AVALON HEALING CENTER: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
AVALON HEALING CENTER (EIN 20-0631006)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-10
IRS object ID
201202239349301465
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-10T15:15:34-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN382050733EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MELLEN SMITH & PIVOZ PLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line130600 TELEGRAPH ROAD SUITE 1131AddressLine1
CityBINGHAM FARMSCity
StateMIState
ZIP Code480254531ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN200631006EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WAYNE COUNTY SAFE PROGRAMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWAYNNameControl
Phone2483020833Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12727 2ND AVENUE NO 120AddressLine1
CityDETROITCity
StateMIState
ZIP Code48201ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKIMBERLY HURSTName
TitleEXECUTIVE DIRECTORTitle
Phone2486422803Phone
Date Signed2012-08-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMARK L SMITHName
PTINP00059974PTIN
Phone2486422803Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKIMBERLY HURSTNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12727 2ND AVE STE 120AddressLine1
CityDETROITCity
StateMIState
ZIP Code48201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts698716GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileMIStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE COMPREHENSIVE MEDICAL AND FORENSIC EXAMINATIONS TO SEXUALLY ASSAULTED PATIENTSActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees10TotalNbrEmployees
Total Nbr Volunteers6TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year166427ContributionsGrantsPriorYear
Contributions Grants Current Year69652ContributionsGrantsCurrentYear
Program Service Revenue Prior Year483071ProgramServiceRevenuePriorYear
Program Service Revenue CY629064ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year32000OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year681498TotalRevenuePriorYear
Total Revenue Current Year698716TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year261303SalariesEtcPriorYear
Salaries Etc Current Year425503SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year55561TotalFundrsngExpCurrentYear
Other Expense Prior Year328675OtherExpensePriorYear
Other Expenses Current Year248326OtherExpensesCurrentYear
Total Expenses Prior Year589978TotalExpensesPriorYear
Total Expenses Current Year673829TotalExpensesCurrentYear
Revenues Less Expenses Prior Year91520RevenuesLessExpensesPriorYear
Revenues Less Expenses CY24887RevenuesLessExpensesCY
Total Assets BOY190994TotalAssetsBOY
Total Assets EOY207689TotalAssetsEOY
Total Liabilities BOY40932TotalLiabilitiesBOY
Total Liabilities EOY32740TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY150062NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY174949NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE COMPREHENSIVE MEDICAL AND FORENSIC EXAMINATIONS TO SEXUALLY ASSAULTED PATIENTSMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense559021Expense
Revenue629064Revenue
DescriptionTO PROVIDE COMPREHENSIVE MEDICAL AND FORENSIC EXAMINATIONS TO SEXUALLY ASSAULTED PATIENTSDescription
Total Program Service Expense559021TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109624NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees10NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KIMBERLY HURSTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number2483020833TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12727 2ND AVENUE STE 120AddressLine1
CityDETROITCity
StateMIState
ZIP Code48201ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
MICHAEL PIVOZ
DIRECTOR2.00X000
NANCY DEGROOTE
DIRECTOR2.00X000
SHOMA PAL
DIRECTOR2.00X000
GLEN HALL
DIRECTOR2.00X000
PATRICIA NOUHAN
DIRECTOR2.00X000
KIMBERLY HURST
CEO/EXECUTIVE DIRECTOR40.008635100X
KRISTINE MCGREGOR
PROGRAM DIRECTOR40.00333300X
FieldValueIRS element (for citing)
Total Reportable Comp From Org89684TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions69652AllOtherContributions
Total Contributions69652TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionMEDICAL & FORENSIC EXADescription
Business Code624100BusinessCode
Total Revenue Column629064TotalRevenueColumn
Related Or Exempt Function Income629064RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue629064TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column698716TotalRevenueColumn
Related Or Exempt Function Income629064RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total342112Total
Program Services273690ProgramServices
Management And General34211ManagementAndGeneral
Fundraising34211Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total83391Total
Program Services66603ProgramServices
Management And General8449ManagementAndGeneral
Fundraising8339Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total51491Total
Program Services49909ProgramServices
Management And General514ManagementAndGeneral
Fundraising1068Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total33081Total
Program Services20779ProgramServices
Management And General2550ManagementAndGeneral
Fundraising9752Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total45139Total
Program Services36719ProgramServices
Management And General7645ManagementAndGeneral
Fundraising775Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total4353Total
Program Services2671ProgramServices
Management And General304ManagementAndGeneral
Fundraising1378Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total5583Total
Program Services5583ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3384Total
Program Services3384ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total7054Total
Program Services7054ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
CONTRACT LABOR8241582415
TELEPHONE103787148319238
EQUIPMENT RENTAL AND MA529830662232
LICENSES & PERMITS150150

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total673829Total
Program Services559021ProgramServices
Management And General59247ManagementAndGeneral
Fundraising55561Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY32492BOY
EOY52122EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY78725BOY
EOY67001EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY38162BOY
EOY42575EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY8191BOY
EOY5360EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis30665LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9743LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY15510BOY
EOY20922EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY17914BOY
EOY19709EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY190994BOY
EOY207689EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY36357BOY
EOY32740EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4575BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY40932BOY
EOY32740EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY132148BOY
EOY157035EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY17914BOY
EOY17914EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY150062BOY
EOY174949EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY190994BOY
EOY207689EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses24887ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years40729CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years149922CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years211651CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year649498CurrentTaxYearMinus1Year
Current Tax Year698716CurrentTaxYear
Total1750516Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years11400CurrentTaxYearMinus2Years
Total11400Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years40729CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years149922CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years223051CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year649498CurrentTaxYearMinus1Year
Current Tax Year698716CurrentTaxYear
Total1761916Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years3000CurrentTaxYearMinus2Years
Total3000Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years3000CurrentTaxYearMinus2Years
Total3000Total
FieldValueIRS element (for citing)
Public Support Total5091758916PublicSupportTotal509

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years40729CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years149922CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years223051CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year649498CurrentTaxYearMinus1Year
Current Tax Year698716CurrentTaxYear
Total1761916Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99830PublicSupportPercentage509
Prior Year Support Percentage0.98830PriorYearSupportPercentage
Investment Income Percentage0.00000InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis30665OtherCostOrOtherBasis
Depreciation9743Depreciation
Book Value20922BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings20922TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionRESTRICTED CASHDescription
Book Value19709BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets19709TotalBookValueOtherAssets
Total Revenue698716TotalRevenue
Total Expenses673829TotalExpenses
Excess Or Deficit For Year24887ExcessOrDeficitForYear
Excess Or Deficit Per FS24887ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt698716TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal698716RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990698716TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt673829TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal673829ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990673829TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11RETURN IS REVIEWED AND SIGNED BY BOARD BEFORE FILED.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST DISCLOSURE FORMS ARE REVIEWED AND UPDATED AS NECESSARY. WRITTEN PROCEDURES ARE OBSERVED IN IDENTIFYING AND RESOLVING CONFLICTS OF INTEREST PRIOR TO ACTION ON CONTRACTS OR TRANSACTIONS THAT INVOLVE A CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15THE GOVERNANCE COMMITTEE REVIEWS AND APPROVES COMPENSATION FOR ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES.
FORM 990, PART VI, SECTION C, LINE 19ALL DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE ENTITY ADDRESS.
NEWLY FORMED FINANCIAL COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT AUDITOR

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