2015-07-31T15:58:59-05:00 2014-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Suite 1300 Minneapolis MN 554027033 990 2014-01-01 133673215 Hazelden New York HAZE 6512134006 PO Box 11 Center City MN 55012 James Blaha Treasurer 6512134006 2015-07-31 1 Kim Hunwardsen CPA P00484560 6122536500 2015-07-30 2014 2016-02-25 16:41:14Z Mark Mishek PO Box 11 Center City MN 55012 3860710 0 X www.hazelden.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. 15 15 50 4 0 0 76206 258987 2897207 3595540 5749 -194930 0 0 2979162 3659597 0 0 0 0 2045190 2127821 0 0 27000 2982834 2947464 5028024 5075285 -2048862 -1415688 18273799 21882561 25762311 30786910 -7488512 -8904349 X Hazelden New York 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 and Los Angeles, California, Texas and Colorado. 0 0 3915285 3595540 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 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 enter 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 2014, the following number of people directly benefited from recovery services at Hazelden New York:Outpatient Treatment Adult: 388Outpatient Treatment Young Adult: 168Room and Board 51Total Patients Served 607Hazelden 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. 3915285 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 12 0 1 50 1 0 0 0 0 0 0 0 0 0 0 X 15 15 1 0 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 0 NY X James Blaha VP CFO and Administrative Officer 6512134006 15251 Pleasant Valley Road Center City MN 55012 William Paulsen Chair 5.00 0.00 X X 0 0 0 Thomas Bradley Member 1.00 0.00 X 0 0 0 Judy Collins Member 1.00 0.00 X 0 0 0 Valery Craane Member 1.00 0.00 X 0 0 0 Stacy Creamer Member 1.00 0.00 X 0 0 0 Paul L Gossling Member 1.00 2.00 X 0 0 0 Frank Greenagel Jr Member 1.00 0.00 X 0 0 0 Margaret Brennan Hassett Member 1.00 0.00 X 0 0 0 Leonard Holzer Member 1.00 0.00 X 0 0 0 Ronald Importico Member 1.00 0.00 X 0 0 0 Robert M Manocherian Member 1.00 0.00 X 0 0 0 Judith Davidson Moyers Member 1.00 0.00 X 0 0 0 Brooke Picotte Member 1.00 0.00 X 0 0 0 Charlie Rubenstein Member 1.00 0.00 X 0 0 0 W Christopher White Member 1.00 1.00 X 0 0 0 Mark Mishek President 5.00 55.00 X 0 741769 101222 James Blaha Secretary/Treasurer 3.00 53.00 X 0 352289 54291 Barbara Rachel Kistenmacher Exec Director New York 50.00 X 196156 0 29351 Kimberly Hoppes Dir Clinical Services 50.00 X 115052 0 4572 311208 1094058 189436 2 0 1 0 0 258987 258987 Recovery Services 621400 3595540 3595540 3595540 6183 6183 201113 -201113 -201113 -201113 3659597 3595540 0 -194930 225507 225507 1440654 1440654 79172 79172 265976 265976 116512 116512 227870 227870 116700 116700 394876 394876 33204 33204 3307 3307 744095 744095 Corporate support mgmt 1160000 1133000 27000 Provision for bad debt 144342 144342 Lab work 68825 68825 Purchased services 31159 31159 23086 23086 5075285 3915285 1133000 27000 263951 267791 26506 17751 277723 198214 86969 54886 13531294 2065839 11902801 11465455 5715849 9878464 18273799 21882561 196641 227863 25565670 30559047 25762311 30786910 X -7655831 -9246596 31106 206034 136213 136213 -7488512 -8904349 18273799 21882561 X -1415688 -149 X X 0 1 X 0 0 X 155625 219728 71030 76206 258987 781576 155625 219728 71030 76206 258987 781576 438840 342736 17556 5514 5439 5749 6183 40441 822017 12104837 0.41690 0.36180 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 135464 5316 6183 134597 120641 20572 5749 135464 109949 16131 5439 120641 119030 -3569 5512 109949 110902 14164 6036 119030 1.00000 0 1 1 12838328 1567611 11270717 655124 498228 156896 37842 37842 11465455 Intercompany Receivable 9878464 9878464 Intercompany Payables 30559047 30559047 X 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 during fiscal year 2014. Open tax years subject to examination by the U.S and state taxing authorities are for the years 2012 to 2014, which statutes expire in 2015 to 2017, respectively. 0 1 0 0 0 0 0 0 0 Mark Mishek President 0 503336 0 232889 0 5544 0 78096 0 24807 0 844672 0 0 James Blaha Secretary/Treasurer 0 260370 0 90119 0 1800 0 34815 0 20555 0 407659 0 0 Barbara Rachel Kistenmacher Exec Director New York 189091 0 6661 0 404 0 13393 0 16812 0 226361 0 0 0 Part I, Line 3 Hazelden New York relies on a related entity, Hazelden Betty Ford Foundation, to determine the compensation for the CEO. Part I, Line 4b Mark Mishek, President and CEO, participated in a nonqualified retirement plan in the amount of $42,396. 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 the Hazelden Betty Ford Foundation. Therefore, business relationships exist between these individuals. 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. As a regional board, Hazelden New York can submit candidates to the Hazelden Betty Ford Foundation Board for approval. Form 990, Part VI, Section A, line 7b Some decisions made by the regional Board of Hazelden New York are subject to approval by the Hazelden Betty Ford Foundation Board of Trustees, sole member 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 11 Hazelden New York sent its Form 990, with Schedule B suppressed, via email to Board members for review and questions prior to filing. It was also reviewed by the CFO and the General Counsel of Hazelden Betty Ford Foundation, sole member of Hazelden New York, 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 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 CEO was most recently done in March of 2015. The compensation review for other officers and key employees was completed in April 2015. 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.hazelden.org. The governing documents and conflict of interest policy are not available for public inspection. Form 990, Part XI, line 9: Rounding -149. 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 The Betty Ford Center PO Box 11 Center City MN 55012 953863994 Addiction recovery services, family and childrens programs, training CA 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