STRATEGY STUDIO / PUBLIC DATA EXPLORER

SERENITY LANE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SERENITY LANE (EIN 93-0606316)
Tax period
2012-04-01 to 2013-03-31
Filed
2014-01-28
IRS object ID
201400289349300440
Schema version
2012v2.1
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

FieldValueIRS element (for citing)
Timestamp2014-01-28T15:05:42-06:00Timestamp
Tax Period End Date2013-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN910189318EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1975 OAK STREET SUITE 500AddressLine1
CityEUGENECity
StateORState
ZIP Code97401ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930606316EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SERENITY LANEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSERENameControl
Phone5414842156Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12133 CENTENNIAL PLAZAAddressLine1
CityEUGENECity
StateORState
ZIP Code97401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMIKE DYERName
TitlePRESIDENT AND CEOTitle
Phone5414842156Phone
Date Signed2014-01-28DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRAY L WIDMER IIIName
PTINP01236627PTIN
Phone5416861040Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMIKE DYERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12133 CENTENNIAL PLAZAAddressLine1
CityEUGENECity
StateORState
ZIP Code97401ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12889209GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SERENITYLANE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTREATMENT OF THE DISEASE OF CHEMICAL DEPENDENCYActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees187TotalNbrEmployees
Total Nbr Volunteers7TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year11919ContributionsGrantsPriorYear
Contributions Grants Current Year6534ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12736410ProgramServiceRevenuePriorYear
Program Service Revenue CY12757441ProgramServiceRevenueCY
Investment Income Prior Year7336InvestmentIncomePriorYear
Investment Income Current Year2448InvestmentIncomeCurrentYear
Other Revenue Prior Year120466OtherRevenuePriorYear
Other Revenue Current Year122786OtherRevenueCurrentYear
Total Revenue Prior Year12876131TotalRevenuePriorYear
Total Revenue Current Year12889209TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8077303SalariesEtcPriorYear
Salaries Etc Current Year7866902SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year346460TotalFundrsngExpCurrentYear
Other Expense Prior Year5149024OtherExpensePriorYear
Other Expenses Current Year4977612OtherExpensesCurrentYear
Total Expenses Prior Year13226327TotalExpensesPriorYear
Total Expenses Current Year12844514TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-350196RevenuesLessExpensesPriorYear
Revenues Less Expenses CY44695RevenuesLessExpensesCY
Total Assets BOY3106128TotalAssetsBOY
Total Assets EOY4502173TotalAssetsEOY
Total Liabilities BOY2143326TotalLiabilitiesBOY
Total Liabilities EOY3494678TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY962802NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1007495NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDING A HEALING ENVIRONMENT IN WHICH CHEMICALLY DEPENDENT INDIVIDUALS AND THEIR FAMILIES DISCOVER AN ENHANCED QUALITY OF LIFE THROUGH LONG-TERM RECOVERY FROM ADDICTIONS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense12498054Expense
Revenue12880227Revenue
DescriptionTREATMENT OF CHEMICAL DEPENDENCY THROUGH INPATIENT AND RESIDENTIAL SERVICES.Description
Total Program Service Expense12498054TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109640NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees187NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DUSTIN STAPLETONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5412848617TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12133 CENTENNIAL PLAZAAddressLine1
CityEUGENECity
StateORState
ZIP Code97401ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
LARRY OLSON
DIRECTOR0.500.50X000
LARRY BRADLEY
CHAIRMAN1.001.00X000X
JOHN DUNPHY
SECRETARY0.500.50X000X
MIKE KEHOE
TREASURER0.500.50X000X
KATE KLOOS
DIRECTOR0.500.50X000
JOHN LIPKIN
VICE CHARIMAN0.500.50X000X
REV JOHN KERNS
DIRECTOR0.500.50X000
PETER ASMUTH
PRESIDENT & CEO1.0040.00017567754312X
MICHAEL DYER
VICE PRESIDENT FINANCE/ADM1.0040.00011569321313X
KAREN WILLOCK
VP OF CLINICAL SERVICES1.0040.000577102886X
RONALD SCHWERZLER
MEDICAL DIRECTOR40.000.00196128026532X
MICHAEL SCHWARTZ
DOCTOR40.000.00146247031001X
JOSH BOLTON
CHIEF INFORMATION OFFICER40.000.0010032305016X
FieldValueIRS element (for citing)
Total Reportable Comp From Org442698TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs349080TotalReportableCompFrmRltdOrgs
Total Other Compensation141060TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions6534AllOtherContributions
Total Contributions6534TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionMEDICAL TREATMENT FORDescription
Business Code621400BusinessCode
Total Revenue Column12757441TotalRevenueColumn
Related Or Exempt Function Income12757441RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue12757441TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2448TotalRevenueColumn
Exclusion$2,448ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionFINANCE CHARGEDescription
Business Code621400BusinessCode
Total Revenue Column122786TotalRevenueColumn
Related Or Exempt Function Income122786RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue122786TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12889209TotalRevenueColumn
Related Or Exempt Function Income12880227RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,448ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total228839Total
Program Services228839ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5579374Total
Program Services5378025ProgramServices
Fundraising201349Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total261482Total
Program Services255231ProgramServices
Fundraising6251Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1275853Total
Program Services1243719ProgramServices
Fundraising32134Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total521354Total
Program Services491581ProgramServices
Fundraising29773Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1300000Total
Program Services1300000ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total17860Total
Program Services17860ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total196564Total
Program Services170934ProgramServices
Fundraising25630Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total491101Total
Program Services491101ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total628910Total
Program Services608057ProgramServices
Fundraising20853Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1226905Total
Program Services1226905ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total82372Total
Program Services66819ProgramServices
Fundraising15553Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total31627Total
Program Services26755ProgramServices
Fundraising4872Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesFundraisingFundraising
DIETARY SUPPLIES375455375455
LAB FEES164848164848
BAD DEBT EXPENSE138441138441
TAXES AND LICENSES1179021122275675

