2014-01-28T15:05:42-06:00 2013-03-31 910189318 MOSS ADAMS LLP 975 OAK STREET SUITE 500 EUGENE OR 97401 990 2012-04-01 930606316 SERENITY LANE SERE 5414842156 2133 CENTENNIAL PLAZA EUGENE OR 97401 MIKE DYER 5414842156 2014-01-28 1 RAY L WIDMER III P01236627 5416861040 2012 2015-11-30 17:44:51Z MIKE DYER 2133 CENTENNIAL PLAZA EUGENE OR 97401 12889209 0 X WWW.SERENITYLANE.ORG X 1973 OR TREATMENT OF THE DISEASE OF CHEMICAL DEPENDENCY 7 7 187 7 0 0 11919 6534 12736410 12757441 7336 2448 120466 122786 12876131 12889209 0 0 0 0 8077303 7866902 0 0 346460 5149024 4977612 13226327 12844514 -350196 44695 3106128 4502173 2143326 3494678 962802 1007495 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 12498054 12880227 TREATMENT OF CHEMICAL DEPENDENCY THROUGH INPATIENT AND RESIDENTIAL SERVICES. 12498054 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 40 0 1 187 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 1 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 LARRY OLSON 0.50 0.50 X 0 0 0 LARRY BRADLEY 1.00 1.00 X X 0 0 0 JOHN DUNPHY 0.50 0.50 X X 0 0 0 MIKE KEHOE 0.50 0.50 X X 0 0 0 KATE KLOOS 0.50 0.50 X 0 0 0 JOHN LIPKIN 0.50 0.50 X X 0 0 0 REV JOHN KERNS 0.50 0.50 X 0 0 0 PETER ASMUTH 1.00 40.00 X 0 175677 54312 MICHAEL DYER 1.00 40.00 X 0 115693 21313 KAREN WILLOCK 1.00 40.00 X 0 57710 2886 RONALD SCHWERZLER 40.00 0.00 X 196128 0 26532 MICHAEL SCHWARTZ 40.00 0.00 X 146247 0 31001 JOSH BOLTON 40.00 0.00 X 100323 0 5016 442698 349080 141060 3 0 1 0 0 6534 6534 MEDICAL TREATMENT FOR 621400 12757441 12757441 12757441 2448 2448 FINANCE CHARGE 621400 122786 122786 122786 12889209 12880227 0 2448 228839 228839 5579374 5378025 201349 261482 255231 6251 1275853 1243719 32134 521354 491581 29773 1300000 1300000 17860 17860 196564 170934 25630 491101 491101 628910 608057 20853 1226905 1226905 82372 66819 15553 31627 26755 4872 DIETARY SUPPLIES 375455 375455 LAB FEES 164848 164848 BAD DEBT EXPENSE 138441 138441 TAXES AND LICENSES 117902 112227 5675 205627 201257 4370 12844514 12498054 0 346460 2605 2655 1430298 3116837 1363633 1242025 157917 140656 151675 0 3106128 4502173 2143326 3494678 2143326 3494678 X 962802 1007495 962802 1007495 3106128 4502173 44695 0 X 0 1 X 1 0 X 0 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: SERENITY 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. 1 1 0 0 1 1 0 1 1 224 396762 396762 0.03120 224 396762 396762 0.03120 182 4454 235510 235510 0.01850 1 114554 114554 0.00900 183 4454 350064 350064 0.02750 183 4678 746826 746826 0.05870 0 138441 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 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, 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. 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. 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. 0 0 0 0 0 0 0 0 0 PETER ASMUTH 0 175677 0 0 0 0 0 38784 0 15528 0 229989 0 0 RONALD SCHWERZLER 196128 0 0 0 0 0 9806 0 16726 0 222660 0 0 0 MICHAEL SCHWARTZ 146247 0 0 0 0 0 7312 0 23689 0 177248 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 AMENDMENTS 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 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 1 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 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 SERENITY LANE HEALTH SERVICES K 917714 CASH SERENITY LANE HEALTH SERVICES M 1300000 CASH