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NORTHWEST HUMAN SERVICES INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NORTHWEST HUMAN SERVICES INC (EIN 93-0605570)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-02-03
IRS object ID
201140349349301404
Schema version
2009v1.3
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)
Timestamp2011-02-03T15:23:13-08:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LarsonAllen LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13000 Northup Way Ste 200AddressLine1
CityBellevueCity
StateWAState
ZIP Code980041446ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930605570EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northwest Human Services IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone5035885828Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1681 Center Street NEAddressLine1
CitySalemCity
StateORState
ZIP Code97301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePaul LoganName
TitleExecutive DirecTitle
Date Signed2011-02-03DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NamePaul M Bailey CPAName
Phone5094530123Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPaul LoganNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1681 Center Street NEAddressLine1
CitySalemCity
StateORState
ZIP Code97301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11664517GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501cXOrganization501c
Web Sitewww.nwhumanservices.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1970YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTo provide advocacy, quality health care, and social services to those in need.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees213TotalNbrEmployees
Total Nbr Volunteers5TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year4180275ContributionsGrantsPriorYear
Contributions Grants Current Year5096684ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5729704ProgramServiceRevenuePriorYear
Program Service Revenue CY6434249ProgramServiceRevenueCY
Investment Income Prior Year128734InvestmentIncomePriorYear
Investment Income Current Year57201InvestmentIncomeCurrentYear
Other Revenue Prior Year7659OtherRevenuePriorYear
Other Revenue Current Year76383OtherRevenueCurrentYear
Total Revenue Prior Year10046372TotalRevenuePriorYear
Total Revenue Current Year11664517TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year177457GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY94550GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7377076SalariesEtcPriorYear
Salaries Etc Current Year7653798SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year34150TotalFundrsngExpCurrentYear
Other Expense Prior Year2808140OtherExpensePriorYear
Other Expenses Current Year2274625OtherExpensesCurrentYear
Total Expenses Prior Year10362673TotalExpensesPriorYear
Total Expenses Current Year10022973TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-316301RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1641544RevenuesLessExpensesCY
Total Assets BOY10382765TotalAssetsBOY
Total Assets EOY12520773TotalAssetsEOY
Total Liabilities BOY2073000TotalLiabilitiesBOY
Total Liabilities EOY2493309TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8309765NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10027464NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide advocacy, quality health care, and social services to those in need.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense6664209Expense
Revenue6204395Revenue
DescriptionWest Salem Clinic and Total Health Community Clinic are federallyqualified health centers that provide comprehensive medical services touninsured and under insured patients of the Willamette Valley andsurrounding rural communities. With a patient population of over 10,000clients our multilingual and multicultural staffs are dedicated tohelping patients manage and improve their health and quality of lifeand are able to communicate with clients in Spanish, Russian,Vietnamese, American Sign Language and other dialects and languages.As an organization, it is our desire to offer quality medical, dentaland mental health services to individuals that otherwise would not beable to access healthcare to meet their needs, regardless of ability topay, age, ethnicity or cultural background. our services include family practice medicine, pediatrics, obstetrics including prenatal andpostnatal care, and internal medicine. We also offer preventativehealth services through our living healthy program, dental diabeticscreenings, full service family dentistry and mental health services.Our dental clinic serves approximately 1,400 clients per year. Forindividuals that do not have insurance, we offer a sliding fee that isbased on family size and income. We have a designated eligibilityspecialist on site to assist in completing the medicaid applicationprocess as well as the percentage of slide discount that individualsqualify for. We provide healthcare to homeless individuals via vanservice that transports those in need of medical or dental attention tothe clinic at a minimum of 3 days per week free of charge. We providevaccines for children through the state VFC program and documentimmunizations in the state registry. We also offer pediatric services and have a 24 hourtelephone advice call service available to clients that might havequestions or concerns after normal clinic hours.West Salem Clinic offers outpatient mental health services that includetherapy, counseling, case management group work and psychiatricservices. The panel of providers available to provide these servicesinclude licensed and unlicensed masters prepared clinicians. One casemanager is available to compliment the efforts of the primary clinicalservices providers. West Salem Mental Health Clinic serves people fromthe ages of 12 to 65 regardless of their ability to pay. Clients who are deaf and hard of hearing receive culturally and linguisticallyappropriate counseling and case management services and are supportedin medication management services through a contracted interpreter. TheWest Salem Mental Health program has a growing client base of over 1,000patients and processes approximately 800 screenings for new servicesper year.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense778668Expense
Revenue208967Revenue
DescriptionSince 1986, Northwest Human Services Inc.'s Homeless Outreach and AdvocacyProject (HOAP) has operated to help adults with chronic mentalillnesses, who are experiencing homelessness. Located in downtownSalem, HOAP offers out-patient mental health services, supportivehousing and a day center.HOAP staff provides 450 clients and visitors with more than 9,000 supportiveinterventions annually, to support them towards independent living inthe community. Mental health services provided include psychiatricvisits, medication management, case management, counseling, advocacy,assistance in obtaining mainstream entitlements, payee services,supportive housing, and skills training.In addition to mental health and housing services, HOAP operates ahealthcare for the homeless van run, transporting 600+ uninsured,homeless adults to the NWHS medical clinic annually for emergentmedical and dental care.During the year the HOAP day center offers services such as showers,snacks, laundry facilities, telephone, community voicemail, and amailing address to both clients and visitors. The HOAP day centerserved 5,500 snacks, 1,875 lunches and offered 1,200 showers. Total services resulted in over 16,000 visits by homeless people seeking a safe place toreceive basic services and support.The HOAP program also operates supportive housing including a safehaven, 24/7 low stress supportive housing for HOAP's chronicallyhomeless clients. Clients living at safe haven can remain there as longas necessary to regain the skills needed to move into more permanentappropriate housing. In addition to Safe Haven, HOAP maintains 22additional housing placements available to enrolled HOAP clients.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense652403Expense
Revenue20887Revenue
DescriptionHomes Offering Shelter to Teens (HOST) provides emergency and long-term shelter care to runaway and homeless youth. Other areas of serviceinclude crisis intervention, counseling and conflict resolution, familylife skills development and information and referral services for youthin crisis and their families. The transitional living program provideshousing and case management services to emancipated youth assistingthem to achieve independence. During the year, HOST provided shelterfor approximately 200 youth. 216 of youth exited the shelter toa safe environment in place. The feedback received from youth andparents/guardians show that there have been improved relationshipsdirectly due to HOST services rendered. Our customer service feedbackforms showed over 92% with extremely high satisfaction levels.We are proud of our continued partnerships with local agencies whichprovide: classes teaching drug and alcohol awareness, cooking andnutrition, teen pregnancy and prevention, access to a homelesseducation program to assist youth in school enrollment and access tothe resource center, assistance with applying for Oregon Health Planand/or food stamps, employment, and employment coaching services.Local faith based organizations refer youth to our services and helpyouth to access: socialization and school programs (GED program),health club services in which youth barter work time for work out time,financial assistance and property identification for rental properties,a program working towards youth becoming self-sufficient and livingindependently, learn life skills and gain work experience throughvolunteering, classes on healthy meal preparation and cookingtechniques. HOST is dedicated to continued quality services andintegrating the positive youth development model.Staff continues to attend ongoing trainings on a monthly basis inefforts to keep our programming at the highest level possible.Trainings includes contractual and licensing mandates as well asenhancing their level of technical skills.A new position of quality improvement assistant has been created inefforts to further enhance our levels of detailed chart audits,updating forms as well as ongoing safety inspection reports. We arecurrently looking into potential expansion of services throughadditional beds and programming.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp394245TotalOfOtherProgramServiceExp
Total Program Service Expense8489525TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees213NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRobert T EdwardsNamePerson
Telephone Number5035885828TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1681 Center Street NEAddressLine1
CitySalemCity
StateORState
ZIP Code97301ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekKey EmployeeKeyEmployeeReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficer
Zoltan Teglassy
Provider40.00X139349012373
William Dettwyler
Director1.00000XX
Scott Byrum
Director1.00000X
Samantha Feldman
Director1.00000X
Robert Edwards
CFO40.007182506883X
Phil Swogger
Director1.00000X
Paul Logan
Executive Direc40.00129477016442X
Michelle Pecora
Treasurer1.00000XX
Michelle N Euzent
Dentist40.00X113189012057
Michael Wise
Chair1.00000XX
Michael J Schiferl
Medical Dir.40.00X11929609250
Marvin Roman
Provider40.00X14457809165
Lynn Martin
Director1.00000X
Lee Herskowitz
Provider40.00X11966407663
Larry Goodreau
Vice Chair1.00000XX
Kory Thomas
Director1.00000X
Joel M Suchow
Provider40.00X159225010377
Hen Mach
Director1.00000X
Harvey B Price
Provider40.00X10282100
Gwendolyn A Oran
Provider40.00X159329010056
Eloisa Hernandez
Secretary1.00000XX
Cynthia S Nocek
Provider40.00X11151003345
Crystina Blaze
Director1.00000X
Amy Martinez
Director1.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1370263TotalReportableCompFromOrg
Total Other Compensation97611TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Tomcor Construction LLC
PO Box 5128SalemOR97304Construction717350
First Impressions Last
4676 Commercial St SESalemOR97302Janitorial Service100232
Defenbaugh & Associates PC
388 State Street Suite 840SalemOR97301Architecture133927
D&Y Locum Tenens
PO Box 635715CincinnatiOH452635715Contract Medical128610
CompHealth
PO Box 972651DallasTX753972651Contract Medical121772
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants4809027GovernmentGrants
All Other Contributions287657AllOtherContributions
Noncash Contributions228093NoncashContributions
Total Contributions5096684TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Other Patient Services483095483095
Mental Health690629690629
Medical Clinics47377804737780
Homeless Outreach208967208967
Dental Clinic292891292891

