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
SAFEHAVEN OF TARRANT COUNTY
Employer identification number
75-1670281
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) 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.") ....
5,156,691
5,365,382
5,830,404
6,153,911
6,387,911
28,894,299
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
5,156,691
5,365,382
5,830,404
6,153,911
6,387,911
28,894,299
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)..
0
6
Public support. Subtract line 5 from line 4.
28,894,299
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..
5,156,691
5,365,382
5,830,404
6,153,911
6,387,911
28,894,299
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
90,446
101,831
85,727
81,377
76,569
435,950
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
7,859
33,519
1,688
250
232
43,548
11
Total support (Add lines 7 through 10).
29,373,797
12
Gross receipts from related activities, etc. (see instructions)
..................
12
3,134,786
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
98.370 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
98.140 %
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.") .
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......
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.
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.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)..
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
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
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:
12000229
Software Version:
2012v2.0
-
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
SAFEHAVEN OF TARRANT COUNTY
Employer identification number
75-1670281
Identifier
Return Reference
Explanation
FORM 990, PART I, LINE I - MISSION
SAFEHAVEN'S MISSION IS TO END DOMESTIC VIOLENCE BY OPERATING 2 EMERGENCY SHELTERS WITH 174 BEDS AND 2 RESOURCE CENTERS OFFERING MULTIPLE SUPPORTIVE SERVICES. FAMILIES LEAVING THE SHELTERS MAY ENTER OUR TRANSITIONAL LIVING PROGRAM TO RECEIVE SUPPORTIVE SERVICES AND NO COST HOUSING FOR UP TO 2 YEARS. SAFEHAVEN ALSO PROVIDES EDUCATIONAL AND PREVENTION PROGRAMS DESIGNED TO BREAK THE CYCLE OF VIOLENCE BEFORE IT BEGINS.
Form 990, Part XI, Line 9
Other Changes In Net Assets Or Fund Balances - Other Increases
FORGIVENESS OF DEBT = $23856
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The Annual Report includes financial information; various documents (determination letter, financial statements, annual report, form 990) are available on Guidestar.org; Annual Report is available on agency website. Policies are available upon request.
Form 990, Part VI, Line 18
Form 990, Part VI, Line 18: Explanation of Other Means Forms Available For Public Inspection
The Annual Report includes financial information; various documents (determination letter, financial statements, annual report, form 990) are available on Guidestar.org; Annual Report is available on agency website. Policies are available upon request.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
The compensation for all of SafeHaven's positions are established by evaluating salary surveys. The ranges are approved by the department head and CEO, and these approvals are documented within the files. The CEO's salary is compared to the same surveys and is approved by the Board of Directors. SafeHaven does not have an established pay range FOR THE CEO POSITION, but the Board recommends and approves the CEO's pay on an annual basis.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
SafeHaven monitors and enforces compliance with the conflict of interest policy with periodically signed statements, as well as by allowing board members to recuse themselves from votes related to their employers, companies, etc.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
The Board of Directors will review the 990 before filing.
Form 990, Part VI, Line 2
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et
THE VICE PRESIDENT OF DEVELOPMENT IS THE MOTHER OF A FORMER BOARD MEMBER. THE FORMER BOARD MEMBER WORKS FOR THE BANK THAT HOLDS THE ORGANIZATION'S LINE OF CREDIT. THE CURRENT BOARD APPROVED THE LINE OF CREDIT WITH THE BANK. THIS RELATIONSHIP WAS DISSOLVED DURING 2013 AS THE VICE PRESIDENT OF DEVELOPMENT LEFT THE EMPLOYMENT OF THE AGENCY. THE BANK CONTINUES TO HOLD THE LINE OF CREDIT AUTHORIZED BY THE BOARD OF DIRECTORS IN 2013.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: Children's and Youth Programs - Specialized programming for children at the emergency shelters includes educational, recreational and therapeutic activities. Trained staff and volunteers provide therapeutic, educational childcare so mothers can attend work, seek employment or fulfill appointments. Children's advocates provide individualized case management and support groups. Licensed therapists offer play therapy and counseling. The Fort Worth shelter operates an onsite school using accredited teachers from Fort Worth ISD while the Arlington shelter enrolls children in Arlington ISD schools. The Organization operates a weekend camping program twice annually for child victims and a day camp program during the summer. 2,101 clients served during FYE 2013. OTHER PROGRAM SERVICES 5: Community Services and Volunteers - The Organization provides comprehensive educational programs in area schools and to companies and civic groups. Community presentations to groups educate about the cycle of violence, needs of victims and services available at the Organization. School presentations implement evidence-based curricula focusing on primary prevention, or stopping violence before it starts. The Organization engages community members as volunteers in client service delivery at all locations, administrative support, fundraising events and speaking opportunities that raise awareness of domestic violence. OTHER PROGRAM SERVICES 6: Thrift Store - The Organization owns and operates Berry Good Buys, a retail thrift store located in Fort Worth. The Store carries gently used clothing, furniture and household items donated by the community which are distributed free of charge to clients or resold at discounted and bargain prices. SafeHaven's Berry Good Buys program intends to generate income to fund the Organization's domestic violence programs and services. The Store also honors vouchers for clothing for clients of other human service agencies in Tarrant County. Last year, more than $26,000 in merchandise was given at no charge to victims of domestic violence as well as low-income and homeless individuals or families.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.