2013-08-13T10:41:19-05:00 2012-12-31 911194016 CLARK NUBER PS 10900 NE 4TH STREET SUITE 1700 BELLEVUE WA 98004 990 2012-01-01 910567261 WELLSPRING FAMILY SERVICES WELL 2068263050 1900 RAINIER AVENUE SOUTH SEATTLE WA 98144 RUTHANN HOWELL 2068263050 2013-08-12 1 SARA ELIZABETH J HYRE P00235495 4254544919 2013-08-12 2012 2016-02-24 21:20:13Z RUTHANN HOWELL 1900 RAINIER AVENUE SOUTH SEATTLE WA 98144 12262221 0 X WWW.WELLSPRINGFS.ORG X 1892 WA TO BUILD EMOTIONALLY HEALTHY SELF-SUFFICIENT FAMILIES AND A NON-VIOLENT COMMUNITY IN WHICH THEY CAN THRIVE. 21 21 148 472 0 0 5645059 4891335 7456852 7309205 11040 7295 -4672 -7010 13108279 12200825 1816741 1262745 0 0 7768966 7507817 0 0 394518 3869074 4202571 13454781 12973133 -346502 -772308 19877708 18930624 7189697 7004204 12688011 11926420 X TO BUILD EMOTIONALLY HEALTHY SELF-SUFFICIENT FAMILIES & A NON-VIOLENT COMMUNITY IN WHICH THEY CAN THRIVE. 0 0 4168100 1217992 44974 SERVICES FOR HOMELESS AND AT-RISK FAMILIES INCLUDING SPECIALIZED CHILDCARE, CLOTHING AND OTHER ESSENTIAL ITEMS FOR HOMELESS CHILDREN. SUPPORTIVE SERVICES, INCLUDING CASE MANAGEMENT, COUNSELING AND ASSISTANCE WITH BASIC NEEDS TO ASSIST THE HOMELESS IN MOVING FROM DEPENDENCY TO SELF-SUFFICIENCY. SERVED 1,523 FAMILIES IN 2012. 2903455 3719383 EMPLOYEE ASSISTANCE PROGRAM PROVIDES EMPLOYEE ASSESSMENT, COUNSELING, WORK-LIFE BALANCE SERVICES, WORKPLACE SEMINARS AND CONSULTATION. SERVED 140,197 CLIENTS IN 2012. 3515872 44753 3412508 PROFESSIONAL COUNSELING, EDUCATION AND SUPPORT FOR FAMILIES AND PARENTS OF NEWBORNS AND INDIVIDUALS FROM A VARIETY OF CULTURES WITH RELATIONSHIP, JOB/CAREER AND EMOTIONAL/BEHAVIORAL PROBLEMS. SERVED 2,094 CLIENTS IN 2012. 350607 132340 DOMESTIC VIOLENCE INTERVENTION AND PREVENTION SERVICES PROVIDE STATE CERTIFIED DOMESTIC VIOLENCE INTERVENTION FOR BATTERERS AND RESPECTFUL PARENTING SKILLS TRAINING. SERVED 159 CLIENTS IN 2012. 350607 132340 10938034 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 509 0 1 148 1 0 0 0 0 0 1 1 0 0 0 0 X 21 21 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DEBORAH TOWNSEND 2068263041 1900 RAINIER AVENUE SOUTH SEATTLE WA 98144 RUSSELL YOUNG 2.00 X X 0 0 0 STEVEN LOSLEBEN 2.00 X X 0 0 0 BRAD MCKEOWN 2.00 X X 0 0 0 CHRISTIAN SCHILLER 2.00 X X 0 0 0 ANNE NIELSEN 2.00 X X 0 0 0 BRIAN BUCKLEY 2.00 X 0 0 0 JESSICA CANTLIN 2.00 X 0 0 0 JEFFREY CORDICK 2.00 X 0 0 0 THERESA DALURIA 2.00 X 0 0 0 EMELIE EAST 2.00 X 0 0 0 AMY HUMPHREYS 2.00 X 0 0 0 SUSANNA HURLEY 2.00 X 0 0 0 NICOLE MATUSKA 2.00 X 0 0 0 MARK METCALF 2.00 X 0 0 0 NANCY MYLES 2.00 X 0 0 0 KEVIN OSBORNE 2.00 X 0 0 0 MARY PEDERSEN 2.00 X 0 0 0 JONATHAN PERRINO 2.00 X 0 0 0 BARNETT SILVER 2.00 X 0 0 0 RICHARD WAGNER 2.00 X 0 0 0 WILLIAM WEIGAND 2.00 X 0 0 0 FAITH HAVICK 2.00 X 0 0 0 PAMELA CONE 2.00 X 0 0 0 CHRIS AGGERHOLM 2.00 X 0 0 0 KATHY LOWER 2.00 X 0 0 0 GEOFFREY MELROSE 2.00 X 0 0 0 BETH PEARSON 2.00 X 0 0 0 TRACY MCPHEE 2.00 X 0 0 0 RUTHANN HOWELL 50.00 X 139755 0 8334 SUSAN SHANNON 40.00 X 117204 0 13076 KEITH MYERS 40.00 X 106547 0 13003 SANDRA LOWE 40.00 X 102947 0 12288 466453 0 46701 4 