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column20887TotalRevenueColumn
Related Or Exempt Function Income20887RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue6434249TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column57201TotalRevenueColumn
Exclusion$57,201ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMiscellaneousDescription
Total Revenue Column76383TotalRevenueColumn
Related Or Exempt Function Income76383RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue76383TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11664517TotalRevenueColumn
Related Or Exempt Function Income6510632RelatedOrExemptFunctionIncome
Exclusion$57,201ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total94550Total
Program Services94550ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1490479Total
Program Services1231005ProgramServices
Management And General259474ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4715323Total
Program Services3735246ProgramServices
Management And General962805ManagementAndGeneral
Fundraising17272Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total887622Total
Program Services720130ProgramServices
Management And General165769ManagementAndGeneral
Fundraising1723Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total560374Total
Program Services454634ProgramServices
Management And General104653ManagementAndGeneral
Fundraising1087Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5651Total
Program Services1243ProgramServices
Management And General4408ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total38480Total
Program Services8466ProgramServices
Management And General30014ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total185519Total
Program Services146148ProgramServices
Management And General39371ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total27842Total
Program Services24577ProgramServices
Management And General3265ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total192100Total
Program Services150389ProgramServices
Management And General38385ManagementAndGeneral
Fundraising3326Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total301486Total
Program Services199045ProgramServices
Management And General102441ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total75168Total
Program Services37304ProgramServices
Management And General37864ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total239971Total
Program Services195998ProgramServices
Management And General43973ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total63833Total
Program Services55163ProgramServices
Management And General8670ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Pharmaceutical, Lab, and other472406472406
Miscellaneous8063210863627467023
Food and Supplies75360713573818185
Direct Client Assistance140314140314
Bad debt194522194522

