 2385 2385 13065819 13057459 0 2385 427603 342082 85521 5471105 5171917 109369 189819 241334 233594 7740 1586148 1541710 44438 540387 505530 11893 22964 1300000 1300000 20001 20001 159665 130868 28797 502267 491798 10469 543329 526353 16976 1234480 1234480 75255 68562 6693 30711 29427 1284 DIETARY SUPPLIES 412832 412832 LAB FEES 179339 179339 TAXES AND LICENSES 141149 135246 5903 HOUSEKEEPING AND LINEN 111157 111157 167339 165757 1582 13144101 12580652 226784 336665 2655 2655 3116837 2742403 1242025 1884076 140656 171649 4502173 4800783 3494678 3871570 3494678 3871570 X 1007495 929213 1007495 929213 4502173 4800783 -78282 0 X 0 1 X 1 0 X 0 X PART X, LINE 2: 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 HAVE 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. 1 1 0 0 1 1 0 1 1 347 427716 427716 0.03260 347 427716 427716 0.03260 138 6107 231104 231104 0.01760 1 73103 73103 0.00560 139 6107 304207 304207 0.02320 139 6454 731923 731923 0.05580 0 39026 0 1 0 1 1 SERENITY LANE 616 E 16TH AVENUE EUGENE OR 97401 X SERENITY LANE 1 1 X X X X X X X 12 1 0 1 X X X X 1 0 1 0 0 1 X X X X 1 1 X 1 X X X 1 X X X X X X 0 X X 0 0 SERENITY LANE PART V, SECTION B, LINE 3: THE HOSPITAL CONSULTED WITH RESPECTED COMMUNITY MEMBERS AND INCLUDED THEIR COMMENTARY IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL CONSULTED WITH WENDY H PARK, PMHCNS-PP, PH.D, CLINICAL SUPERVISOR OF MENTAL HEALTH SERVICES FOR THE UNIVERSITY OF OREGON HEALTH CENTER AND CANDACE LANGHOUSE, PEACEHEALTH HUMAN RESOURCES AT SACRED HEART MEDICAL CENTER. SERENITY LANE PART V, SECTION B, LINE 10: PATIENT'S PROVIDE DOCUMENTATION TO SUPPORT INCOME AND EXPENSES. THIS INFORMATION IS USED TO DETERMINE THE LEVEL OF FINANCIAL ASSISTANCE. SERENITY LANE PART V, SECTION B, LINE 20D: CHARGES TO FAP ELIGIBLE PATIENTS ARE DETERMINED BASED ON FINANCIAL NEED ON A CASE BY CASE BASIS. 9 SERENITY LANE 1050 PRICE ROAD SE ALBANY OR 97322 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 601 NW HARMON BLVD BEND OR 97701 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 10920 SW BARBUR BLVD PORTLAND OR 97219 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 12662 SE STARK STREET PORTLAND OR 97233 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 1800 NW 167TH PL BEAVERTON OR 97006 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 2575 NW KLINE STREET ROSEBURG OR 97471 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 1885 FISHER ROAD NE SALEM OR 97305 OUTPATIENT REHABILITATION CLINIC SERENITY LANE - NEW HOPE 2133 CENTENNIAL PLAZA EUGENE OR 97401 OUTPATIENT REHABILITATION CLINIC SERENITY LANE 4305 NE THURSTON WAY VANCOUVER WA 98662 OUTPATIENT REHABILITATION CLINIC PART I, LINE 3C: PATIENTS WHO REQUEST FINANCIAL ASSISTANCE ARE ASKED TO COMPLETE A FINANCIAL STATEMENT DESCRIBING THEIR SOURCES OF INCOME AND ALL EXPENSES. EACH DETAIL OF EACH APPLICATION IS REVIEWED AND A DECISION IS MADE WHETHER TO PROVIDE A CHARITY CARE DISCOUNT WITHIN THE FINANCIAL CAPABILITIES OF ORGANIZATION. PART I, LN 7 COL(F): X PART III, LINE 4: THE ORGANIZATION UTILIZES THE ALLOWANCE METHOD TO ACCOUNT FOR BAD DEBTS BASED UPON EVALUATION OF ACCOUNTS RECEIVABLE, ANALYSIS OF HISTORICAL DATA AND EXISTING ECONOMIC CONDITIONS. THE ORGANIZATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND FOR ADMINISTRATIVE ADJUSTMENTS THAT IS BASED UPON REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. DISCOUNTS AND PAYMENTS ARE APPLIED TO PATIENT ACCOUNTS PRIOR TO RECORDING ANY BAD DEBT EXPENSE. 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 SURVEYS5. 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. X 1 1 0 0 0 0 0 0 0 1 0 MIKE DYER PRESIDENT & CEO 0 137742 0 0 0 0 0 6887 0 17337 0 161966 0 0 PETER ASMUTH FORMER PRESIDENT & CEO 0 176792 0 0 0 0 0 28840 0 19170 0 224802 0 0 RONALD SCHWERZLER MEDICAL DIRECTOR 189733 0 0 0 0 0 9487 0 16726 0 215946 0 0 0 MICHAEL SCHWARTZ DOCTOR 174691 0 0 0 0 0 8735 0 16726 0 200152 0 0 0 PART I, LINE 1A COUNTRY CLUB DUES ARE PAID ON BEHALF OF MIKE DYER, PRESIDENT & CEO. THE COUNTRY CLUB IS USED FOR BUSINESS MEETINGS AND FOR DEVELOPMENT AND FUNDRAISING PURPOSES. PART I, LINE 7 CEO & PRESIDENT RECEIVED A $15,000 BONUS AS APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVEIWED BY THE CFO, CEO AND THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THROUGH A CONFLICT OF INTEREST STATEMENT FILLED OUT AND SIGNED ANNUALLY FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION IS SET BY THE BOARD OF DIRECTORS USING DATA FROM COMPARABLE ORGANIZATIONS. VICE PRESIDENT'S COMPENSATION IS SET BY THE CEO USING THE SAME METHOD. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST SERENITY LANE HEALTH SERVICES 2133 CENTENNIAL PLAZA EUGENE OR 97401 943113708 ADMINISTRATIVE SERVICE AND SUPPORT FOR SERENITY LANE OR 501(C)(3) 509(A)(3) TYPE I SERENITY LANE 0 SERENITY LANE HEALTH SERVICES FOUNDATION 2133 CENTENNIAL PLAZA EUGENE OR 97401 461684147 FINANCIAL SUPPORT FOR SERENITY LANE OR 501(C)(3) 509(A)(3) TYPE I SERENITY LANE 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 1 1 SERENITY LANE HEALTH SERVICES K 917714 CASH SERENITY LANE HEALTH SERVICES M 1300000 CASH