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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PRESBYTERIAN COUNSELING SERVICE DBA SAMARITAN CENTER OF PUGET SOUND
Employer identification number
91-1268538
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)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
168,264
232,852
130,861
95,983
139,461
767,421
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......
2,230,502
2,193,435
2,154,036
2,147,892
2,079,097
10,804,962
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.
2,398,766
2,426,287
2,284,897
2,243,875
2,218,558
11,572,383
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.)
11,572,383
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
2,398,766
2,426,287
2,284,897
2,243,875
2,218,558
11,572,383
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
12,552
15,512
18,407
16,219
17,003
79,693
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
12,552
15,512
18,407
16,219
17,003
79,693
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.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
2,411,318
2,441,799
2,303,304
2,260,094
2,235,561
11,652,076
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.320 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.440 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.680 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.560 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PRESBYTERIAN COUNSELING SERVICE DBA SAMARITAN CENTER OF PUGET SOUND
Employer identification number
91-1268538
Return Reference
Explanation
FORM 990, PART III, LINE 4A
SAMARITAN CENTER OF PUGET SOUND, A NON-PROFIT ORGANIZATION WITH ROOTS AND TRADITION IN THE CHRISTIAN COMMUNITY, PROVIDED 22,199 HOURS OF COUNSELING SERVICES THIS PAST YEAR. THERE WERE 2905 PEOPLE: INDIVIDUALS, COUPLES AND FAMILIES SERVED BY 32 STATE LICENSED, MASTER'S AND DOCTORAL LEVEL THERAPISTS WHO MET CLIENTS IN 20 LOCATIONS THROUGHOUT KING, PIERCE AND KITSAP COUNTIES IN THE PUGET SOUND AREA. OUR STAFF INCLUDED THERAPISTS WHO SPEAK SPANISH, KOREAN, GERMAN, CANTONESE, MANDARIN AND SEVERAL OF THE MANY LANGUAGES SPOKEN IN THE PHILIPPINES. WE WELCOME PEOPLE OF ALL FAITHS, BACKGROUNDS AND LIFESTYLES. MORE THAN HALF OF THOSE WHO CAME TO SAMARITAN FOR COUNSELING DID NOT PAY OUR FULL FEE DUE TO ECONOMIC DILEMMAS OR INSURANCE COMPANY FEE ADJUSTMENTS, BASED ON THEIR INSURANCE BENEFIT. THIS REQUIRED AN ESTIMATED $750,653 COMMITMENT OF PROVIDING UNCOMPENSATED CARE. OUR ABILITY TO MEET THIS EVER-INCREASING NEED IS BASED ON FUNDRAISING EFFORTS OVERSEEN BY OUR PRESIDENT AND BOARD OF DIRECTORS. OF OUR TOTAL COUNSELING HOURS, 903 WERE PROVIDED THROUGH THE LOW FEE CLINIC WHERE SAMARITAN EXTERNS SERVED CLIENTS IN THREE LOCATIONS. WE OFFER EXTERNSHIPS TO QUALIFIED MASTERS LEVEL THERAPISTS WHO ARE WORKING TOWARD STATE LICENSURE AND WHO, IN RETURN FOR SUPERVISION BY EXPERIENCED SAMARITAN THERAPISTS, PROVIDE COUNSELING FOR EXTREMELY LOW-INCOME CLIENTS. WE HAVE 13 EXTERNS WHO PROVIDED SERVICES DURING THE YEAR AND 209 HOURS OF SUPERVISION WERE PROVIDED BY SAMARITAN THERAPISTS. IN ADDITION TO COUNSELING SERVICES, SAMARITAN PROVIDES MEDIATION, CONSULTATION FOR CHURCHES, ORGANIZATIONS AND BUSINESSES, ALONG WITH PROFESSIONAL TRAINING FOR THERAPISTS AND EDUCATIONAL OFFERINGS FOR THE COMMUNITY. IN FEBRUARY 2014, SAMARITAN CENTER ACQUIRED THE CARETEAM PROGRAM FROM ANOTHER NON-PROFIT IN SEATTLE THAT CEASED OPERATIONS. THE CARETEAM PROGRAM HAS OVER 125 TRAINED VOLUNTEERS SERVING ON 20 CARETEAMS, WHICH PROVIDE EMOTIONAL AND PRACTICAL SUPPORT TO 27 CLIENTS, KNOWN AS CAREPARTNERS. DURING THE SIX WEEKS IN THE 2013-2014 FISCAL YEAR THAT CARETEAMS WAS PART OF SAMARITAN CENTER OF PUGET SOUND, VOLUNTEERS PROVIDED 431 HOURS OF SUPPORT.
FORM 990, PART VI, SECTION B, LINE 11
DRAFT FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND OTHERS UPON REQUEST. FORM 990 IS USED TO REVIEW THE PAST YEAR'S FINANCIAL POSITION, REINFORCE THE FIDUCIARY RESPONSIBILITY OF THE GOVERNING BOARD, AND AS AN INDICATOR OF ANY CHANGES THAT MAY NEED TO BE MADE IN THE FUTURE.
FORM 990, PART VI, SECTION B, LINE 12C
DISCLOSURE OF CONFLICTS OF INTEREST ARE DISCUSSED OPENLY THROUGHOUT THE YEAR.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD OF TRUSTEES PERFORMS A REVIEW OF THE EXECUTIVE DIRECTOR. ALL CLINICAL STAFF AND ADMINISTRATIVE STAFF HAVE PERFORMANCE REVIEWS BY THE EXECUTIVE DIRECTOR. COMPENSATION IS DETERMINED USING COMPARABLE DATA, REGIONAL DATA, SAMARITAN INSTITUTE GUIDEANCE, AND FISCAL RESOURCES. THE BOARD OF TRUSTEES APPROVES THE EXECUTIVE DIRECTOR'S COMPENSATION. THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES APPROVES ALL OTHER LEADERSHIP AND ADMINISTRATIVE MEMBERS' COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19
DOCUMENTS ARE MADE AVAILABLE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.