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total181341Total
Program Services546165ProgramServices
Management And General-368358ManagementAndGeneral
Fundraising3534Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10022973Total
Program Services8489525ProgramServices
Management And General1499298ManagementAndGeneral
Fundraising34150Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY7836BOY
EOY377769EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2645860BOY
EOY250000EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY418366BOY
EOY472865EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1631262BOY
EOY1488656EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY77021BOY
EOY111258EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY59974BOY
EOY79034EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis7400002LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2620098LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3909654BOY
EOY4779904EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1375239BOY
EOY4688150EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY57462BOY
EOY55074EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY200091BOY
EOY218063EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10382765BOY
EOY12520773EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY693930BOY
EOY1157871EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1379070BOY
EOY1335438EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2073000BOY
EOY2493309EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8309765BOY
EOY10027464EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8309765BOY
EOY10027464EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10382765BOY
EOY12520773EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4926713CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4306702CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4320765CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4180275CurrentTaxYearMinus1Year
Current Tax Year5117179CurrentTaxYear
Total22851634Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4926713CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4306702CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4320765CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4180275CurrentTaxYearMinus1Year
Current Tax Year5117179CurrentTaxYear
Total22851634Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17022851634PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years197923CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years195169CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years148730CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year114099CurrentTaxYearMinus1Year
Current Tax Year112862CurrentTaxYear
Total768783Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support23620417TotalSupport
Gross Receipts From Admissions Etc30077274GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.96750PublicSupportPertcentage170
Public Support Pertcent Prior Year0.96460PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis523078OtherCostOrOtherBasis
Book Value523078BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5387121OtherCostOrOtherBasis
Depreciation1295593Depreciation
Book Value4091528BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1407654OtherCostOrOtherBasis
Depreciation1248645Depreciation
Book Value159009BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis82149OtherCostOrOtherBasis
Depreciation75860Depreciation
Book Value6289BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4779904TotalOfBookValueLandBuildings
Total Revenue11664517TotalRevenue
Total Expenses10022973TotalExpenses
Excess Or Deficit For Year1641544ExcessOrDeficitForYear
Net Unrealized GL On Investments55661NetUnrealizedGLOnInvestments
Donated Services And Facilities20495DonatedServicesAndFacilities
Total Adjustments76156TotalAdjustments
Excess Or Deficit Per FS1717700ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt11740673TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments55661NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities20495DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F99076156RevenueNotRptdF990
Revenue Subtotal11664517RevenueSubtotal
Total Revenue Per Form99011664517TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10022973TotExpensesEtcAuditedFinclStmt
Expenses Subtotal10022973ExpensesSubtotal
Total Expenses Per Form99010022973TotalExpensesPerForm990

