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
2012
Open to Public Inspection
Name of the organization
NAFI CONNECTICUT INC
Employer identification number
90-0059160
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
98,398
44,889
60,227
36,075
20,916
260,505
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......
20,399,989
21,466,421
23,174,298
22,418,187
22,672,372
110,131,267
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
20,498,387
21,511,310
23,234,525
22,454,262
22,693,288
110,391,772
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
110,391,772
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
20,498,387
21,511,310
23,234,525
22,454,262
22,693,288
110,391,772
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
77,246
55,889
40,241
70,660
97,961
341,997
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
77,246
55,889
40,241
70,660
97,961
341,997
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
4,392
25,982
31,944
10,191
9,933
82,442
13
Total support. (Add lines 9, 10c, 11, and 12.)..
20,580,025
21,593,181
23,306,710
22,535,113
22,801,182
110,816,211
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
99.617 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.630 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.309 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.300 %
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
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
2012
Open to Public Inspection
Name of the organization
NAFI CONNECTICUT INC
Employer identification number
90-0059160
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
PART I AND PART III
NAFI CONNECTICUT, INC.'S MISSION IS CREATING DIVERSE AND INNOVATIVE SERVICES FOR PEOPLE. NAFI CT IS A MULTI-SERVICE AGENCY THAT PROVIDES PROGRAMMING, CONSULTATION AND INDIVIDUAL SUPPORT SERVICES TO YOUTH, FAMILIES AND YOUNG ADULTS IN A VARIETY OF SETTINGS. FOSTER CARE, DEVELOPMENTAL SERVICES, RESIDENTIAL TREATMENT, HOME-BASED SERVICES AND CONSULTATION ARE THE BROAD SCOPE DIVISIONS WHICH MAKE UP NAFI CT.
NEW/SIGNIFICANT CHANGE PROGRAM SERVICES
PART III, QUESTIONS 2 & 3
NEW SERVICE #1 NAFI CT EXPANDED ITS COMMUNITY BASED SERVICES TO INCLUDE A MST PROBLEM SEXUAL BEHAVIOR (PSB) PROGRAM AND A FOSTERING RESPONSIBILITY, EDUCATION AND EMPLOYMENT (FREE) PROGRAM. BOTH PROGRAMS ARE FUNDED BY DEPARTMENT OF CHILDREN AND FAMILIES. THE PSB PROGRAM PROVIDES CLINICAL INTERVENTIONS FOR ADOLESCENTS THAT DEMONSTRATE PROBLEM SEXUAL BEHAVIOR THAT REQUIRES INTENSIVE INTERVENTION. THE FREE PROGRAM PROVIDES REENTRY SERVICES TO SUPPORT ADOLESCENTS AND YOUNG ADULTS INVOLVED WITH THE JUVENILE JUSTICE SYSTEM WHO ARE RETURNING TO THEIR COMMUNITY FROM OUT-OF-HOME CARE. NAFI CT ALSO BEGAN OPERATING A MULTI-DIMENSIONAL FAMILY THERAPY (MDFT) COMMUNITY RESIDENTIAL PROGRAM FOR YOUTH. THIS IS A SIX BED RESIDENTIAL PROGRAM PROVIDING GENDER SPECIFIC PROGRAMMING FOR ADOLESCENT GIRLS. NAFI CT ACQUIRED A COMMUNITY RESIDENTIAL SERVICE (CRS) PROGRAM FOR THREE MEN IN MIDDLEBURY. THIS PROGRAM PROVIDES 24/7 CARE FOR THESE MEN ASSISTING THEM WITH LIFE SKILLS AND MANY COMMUNITY INTEGRATION ACTIVITIES. SIGNIFICANT CHANGE SERVICE #1 DURING YEAR ENDED JUNE 30, 2013 NAFI CT CEASED OPERATION OF ITS DOVER ROAD GROUP HOME AND JCMC PROGRAMS RESULTING IN ANNUAL LOSS OF REVENUE OF $1.5M.
PROGRAM SERVICE ACCOMPLISHMENTS
PART III, QUESTION 4D
NAFICT'S OTHER MULTISERVICE PROGRAMS INCLUDE: SHORT AND LONG-TERM FOSTER CARE AND PROGRAMS FOR DEVELOPMENTALLY DELAYED CLIENTS LIVING IN APARTMENTS AND GROUP HOMES.
MANAGEMENT DUTIES
PART VI, SECTION A, QUESTION 3
NORTH AMERICAN FAMILY INSTITUTE (NAFI) IS THE SOLE CORPORATE MEMBER OF NAFI CONNECTICUT, INC. NAFI CONNECTICUT PAYS A MANAGEMENT FEE OF $1,058,797 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. NAFI PAYS COMPENSATION TO OFFICERS AND DIRECTORS OF NAFI CONNECTICUT: JAMES ISENBERG, DANIEL NAKAMOTO, LYNN BISHOP, AND HILDEGARDE PARIS. THE COMPENSATION IS REPORTED IN COLUMN (E) OF FORM 990, PART VII.
ORGANIZATION MEMBERS
PART VI, SECTION A, QUESTION 6-7B
NORTH AMERICAN FAMILY INSTITUTE, INC. (NAFI) IS SOLE MEMBER OF NAFI CONNECTICUT, 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
EXECUTIVE DIRECTOR'S COMPENSATION IS PROVIDED THROUGH THE MANAGEMENT AGREEMENT WITH NORTH AMERICAN FAMILY INSTITUTE (NAFI). NAFI CONNECTICUT'S BOARD OF DIRECTORS IN CONJUNCTION WITH THE NAFI EXECUTIVE MANAGEMENT REVIEWS THE EXECUTIVE DIRECTOR'S PERFORMANCE AND SALARY ON AN ANNUAL BASIS. NAFI CONNECTICUT AND NAFI UTILIZE THE COMPENSATION POLICY SHOWN BELOW. NORTH AMERICAN FAMILY INSTITUTE, INC. HAS INSTITUTED A PROCESS TO REVIEW THE COMPENSATION PAID TO ITS EXECUTIVES AND FOLLOWS THE REBUTTABLE PRESUMPTION RULES OF SECTION 53.4958-6 OF THE IRS TREASURY REGULATIONS. THE EXECUTIVE DIRECTOR COMPLETES A SELF EVALUATION REFLECTING ON ACCOMPLISHMENTS, AREAS OF GROWTH AND GOALS FOR THE COMING YEAR. THE CEO OF THE PARENT ORGANIZATION COMPLETES AN EVALUATION SUMMARY WHICH IS REVIEWED, DISCUSSED AND APPROVED AT AN EXECUTIVE SESSION OF THE BOARD OF DIRECTORS. SALARY CONSIDERATIONS ARE PART OF THIS PROCESS AND INCLUDE APPROVALS, IN ADVANCE OF ANY COMPENSATION PAYOUTS, BY THE CEO OF THE PARENT ORGANIZATION AND THE BOARD OF DIRECTORS WHO ARE INDEPENDENT OF MANAGEMENT AND FREE OF ANY CONFLICTS THAT WOULD INTERFERE WITH THEIR EXERCISE OF INDEPENDENT JUDGMENT. 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. NAFI CONDUCTS PERIODIC ANALYSIS OF LIKE POSITIONS AT COMPARABLE HUMAN SERVICE ORGANIZATIONS AND THIS ANALYSIS IS CONSIDERED WHEN DETERMINING COMPENSATION. ONCE COMPENSATION IS DETERMINED, IT IS ADEQUATELY DOCUMENTED BY THE CEO AND BOARD OF DIRECTORS.
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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.