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
DOC WAYNE YOUTH SERVICES INC
Employer identification number
27-4216064
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.") .
73,688
80,317
205,237
359,242
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......
37,690
55,073
92,763
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.
73,688
118,007
260,310
452,005
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.)
452,005
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...
73,688
118,007
260,310
452,005
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,560
3,954
5
5,519
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
1,560
3,954
5
5,519
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.)..
75,248
121,961
260,315
457,524
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
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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
DOC WAYNE YOUTH SERVICES INC
Employer identification number
27-4216064
Return Reference
Explanation
FORM 990, PART III, LINE 1
DOC WAYNE YOUTH SERVICES PROVIDES PROVEN ALTERNATIVE MENTAL HEALTH SERVICES BY USING SPORTS AS A WAY TO ENGAGE YOUTH IN THERAPY. WE WORK PRIMARILY WITH LOW-INCOME YOUTH WHO SUFFER FROM A VARIETY OF MENTAL HEALTH CHALLENGES, INCLUDING VICTIMS OF NEGLECT, ABUSE, VIOLENT CRIME AND SEXUAL TRAFFICKING. OVERALL, 1 IN 5 CHILDREN UNDER THE AGE OF 19 SUFFERS FROM A MENTAL ILLNESS THAT IMPAIRS HOW THEY FUNCTION AT HOME, AT SCHOOL, AND WITH PEERS, BUT ONLY 20-34% RECEIVE TREATMENT. WHILE MASSACHUSETTS HAS THE NATION'S HIGHEST RATES OF CHILDREN SCREENED FOR BEHAVIORAL HEALTH ISSUES, DOCTORS AND ADVOCATES INTERVIEWED ON THE SUBJECT IN LATE 2013 BY THE BOSTON GLOBE REPORTED THAT MANY OF THESE CHILDREN AND YOUTH WERE NOT RECEIVING APPROPRIATE TREATMENT. OBSTACLES INCLUDED STIGMA, TRANSPORTATION, LANGUAGE BARRIERS AND RELUCTANCE TO ENGAGE IN TREATMENT. TRADITIONAL MODELS OF TREATMENT THAT FOCUS ON DEFICITS HAVE YIELDED ONLY MODEST RESULTS. DOC WAYNE OFFERS PROGRAMS IN SCHOOL, RESIDENTIAL AND COMMUNITY SETTINGS TO EFFECTIVELY REACH CHILDREN WHO DO NOT HAVE ACCESS TO OR ARE RESISTANT TO THERAPY. YOUTH WHO RESIST OR FAIL TO PROGRESS IN TRADITIONAL "TALK THERAPY" SETTINGS THRIVE IN DOC WAYNE PROGRAMS BECAUSE THEY APPEAL TO YOUNG PEOPLE AS FUN AND CHALLENGING SPORTS ACTIVITIES. OUR PROGRAMS BUILD CRITICAL LIFE SKILLS, DEVELOPED ON THE FIELD AND ON THE COURT, THAT HELP YOUTH TO DEVELOP INTO FUNCTIONAL, INDEPENDENT ADULTS. ESTABLISHED AS AN INDEPENDENT 501(C)(3) NONPROFIT IN 2010, DOC WAYNE YOUTH SERVICES WORKS WITH 500 YOUTH EACH YEAR FROM GREATER BOSTON, EASTERN AND CENTRAL MASSACHUSETTS THROUGH OUR THERAPEUTIC SPORTS PROGRAM AND CHALK TALK GROUP THERAPY. THE YOUTH WE SERVE ARE DRAWN FROM RESIDENTIAL TREATMENT CENTERS AND INTENSIVE THERAPY PROGRAMS AS WELL AS LOW-INCOME HOUSING COMMUNITIES AND PUBLIC SCHOOLS. THEY STRUGGLE WITH THE BURDEN OF TRAUMATIC LIFE EXPERIENCES, BEHAVIORAL AND EMOTIONAL CHALLENGE AND WITH THE DAILY KNOWLEDGE THAT VERY LITTLE IS EXPECTED OF THEM BY ANYONE. IN EACH OF OUR PROGRAMS, CLINICIANS AND THERAPEUTIC MENTOR COACHES TEACH BEHAVIORAL AND SOCIAL EMOTIONAL SKILLS IN A SPORTS SETTING. WHILE PLAYING SPORTS, YOUTH PRACTICE PRO-SOCIAL BEHAVIORS SUCH AS POSITIVE DECISION-MAKING AND COMMUNICATION SKILLS AND IMPULSE CONTROL. THESE LIFE SKILLS INCREASE BEHAVIORAL HEALTH AND ENABLE YOUTH TO SUCCEED AT SCHOOL, AT HOME, AND IN THEIR COMMUNITIES.
FORM 990, PART VI, SECTION A, LINE 3
MANAGEMENT DECISIONS ARE RESERVED TO THE SOLE MEMBER, COMMUNITIES FOR PEOPLE, INC.
FORM 990, PART VI, SECTION A, LINE 6
COMMUNITIES FOR PEOPLE. INC. IS THE AGENCYS SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A
COMMUNITIES FOR PEOPLE, INC. HAS THE AUTHORITY TO ELECT OR APPOINT OTHER MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7B
GOVERNANCE DECISIONS ARE RESERVED TO THE SOLE MEMBER, COMMUNITIES FOR PEOPLE, INC.
FORM 990, PART VI, SECTION B, LINE 11
THE BOARD OF DIRECTORS REVIEWS THE 990 PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD REVIEWS THE CONFLICT OF INTEREST POLICY ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15
COMMUNITIES FOR PEOPLE, INC. (CFP) IS THE SOLE MEMBER OF DOC WAYNE YOUTH SERVICES, INC. (DOC WAYNE). DOC WAYNE IS AN INDEPENDENT 501(C)(3) NON-PROFIT ORGANIZATION AND CFP IS NOT A FISCAL AGENT FOR DOC WAYNE. DOC WAYNE PAYS A MANAGEMENT FEE TO COMMUNITIES FOR PEOPLE, INC. FOR ADMINISTRATIVE SERVICES. CFP'S CEO AND CFO OVERSEE DOC WAYNE AS OFFICERS OF ITS SOLE MEMBER AND ARE NOT PAID DIRECTLY BY DOC WAYNE.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND TAX RETURNS ARE AVAILABLE UPON REQUEST. THE TAX RETURNS ARE ALSO AVAILABLE ONLINE THROUGH THE MASSACHUSETTS ATTORNEY GENERALS OFFICE.
PART VII SECTION A
THE FOLLOWING ARE MEMBERS OF DOC WAYNE YOUTH SERVICES, INC. ADVISORY BOARD: CHRISTOPHER ERNEST, CHAIRMAN CRAIG GORDON, CLERK WILLIAM LYTTLE, DIRECTOR KAYLA HARRISON, DIRECTOR HEIDI GARCIA, DIRECTOR ANDREW MINGLE, DIRECTOR RANDY BARTH, DIRECTOR JOSEPH LEAVEY, DIRECTOR
FORM 990, PART XII, LINE 2C
THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN SELECTION OF AN INDEPENDENT AUDITOR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.