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
No Grant More Than5000XNoGrantMoreThan5000
Total Nbr Of501 C3 And Govt Grants0TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII (5 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
Utilities Assistance45323917
Transportation Assistance - Provision for Bus Passes4654650
Rent Assistance13011483
Pharmacy Support27130000
Clothing & Other Personal Items31524500Estimated value per article of clothingNew and Used Clothing

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
Zoltan Teglassy
13934912373151722
Marvin Roman
14457852651537433900
Joel M Suchow
15922555771696024800
Gwendolyn A Oran
15932952451693854811

Schedule M IRS990ScheduleM

Food Inventory FoodInventory

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F99040078NoncashContribsRptdF990
Method Of Determining RevenuesOR Food bankMethodOfDeterminingRevenues

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F990125235NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
DescriptionSuppliesDescription
Noncash Contribs Rptd F99062779NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableGoverning documents, conflict of interest policy and financial statements are not made available to the public. Form 990 and Form 1023 are avaliable to the public upon request.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesEvaluation and compensation of other officers or key employees is determined by the Executive Director.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsThe organization monitors and enforces compliance with the conflict of interest policy through annual evaluation and updating. Officers, directors, and key employees would not be able to discuss or vote on an issue where a conflict of interest exists.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessA review will be conducted by the audit committee and their recommendation goes to the Board of Directors prior to filing the return
Form 990, Part III, Line 4dForm 990, Part III, Line 4d : Other Program Services DescriptionOTHER PROGRAM SERVICES 4: The crisis hotline is a 24 hour / 7 day a week / 365 days a yearprogram that offers crisis and suicide intervention services by phoneor on a walk-in basis, and a trauma response team to respond tocritical events in the community. To assist with crises of a financialnature, we also offer emergency financial assistance for needs such asrent, utilities and financial support to pay for life-sustainingprescription medications. We provide a free community voice mailservice for individuals who may be homeless, in transition fromincarceration or are victims of a domestic violence situation. Ourhotline also offers community presentations on our services, and weoffer trainings on suicide intervention and other service-relatedtopics. During our 2009-2010 fiscal year, we provided services to23,253 individuals. Of that total we assisted 854 individuals withrent and utilities, 271 with prescription medications, and 458individuals with emergency food boxes. In addition to our paid staff,our volunteers provided 332 hours of service, and $4,565 in donations,which were used to financially assist individuals living in the city ofKeizer.