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total205627Total
Program Services201257ProgramServices
Fundraising4370Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12844514Total
Program Services12498054ProgramServices
Management And General0ManagementAndGeneral
Fundraising346460Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2605BOY
EOY2655EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1430298BOY
EOY3116837EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1363633BOY
EOY1242025EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY157917BOY
EOY140656EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY151675BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3106128BOY
EOY4502173EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2143326BOY
EOY3494678EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2143326BOY
EOY3494678EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY962802BOY
EOY1007495EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY962802BOY
EOY1007495EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3106128BOY
EOY4502173EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses44695ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationSERENITY LANE IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES. SERENITY LANE HAS ALSO BEEN CLASSIFIED AS AN ENTITY THAT IS NOT A PRIVATE FOUNDATION 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 FINANCIAL STATEMENTS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care0FPGReferenceFreeCare
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served224PersonsServed
Total Community Benefit Expense396762TotalCommunityBenefitExpense
Net Community Benefit Expense396762NetCommunityBenefitExpense
Percent Of Total Expense0.03120PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served224PersonsServed
Total Community Benefit Expense396762TotalCommunityBenefitExpense
Net Community Benefit Expense396762NetCommunityBenefitExpense
Percent Of Total Expense0.03120PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs182NumberOfActivitiesOrPrograms
Persons Served4454PersonsServed
Total Community Benefit Expense235510TotalCommunityBenefitExpense
Net Community Benefit Expense235510NetCommunityBenefitExpense
Percent Of Total Expense0.01850PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense114554TotalCommunityBenefitExpense
Net Community Benefit Expense114554NetCommunityBenefitExpense
Percent Of Total Expense0.00900PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs183NumberOfActivitiesOrPrograms
Persons Served4454PersonsServed
Total Community Benefit Expense350064TotalCommunityBenefitExpense
Net Community Benefit Expense350064NetCommunityBenefitExpense
Percent Of Total Expense0.02750PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs183NumberOfActivitiesOrPrograms
Persons Served4678PersonsServed
Total Community Benefit Expense746826TotalCommunityBenefitExpense
Net Community Benefit Expense746826NetCommunityBenefitExpense
Percent Of Total Expense0.05870PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$138,441BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1SERENITY LANEBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1616 E 16TH AVENUEAddressLine1
CityEUGENECity
StateORState
ZIP Code97401ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SERENITY LANEBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed1AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
No Emergency CareXNoEmergencyCare
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities9NumberOfOtherFacilities

