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
ODYSSEY HOUSE INC - UTAH
Employer identification number
87-0292487
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.") ....
5,504,988
5,869,611
5,581,150
5,808,535
6,260,275
29,024,559
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
5,504,988
5,869,611
5,581,150
5,808,535
6,260,275
29,024,559
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.
29,024,559
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..
5,504,988
5,869,611
5,581,150
5,808,535
6,260,275
29,024,559
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
29,514
13,668
10,542
9,661
4,495
67,880
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
38,018
18,338
1,903
58,259
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).
29,150,698
12
Gross receipts from related activities, etc. (see instructions)
..................
12
5,885,706
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
99.570 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
99.010 %
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:
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
ODYSSEY HOUSE INC - UTAH
Employer identification number
87-0292487
Identifier
Return Reference
Explanation
DOING BUSINESS AS
FORM 990, PAGE 1, ITEM C
ODYSSEY HOUSE OF UTAH
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
AT ODYSSEY HOUSE OF UTAH WE CREATE ACCOUNTABLE, SELF-SUFFICIENT, CONTRIBUTING, HEALTHY, AND HAPPY INDIVIDUALS AND FAMILIES BY USING THE THERAPEUTIC COMMUNITY METHOD TO PROVIDE QUALITY AND EFFECTIVE SUBSTANCE ABUSE AND MENTAL HEALTH TREATMENT, EDUCATION, VOCATION, HOUSING, AND PREVENTION SERVICES TO INDIVIDUALS AND FAMILIES IN NEED, ESPECIALLY THOSE WHO ARE SOCIALLY AND ECONOMICALLY DISADVANTAGED.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
RESIDENTIAL PROGRAM, AN OUTPATIENT PROGRAM, ASSESSMENTS AND DRUG TESTING, AND ALSO IN-HOME PROGRAMS. SERVED 102 INDIVIDUALS DURING THE FISCAL YEAR. PARENTS WITH CHILDREN SERVICES - THIS RESIDENTIAL PROGRAM PROVIDES SERVICES FOR PARENTS TO REUNITE WITH THEIR CHILDREN AND LEARN THE SKILLS TO BE SUCCESSFUL, HEALTHY PARENTS FOR THE REST OF THEIR LIVES. THE PROGRAM INCLUDES A FATHERS WITH CHILDREN PROGRAM, A MOTHERS WITH CHILDREN PROGRAM, AND A THERAPEUTIC DAYCARE. SERVED 45 INDIVIDUALS DURING THE FISCAL YEAR. TRANSITION HOUSE - THIS PROGRAM OFFERS RESIDENCE IN A DRUG-FREE TRANSITIONAL LIVING HOUSE. THESE FACILITIES PROVIDE PROGRAM GRADUATES WITH A SUPPORTIVE ENVIRONMENT AND AN ON-SITE STAFF SPECIFICALLY TRAINED TO SUPERVISE THE TRANSITION FROM A STRUCTURED PROGRAM TO INDEPENDENT LIVING. IN THIS ENVIRONMENT RESIDENTS GAIN SUPPORT, RECEIVE COUNSELING, AND LEARN HOW TO MANAGE MONEY, PLAN FOR THEIR EDUCATION AND FIND EMPLOYMENT. SERVED 64 INDIVIDUALS DURING THE FISCAL YEAR. VOCATIONAL TRAINING - THIS PROGRAM GIVES RESIDENTS JOB TRAINING AND EXPERIENCE AS PART OF THEIR TREATMENT PROCESS. THESE PROJECTS ALSO RAISE FUNDS AND HELP DEFRAY EXPENSES FOR RESIDENTS WHO ARE UNABLE TO AFFORD THE FULL COST OF TREATMENT. ON-THE-JOB TRAINING GIVES RESIDENTS THE OPPORTUNITY TO DEVELOP MARKETABLE JOB SKILLS AND WORK HABITS. WORK CREWS RECEIVE TRAINING IN PROBLEM-SOLVING TECHNIQUES, TECHNICAL SKILLS DEVELOPMENT, JOB SAFETY, PUNCTUALITY, AND EFFECTIVE COMMUNICATION SKILLS. INTEGRATED HEALTH CLINIC - THE MARTINDALE INTEGRATED HEALTH CLINIC PROVIDES BEHAVIORAL HEALTH INFORMED PRIMARY CARE TO PATIENTS WITH SUBSTANCE USE DISORDERS AND MENTAL HEALTH CONDITIONS. THE CLINIC IS STAFFED BY BOTH MEDICAL PRACTITIONERS AND BEHAVIORAL HEALTH PROVIDERS INCLUDING MDS, PAS, RNS, SOCIAL WORKERS, AND SUBSTANCE USE DISORDER COUNSELORS. CONSISTENT WITH THE ORGANIZATION'S HOLISTIC CARE MISSION, STABILIZING MEDICAL CONDITIONS WHILE IN ADDICTION TREATMENT SERVICES HELPS ODYSSEY HOUSE DELIVER A FULLY-ROUNDED TREATMENT REGIMEN FOR CLIENTS TO LEAVE HEALTHY AND PRODUCTIVE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
AFTER THE 990 IS PREPARED IT IS REVIEWED BY THE DIRECTOR OF FINANCE AND BY THE EXECUTIVE DIRECTOR FOR ACCURACY. THE NUMBERS ARE COMPARED TO THE AUDITED FINANCIAL STATEMENTS FOR ACCURACY. THE 990 IS THEN DISTRIBUTED TO THE BOARD MEMBERS FOR THEIR REVIEW. IF NO PROBLEMS ARE IDENTIFIED, THEN THE 990 IS CONSIDERED CORRECT.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
THE BOARD OF DIRECTORS AND ALL FULL-TIME EMPLOYEES ARE REQUIRED TO ANNUALLY FILL OUT A CONFLICT OF INTEREST DECLARATION FORM. THESE FORMS ARE REVIEWED BY APPROPRIATE MANAGEMENT STAFF OR BY THE CHAIRMAN OF THE BOARD IN ORDER TO IDENTIFY AND ELIMINATE ANY CONFLICTS.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE SALARY OF THE EXECUTIVE DIRECTOR IS REVIEWED BY THE BOARD OF DIRECTORS AND THAT LEVEL IS SET BASED ON THE BOARD OF DIRECTORS REVIEW OF APPROPRIATE COMPARABLE INDUSTRY AND REGIONAL SALARY LEVELS. DELIBERATION IS DOCUMENTED IN BOARD MINUTES.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
THE SALARY LEVELS FOR ALL OTHER EMPLOYEES ARE REVIEWED AND SET BY THE APPROPRIATE MANAGEMENT TEAM INCLUDING THE EXECUTIVE DIRECTOR, THE DIRECTOR OF THEIR WORK AREA AND THEN FINAL APPROVAL IS GIVEN BY THE BOARD OF DIRECTORS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
RECONCILIATION OF CHANGES - OTHER
FORM 990, PART XI, LINE 9
SPECIAL EVENTS EXPENSES 62,469 SPECIAL EVENTS EXPENSES -62,469
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.