0 0 0 WORK PLACE BENEFITS LLC 2912 HIGHWOODS BLVD RALEIGH NC 27604 COUNSELING SERVICES 268771 THE GOTTMAN INSTITUTE INC 1401 E JEFFERSON ST 501 SEATTLE WA 98122 COUNSELING SERVICES 106650 2 838974 367221 2348150 1336990 187692 4891335 EMPLOYEE ASSISTANCE 624100 3678781 3678781 COUNSELING SERVICES 621300 3412508 3412508 COMMUNITY SERVICES 621300 177314 177314 TRAINING SERVICES 624100 40602 40602 7309205 3470 3470 6957 0 6957 6957 6957 3825 0 3825 3825 3825 44250 367221 61396 -17146 -17146 INTERNATIONAL FEES 900099 1975 1975 INTER-AGENCY RECEIPTS 900099 785 785 NON EAP & OTHER FEES 900099 419 419 3179 12200825 7309205 0 285 X 1262745 1262745 278369 278369 5832463 5049418 590204 192841 217319 204255 6273 6791 667521 590975 67851 8695 512145 393119 103706 15320 63444 58135 5309 67348 67348 7500 7500 1612817 1398244 200896 13677 109811 63932 45528 351 314200 231734 24412 58054 249739 214124 17856 17759 486522 458101 25016 3405 29044 28190 488 366 1076 1076 161382 145946 10762 4674 629848 439499 173554 16795 59686 54755 3044 1887 BAD DEBT EXPENSE 274341 268555 5786 STAFF TRAINING/DEVEL 56839 41963 13160 1716 VOLUNTEER AND DONOR EXP 38762 38762 HR SERVICES 35368 29182 6164 22 4844 4086 641 117 12973133 10938034 1640581 394518 1535513 1729267 445697 145590 931247 761919 1035744 872427 347958 136225 17809661 2665509 15395843 15144152 185706 141044 19877708 18930624 1086579 953270 6103118 5905988 0 144946 7189697 7004204 X 12092260 11311859 553251 569061 42500 45500 12688011 11926420 19877708 18930624 -772308 10717 0 X 0 1 X 1 1 1 X 5880704 9409981 5015728 5645059 4891335 30842807 14400 14400 14400 14400 14400 72000 5895104 9424381 5030128 5659459 4905735 30914807 957884 29956923 46434 53984 7155 5368 10427 123368 93210 43328 3179 139717 31177892 37534916 0.96080 0.96330 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: INTER-AGENCY RECEIPTS - 2010 AMOUNT: $ 53,745. 2011 AMOUNT: $ 6,100. 2012 AMOUNT: $ 785. TRAINING REVENUE - 2010 AMOUNT: $ 33,159. MISCELLANEOUS - 2010 AMOUNT: $ 6,306. NON EAP OTHER FEES - 2011 AMOUNT: $ 37,228. 2012 AMOUNT: $ 419. INTERNATIONAL FEES - 2012 AMOUNT: $ 1,975. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 7500 0 0 7500 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING ACTIVITIES INCLUDE MEETING WITH STATE LEGISLATORS AND STAFF. 42500 3000 45500 42500 42500 42500 42500 32250 10250 42500 5750 26500 32250 0.00000 1.00000 0.00000 0 0 2456349 2456349 13588083 1568885 12019198 436954 391955 44999 1079578 702740 376838 248697 1929 246768 15144152 SUBLEASE DEPOSITS 2000 CAPITAL LEASE OBLIGATION 142946 144946 12374647 10717 101709 112426 12262221 -61396 -61396 12200825 13136238 101709 61396 163105 12973133 0 12973133 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS WERE ESTABLISHED UNDER THE CAPITAL CAMPAIGN AND THE FUNDS ARE TO BE USED FOR CREATING A FUTURE FUNDING SOURCE FOR THE ORGANIZATION AND THE PROGRAMS THAT SERVE CLIENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -61,396. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 61,396. LUNCHEON 411471 367221 44250 61396 411471 367221 44250 61396 61396 -17146 1 HOUSING ASSISTANCE 333 0 1219026 FAIR MARKET VALUE HOUSING ASSISTANCE INCLUDING PAYMENT FOR RENT, UTILITIES, GROCERY DEBIT CARDS AND IDENTIFICATION REPLACEMENT. EMERGENCY FUNDS AND RETRAINING 86 43719 0 N/A N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL GRANTS TO INDIVIDUALS ARE AWARDED AND DOCUMENTED THROUGH A PROCESS THAT IS MANAGED BY AGENCY CASE WORKERS. ONCE APPROVED, FUNDS ARE DISBURSED IN ACCORDANCE WITH AUTHORIZED DOCUMENTATION. EXAMPLES INCLUDE PAYMENT OF RENT ON BEHALF OF CLIENTS, PAYMENTS TO GOVERNMENT OFFICES FOR REPLACEMENT OF LEGAL IDENTIFICATION OR GIFT CARDS FOR PURCHASE OF FOOD. GRANTS ARE BUDGETED AT THE FUNDING SOURCE AND PROGRAM LEVEL TO ENSURE THAT OVERALL GRANT EXPENDITURES MEET THE REQUIREMENTS OF THE FUNDING SOURCES AS WELL AS THE FINANCIAL RESOURCES OF THE AGENCY. X 157692 FAIR MARKET VALUE X EQUIPMENT 1 30000 FAIR MARKET VALUE 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER IN COLUMN B IS BASED ON THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART I, LINE 6: NUMBER OF VOLUNTEERS THE NUMBER OF VOLUNTEERS IS TRACKED BY THE HOUSING PROGRAM, BABY BOUTIQUE AND FUND DEVELOPMENT PROGRAMS. 15% VOLUNTEER IN HOUSING SERVICES, ASSISTING FAMILIES IN THE PREVENTION AND INTERVENTION HOUSING PROGRAMS. 70% VOLUNTEER IN BABY BOUTIQUE, SETTING UP AND STORING THE DONATIONS FOR FAMILIES TO GET FREE BABY SUPPLIES, CLOTHES AND TOYS. 15% HELP WITH THE ANNUAL LUNCHEON. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY THE OUTSIDE CPA FIRM. BOARD MEMBERS ARE PROVIDED COPIES OF THE FORM 990 PRIOR TO FILING WITH THE IRS. IN ADDITION, THE FORM 990 IS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST ANNUALLY. THE POLICY IS MONITORED AND ENFORCED AS A PART OF THE FISCAL AUDIT PROCESS. THE AUDIT COMMITTEE ADDRESSES ANY FINDINGS IF THERE ARE ANY. IF A CONFLICT ARISES, THE BOARD MEMBER RECUSES HIM/HERSELF FROM VOTING AND DISCUSSIONS ON THE RELEVANT MATTER WITH THE AUDIT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, IF THERE IS A SALARY INCREASE, THE BOARD EXECUTIVE COMMITTEE REVIEWS AND APPROVES THE SALARIES OF THE CEO AND SENIOR EXECUTIVES. THE APPROVAL INCLUDES VERIFICATION BY THE APPROVING MEMBERS THAT THEY ARE INDEPENDENT AND UNRELATED TO THE EXECUTIVES. COMPENSATION MARKET DATA IS USED TO MAKE THE DECISION. THE LAST REVIEW WAS DONE IN DECEMBER 2012. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT THERAPISTS: PROGRAM SERVICE EXPENSES 1,071,572. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,071,572. CONTRACT TRAINERS: PROGRAM SERVICE EXPENSES 58,122. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,122. EAP VENDOR: PROGRAM SERVICE EXPENSES 127,969. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,969. OTHER: PROGRAM SERVICE EXPENSES 140,581. MANAGEMENT AND GENERAL EXPENSES 200,896. FUNDRAISING EXPENSES 13,677. TOTAL EXPENSES 355,154. FAMILY SERVICES PROPERTY LLC 1900 RAINIER AVENUE SOUTH SEATTLE WA 98144 260217889 OWNERSHIP OF FACILITY USED BY WELLSPRING FAMILY SERVICES WA 480000 14952577 WELLSPRING FAMILY SERVICES 1