2012-07-30T13:28:08-05:00 2011-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Suite 1300 Minneapolis MN 554027033 990 2011-01-01 133673215 Hazelden New York HAZE 6512134006 PO Box 11 Center City MN 55012 James Blaha 6512134006 2012-07-26 1 Kim Hunwardsen CPA P00484560 6122536500 2012-07-26 2011 2016-02-24 21:20:13Z Mark Mishek PO Box 11 Center City MN 55012 1942837 0 X www.hazelden.org X 1992 NY Hazelden helps restore hope, healing, and health to people affected by addiction to alcohol and other drugs. 10 10 32 4 0 0 155625 219728 1335443 1717595 17556 5514 0 0 1508624 1942837 0 0 0 0 951641 1633232 0 0 4000 1304876 2324198 2256517 3957430 -747893 -2014593 7072661 13157219 7962055 16061206 -889394 -2903987 X Hazelden New York is a vital affiliated entity of the Hazelden Foundation. Hazelden's mission is to help restore hope, healing and health to people 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 and continuing care services for addicted people and their families in New York, New York and has affiliated entities in Center City, Chaska (opened in March 2012), Maple Grove, Plymouth, and St. Paul, Minnesota; Chicago, Illinois; Naples, Florida, and Springbrook, Oregon. 0 0 3055430 1717595 Recovery ServicesCaring experts at Hazelden in New York deliver a wide array of recovery services to men and women needing treatment for alcohol and other drug addiction. Hazelden in 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's programs and services in the greater New York City area while also serving as an access point to all of Hazelden'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 2011, the following number of people directly benefited from recovery services at Hazelden in New York: Outpatient Treatment 419 Family Program 19 TOTAL PATIENTS SERVED 438Hazelden also hosted alumni events and related services at its New York location and made its facility available for groups to hold recovery-related meetings. The facility is used by other groups for networking and educational opportunities. 3055430 1 1 0 0 0 0 0 0 0 1 1 0 0 0 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 0 1 0 0 32 1 0 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 0 1 1 1 0 NY X James Blaha Chief Financial and Administrative Officer 6512134006 15251 Pleasant Valley Road Center City MN 55012 W Christopher White 5.00 X X 0 0 0 Judy Collins 1.00 X 0 0 0 Valery Craane 1.00 X 0 0 0 Paul Gossling 1.00 X 0 0 0 Margaret Brennan Hassett 1.00 X 0 0 0 Leonard Holzer 1.00 X 0 0 0 Robert Manocherian 1.00 X 0 0 0 Judith Davidson Moyers 1.00 X 0 0 0 Paul Robert 1.00 X 0 0 0 Brooke Picotte 1.00 X 0 0 0 Manfred Altstadt 5.00 X 0 0 0 James Blaha 3.00 X 0 253952 34829 Mark Mishek 5.00 X 0 598982 83630 Barbara Kistenmacher 50.00 X 155351 0 12191 Maureen Borkowski 45.00 X 115162 0 1948 270513 852934 132598 2 0 1 0 Columbia University 1051 Riverside Dr Unit 5 New York NY 10032 Psychiatric services 224684 1 219728 219728 Recovery Services 621400 1717595 1717595 1717595 5514 5514 1942837 1717595 0 5514 168193 168193 1100948 1100948 71914 71914 200596 200596 91581 91581 2527 2527 329110 329110 133914 133914 81192 81192 462866 462866 28325 28325 1020 1020 248397 248397 Corporate support mgmt 902000 898000 4000 Provision for bad debt 98752 98752 Lab work 20155 20155 Program/Client supplies 7057 7057 8883 8883 3957430 3055430 898000 4000 17791 52280 2880 0 134965 223047 200000 475 14255009 1373592 950514 12881417 5766511 0 7072661 13157219 319357 305794 7642698 15755412 7962055 16061206 X -1115793 -3066671 90186 26471 136213 136213 -889394 -2903987 7072661 13157219 -2014593 0 X X 0 1 0 X 0 X 4184212 770251 86554 155625 219728 5416370 4184212 770251 86554 155625 219728 5416370 879460 4536910 334310 211262 52396 17556 5514 621038 -10428 -10428 6026980 0.75280 0.74630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 119030 -3569 5512 109949 110902 14164 6036 119030 136213 -17499 7812 110902 157629 -17854 3562 136213 1.00000 0 1 1 13637467 1145900 12491567 617542 227692 389850 12881417 Intercompany Payables 15755412 15755412 Description of Intended Use of Endowment Funds: Part V, Line 4: Earnings from the endowment funds are used to provide financial aid to qualified patients. Description of Uncertain Tax Positions Under FIN 48: Part X: 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 2011. Open tax years subject to examination by the U.S and the state taxing authorities are for the years 2009 to 2011, which statutes expire in 2012 to 2014, respectively. X X X X X 0 1 0 0 0 0 0 0 0 James Blaha 0 234278 0 18135 0 1539 0 20062 0 15955 0 289969 0 0 Mark Mishek 0 480865 0 114553 0 3564 0 63004 0 22966 0 684952 0 0 Barbara Kistenmacher 135152 0 20000 0 199 0 950 0 11892 0 168193 0 0 0 Part I, Line 4b Part 1, Line 4b: Mark Mishek, President and CEO, participated in a nonqualified retirement plan from a related organization in the amount of $36,967. Form 990, Part VI, Section A, line 2 Officers are employed by Hazelden Foundation, a related exempt organization. Certain members of the board are also board members of the Hazelden Foundation. Therefore, business relationships exist between these individuals. Form 990, Part VI, Section A, line 6 Hazelden Foundation is the sole member of Hazelden New York. Form 990, Part VI, Section A, line 7a As the sole member, Hazelden Foundation has the right to elect one or more members of the governing body of Hazelden New York. As a regional board, Hazelden New York, can submit candidates to the Hazelden 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 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 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 Foundation, sole member of Hazelden New York, prior to filing. Form 990, Part VI, Section B, line 12c Hazelden 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 himself 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 has an established process for determining the compensation of the CEO, other officers and key employees that starts with the Board of Trustees. The Hazelden Foundation by-laws delegate responsibility for determining compensation for the 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 Foundation. Based on this philosophy, the Executive Committee engages the use of an outside independent compensation consultant to identify comparable market data for comparable positions. Generally the market analysis includes competitive data from published survey sources, supplemented with compensation data from custom 990 analyses. Comparable market data are reviewed and discussed by the Executive Committee and minutes record those discussions and any resulting compensation decisions. The President/CEO has the ability to adjust the pay of other officers and key employees if the pay raise or adjustment falls within the market data and compensation philosophy approved prior by the Executive Committee. For the President/CEO, no employment offers or compensation changes are made by the Executive Committee without comparable data and an opinion from the outside compensation consultant. This process was last updated in February, 2010. Form 990, Part VI, Section C, line 19 Hazelden 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. Average Hours per Week: Form 990, Part VII, Section A: Officers paid by a related organization served the following hours per week at these related organizations: Mark Mishek 50 hours at Hazelden Foundation and 5 hours at Hazelden Chicago James Blaha 50 hours at Hazelden Foundation and 3 hours at Hazelden Chicago 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 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 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 Foundation 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0