Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
NFI VERMONT INC
Employer identification number
03-0304434
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
28,844
15,515
765,463
74,446
34,604
918,872
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
10,703,037
11,015,462
12,003,062
11,978,219
11,675,444
57,375,224
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
10,731,881
11,030,977
12,768,525
12,052,665
11,710,048
58,294,096
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
58,294,096
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10,731,881
11,030,977
12,768,525
12,052,665
11,710,048
58,294,096
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
5,116
5,719
1,658
6,379
12,889
31,761
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
5,116
5,719
1,658
6,379
12,889
31,761
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
8,332
22,727
6,158
8,113
5,131
50,461
13
Total support (Add lines 9, 10c, 11 and 12.).
10,745,329
11,059,423
12,776,341
12,067,157
11,728,068
58,376,318
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
99.859 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
99.857 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0.054 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
0.052 %
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
NFI VERMONT INC
Employer identification number
03-0304434
Identifier
Return Reference
Explanation
OTHER PROGRAM SERVICES
PART III, LINE 4D
IN ADDITION TO OUR THREE PRIMARY TYPES OF PROGRAMS WE ALSO PROVIDE OUTPATIENT THERAPY TO YOUTH AND FAMILIES, POST ADOPTION SERVICES TO FAMILIES OF YOUTH ADOPTED FROM STATE CUSTODY, JUVENILE JUSTICE SERVICES AND YOUTH TRANSITION TO KIDS IN STATE.
MANAGEMENT DUTIES
PART VI, SECTION A, QUESTION 3
NORTH AMERICAN FAMILY INSTITUTE, INC. (NAFI) IS THE SOLE CORPORATE MEMBER OF NFI VERMONT. NFI VERMONT PAYS A MANAGEMENT FEE OF $525,901 TO NAFI FOR OVERSIGHT OF FINANCIAL, BUDGETING, HUMAN RESOURCE OPERATIONS, AND EXEMPT OPERATIONS. NAFI ALSO PROVIDES ACCOUNTING AND AUDITING SERVICES, PERSONNEL POLICIES AND BENEFITS, AND INFORMATION TECHNOLOGY BACKBONE FOR THE SUBSIDIARY CORPORATE OFFICES.
ORGANIZATION MEMBERS
PART VI, SECTION A , QUESTION 6-7B
NORTH AMERICAN FAMILY INSTITUTE, INC. (NAFI) IS SOLE MEMBER OF NFI VERMONT, INC. AND MAY ELECT MEMBERS OF THE GOVERNING BOARD.
FORM 990 REVIEW PROCESS
PART VI, SECTION B, QUESTION 11B
INFORMATION IS GATHERED FROM THE BUSINESS OFFICE/EXECUTIVE DIRECTOR BY THE CHIEF FINANCIAL OFFICER AND USED TO POPULATE THE FORM 990 IN CONJUNCTION WITH INDEPENDENT TAX AUDITORS. ONCE COMPLETED, THE DRAFT FORM IS REVIEWED AND FORWARDED BY THE CFO TO THE DESIGNATED COMMITTEE FOR REVIEW PRIOR TO ITS SUBMISSION. THE DESIGNATED COMMITTEE HAS BEEN AUTHORIZED TO REVIEW AND APPROVE THE FORM 990 ON BEHALF OF THE BOARD OF DIRECTORS. A FILING COPY OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
CONFLICT OF INTEREST
PART VI, SECTION B, QUESTION 12C