Other Facilities OtherFacilities (9 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
SERENITY LANE
1050 PRICE ROAD SEALBANYOR97322OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
601 NW HARMON BLVDBENDOR97701OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
10920 SW BARBUR BLVDPORTLANDOR97219OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
12662 SE STARK STREETPORTLANDOR97233OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
1800 NW 167TH PLBEAVERTONOR97006OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
2575 NW KLINE STREETROSEBURGOR97471OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
1885 FISHER ROAD NESALEMOR97305OUTPATIENT REHABILITATION CLINIC
SERENITY LANE - NEW HOPE
2133 CENTENNIAL PLAZAEUGENEOR97401OUTPATIENT REHABILITATION CLINIC
SERENITY LANE
4305 NE THURSTON WAYVANCOUVERWA98662OUTPATIENT REHABILITATION CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

ExplanationExplanationIdentifierIdentifier
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, L7 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 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.SERENITY LANE
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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
PETER ASMUTH
PRESIDENT & CEO01756770000038784015528022998900
RONALD SCHWERZLER
MEDICAL DIRECTOR1961280000098060167260222660000
MICHAEL SCHWARTZ
DOCTOR1462470000073120236890177248000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 4AMENDMENTS HAVE BEEN MADE TO SERENITY LANE'S BYLAWS. THESE AMENDMENTS HAVE INCREASED THE NUMBER OF POSSIBLE DIRECTORS FROM 7 TO 9, CHANGED THE BOARD OF DIRECTOR TITLES FROM PRESIDENT, VICE-PRESIDENT, SECRETARY, AND TREASURER TO BOARD CHAIR, BOARD VICE-CHAIR, BOARD SECRETARY, AND BOARD TREASURER, RESPECTIVELY, AND HAVE ALSO CREATED THREE OPERATIONAL OFFICERS. THESE OPERATIONAL OFFICERS, CONSISTING OF THE PRESIDENT AND CEO, VICE-PRESIDENT OF FINANCE AND ADMINISTRATION, AND VICE-PRESIDENT OF CLINICAL SERVICES, DO NOT HAVE A VOTE ON THE BOARD OF DIRECTORS, AND ARE REPONSIBLE FOR THE DAY-TO-DAY OPERATIONS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS REVEIWED BY THE CFO, CEO AND THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CTHROUGH A CONFLICT OF INTEREST STATEMENT FILLED OUT AND SIGNED ANNUALLY
FORM 990, PART VI, SECTION B, LINE 15CEO 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 19UPON REQUEST

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
SERENITY LANE HEALTH SERVICES
2133 CENTENNIAL PLAZAEUGENEOR97401943113708ADMINISTRATIVE SERVICE AND SUPPORT FOR SERENITY LANEOR501(C)(3)509(A)(3) TYPE ISERENITY LANE1
SERENITY LANE HEALTH SERVICES FOUNDATION
2133 CENTENNIAL PLAZAEUGENEOR97401461684147FINANCIAL SUPPORT FOR SERENITY LANEOR501(C)(3)509(A)(3) TYPE ISERENITY LANE1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
SERENITY LANE HEALTH SERVICES
K917714CASH
SERENITY LANE HEALTH SERVICES
M1300000CASH