IN ADDITION TO SUBMISSION OF SIGNED BOARD MEMBER ANNUAL STATEMENT AFFIRMING RECEIPT OF THE CONFLICT OF INTEREST POLICY, THAT THEY HAVE READ AND UNDERSTAND THE POLICY, THAT THEY AGREE TO COMPLY WITH THE POLICY AND UNDERSTAND THAT THE CORPORATION IS CHARITABLE AND MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ITS CHARITABLE PURPOSES, BOARD MEMBERS HAVE A DUTY TO DISCLOSE POSSIBLE CONFLICTS OF INTEREST. WHEN SUCH A DISCLOSURE IS MADE, THE BOARD OF DIRECTORS WILL DISCUSS THE ISSUE WITH THE INTERESTED PARTY. THE INTERESTED PARTY WILL THEN LEAVE THE BOARD MEETING WHILE A DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT A DIRECTOR HAS FAILED TO DISCLOSE A POSSIBLE CONFLICT OF INTEREST, THE BOARD WILL AFFORD THAT DIRECTOR AN OPPORTUNITY TO EXPLAIN. THE BOARD WILL CONDUCT FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES. THAT DIRECTOR WILL BE RECUSED FROM THE BOARD MEETING WHILE A DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. IF THE BOARD DETERMINES THAT THE BOARD MEMBER FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
DETERMINING COMPENSATION
PART VI, SECTION B, QUESTION 15
NFI VERMONT, INC. DOES NOT DIRECTLY COMPENSATE ITS TOP MANAGEMENT OFFICIAL. NFI VERMONT, INC. CONTRACTS WITH NORTH AMERICAN FAMILY INSTITUTE (NAFI), A RELATED ORGANIZATION, FOR THE EXECUTIVE DIRECTOR POSITION. NFI VERMONT ALSO DOES NOT HAVE ANY EMPLOYEES THAT MEET THE CRITERIA OF A KEY EMPLOYEE. THE BOARD MEMBERS LISTED IN FORM 990, PART VII ARE COMMUNITY LEADERS THAT VOLUNTARILY DEVOTE THEIR TIME TO THE ORGANIZATION. THE EXECUTIVE DIRECTOR AND TREASURER ARE COMPENSATED UNDER THE COMPENSATION POLICIES OF PARENT ORGANIZATION, NORTH AMERICAN FAMILY INSTITUTE AS SHOWN BELOW. ANNUALLY THE EXECUTIVE DIRECTOR, BOARD OF DIRECTORS AND PARENT ORGANIZATION CEO PARTICIPATE IN AN EVALUATION PROCESS. THE EXECUTIVE DIRECTOR COMPLETES A SELF EVALUATION REFLECTING ON ACCOMPLISHMENTS, AREAS OF GROWTH AND GOALS FOR THE COMING YEAR. THE BOARD OF DIRECTORS ALSO COMPLETES AN EVALUATION SUMMARY FOR THE EXECUTIVE DIRECTOR AS DOES THE CEO OF THE PARENT ORGANIZATION. THIS INFORMATION IS REVIEWED AND DISCUSSED AT AN EXECUTIVE SESSION OF THE BOARD OF DIRECTORS. SALARY CONSIDERATIONS ARE PART OF THIS PROCESS AND INCLUDE APPROVALS BY THE CEO OF THE PARENT ORGANIZATION AND THE BOARD OF DIRECTORS. OTHER KEY EMPLOYEES OF THE ORGANIZATION ARE REVIEWED BY THE EXECUTIVE DIRECTOR USING A SIMILAR PROCESS AND SALARY CONSIDERATIONS ARE A PART OF THE OVERALL BUDGET APPROVED BY THE BOARD OF DIRECTORS. CURRENT MARKET AND FORM 990 OF OTHER COMPARABLE ORGANIZATIONS ARE TOOLS USED TO ESTABLISH COMPENSATION.
JOINT VENTURES-COLLABORATIVE AGREEMENT
PART VI, SECTION B, QUESTION 16B
NFIV PARTICIPATES IN A COLLABORATIVE AGREEMENT WITH TWO UNRELATED ORGANIZATIONS TO OPERATE THE CENTERPOINT ADOLESCENT TREATMENT SERVICES PROGRAM. THIS AGREEMENT PROVIDES FOR COST AND REVENUE SHARING ABOVE CERTAIN PREDEFINED THRESHOLDS. AS OF JUNE 30, 2012 THE ORGANIZATION HAD NOT ADOPTED A WRITTEN POLICY OR PROCEDURE REQUIRING THE ORGANIZATION TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS. HOWEVER, THE CONTRACT THAT NFIV HAS ENTERED INTO DOES HAVE SUFFICIENT SAFEGUARDS THAT THE PROGRAM WILL BE RUN IN ACCORDANCE WITH ITS EXEMPT PURPOSE.
DISCLOSURE OF DOCUMENTS
PART VI, SECTION C, QUESTION 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND FORM 990 ARE AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO POSTED ON WWW.GUIDESTAR.ORG.
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DR. NANCY GROSSMAN TITLE:PRESIDENT & DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DANIEL NAKAMOTO TITLE:TREASURER & DIRECTOR HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.