Iefile GRAPHIC print - DO NOT PROCESS I As Filed Data - I M990 Department of the Treasury lntemal Revenue Service A For the Check if applicable Address change Name change Inmal return Number and street (or 0 box if mail is not delivered to street address) Room/suite 0 BOX 2221 i_ Terminated i_ Amended return City or town, state or country, and ZIP 4 i_ Application pending benefit trust or private foundation) 2011 calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012 Name of organization COLONIAL HOUSE INC Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung Doing Business As OMB No 1545-0047 2 3-17 1 3846 Telephone number 2011 Open to Public F-The organization may have to use a copy ofthis return to satisfy state reporting requirements Inspection Employer identification number (717)792-9702 Gross receipts 1,853,420 YORK, PA 17405 Name and address of principal officer JOHN HYND PO BOX 2221 17405 I Tax--exem pt status I7 501(c)(3) 501(c)( )1 (insert no) 4947(a)(1) or 527 Website: II- CO LONIALHOUSEINC COM H(a) Is this a group return for affiliates? H(b) Are all affiliates included? |_No Yes |_Yes If"No," attach a list (see instructions) H(c) Group exemption number Ir Form of organization '7 Corporation Trust Association Other Summary Year of formation 1969 State of legal domicile PA 1 Briefly describe the organization's mission or most significant activities DRUG AND ALCOHOL REHABILITATION 2 Check this box ifthe organization discontinued its operations or disposed of more than 25% ofits net assets 3 Number ofvoting members ofthe governing body (Part VI, line la) 3 11 4 Number ofindependent voting members of the governing body (Part VI, line 1b) 4 11 5 Total numberofindividuals 2a) 5 54 6 Total number ofvolunteers (estimate if necessary) 6 7: 7aTota| unrelated business revenue from Part column (C), line 12 7a Net unrelated business taxable income from Form 990-T, line 34 7b Prior Year Current Year 8 Contributions and grants 1h) 10,187 6,053 Program service revenue (Part 2g) 1,856,405 1,847,367 10 Investmentincome (Part 3,4,and 7d) 0 0 I: 11 5,6d,8c,9c,10c,and11e) 0 0 12 Total revenue--add lines 8 through 11 (must equal Part column (A), line 12) 1,866,592 1,853,420 13 Grants and similaramounts 1-3) 0 0 14 Benefits paid to orfor members (PartIX,co|umn 4) 0 0 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 3 5.10) 1,089,712 1,166,027 16a Professionalfundraising fees (PartIX,co|umn 11e) 0 0 Total fundraising expenses (Part column (D), line 25) F-0 17 597,856 666,143 18 Totalexpenses Add lines 13-17 1,687,568 1,832,170 19 Revenue less expenses Subtract line 18 from line 12 179,024 21,250 Beginning of Current End of Year fig Year E3 20 Totalassets (Part X,|ine 16) 1,012,808 1,080,314 5'3 21 Total liabilities (Part X, line 26) 489,153 585,140 22 Net assets orfund balances Subtract line 21 from line 20 523,655 495,174 Signature Block Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. 2012-10-29 Sign Sig nature of officer Date Here JOHN HYND TREASURER Type or print name and title Preparers Date Check if Preparer's taxpayer identification number 5,9 nature EDWARD WAGONER se|f-- (see instructions) Paid employed i- P00737212 Preparer 5 FIrT'n's name (or yours FRIEDMAN co PC Use if EIN 23'2708607 address, and ZIP 4 1027 MUMMA ROAD Phone no II (717) 761-0211 WORMLEYSBURG, PA 17043 May the IRS discuss this return with the preparer shown above? (see instructions) I7Yes For Paperwork Reduction Act Notice, see the separate instructions. Cat No 11282Y Form 990 (2011) Form 99o(2o11) Page2 Statement of Program Service Accomplishments Check ifSchedu|e 0 contains a response to any question in this Part . . . . . . . . . J7 1 Briefly describe the organization's mission COLONIAL HOUSE CREATES A STABLE, NURTURING ENVIRONMENT, WHICH IS CONDUCIVE TO NOT ONLY ALLOWING EACH CLIENT TO DEVELOP HEALTHY PRODUCTIVE, DRUG FREE LIVES, BUT TO ASSIST THEM IN ACQUIRING THE SKILLS TO ACHIEVE SOBRIETY AND MAINTAIN A CHEMICAL FREE LIFESTYLE WE BELIEVE IN NOT ONLY GUIDING OUR CLIENTS THROUGH EACH AND EVERY STEP TO BECOME CLEAN AND SOBER, BUT TO ALSO ACKNOWLEDGE AND RESOLVE ANY UNDERLYING ISSUES WHICH ARE SO OFTEN OVERLOOKED 2 Did the organization undertake any significant program services during the year which were not listed on thepriorForm990or990-EZIf"Yes," describe these new services on Schedule 0 3 Did the organization cease conducting, or make significant changes in how it conducts, any program If"Yes," describe these changes on Schedule 0 4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses Section 501(c)(3)and 501(c)(4) organizations and section 4947(a)(1)trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, ifany, for each program service reported 4a (Code (Expenses 1,131,916 including grants of (Revenue 1,397,882 REHABILITATION TREATMENT OF DRUG AND ALCOHOL DEPENDENTS INCLUDING SELF-HELP EMPLOYMENT FAMILY COUNSELING IN AN INPATIENT NON- HOSPITAL FACILITY 4b (Code (Expenses 362,120 including grants of (Revenue 469,372 OUTPATIENT DRUG AND ALCOHOL, AFTERCARE, ANGER MANAGEMENT, AND DUI EDUCATION AND TRAINING 44; (Code (Expenses including grants of (Revenue 4d Other program services (Describe in Schedule 0 (Expenses including grants of$ (Revenue 4e Total program service expenses!-$ 1 ,4 94 ,0 3 6 Form 990 (20 1 1) Form 990 (201120a Page 3 Part IV Checklist of Required Schedules Yes No Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," Yes complete Schedule A 1 Is the organization required to complete Schedule 5, Schedule of instructions)? 2 No Did the organization engage in direct or indirect political campaign activities on behalf ofor in opposition to No candidates for public office? If "Yes/'complete Schedule C, Part I 3 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) No election in effect during the tax year? If "Yes,"complete Schedule C, Part the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes,"complete Schedule C, Part 5 NO Did the organization maintain any donor advised funds or any similarfunds or accounts for which donors have the right to provide advice on the distribution or investment ofamounts in such funds or accounts? If "Yes,"complete Schedule D, Part I 5 0 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas or historic structures? If "Yes/complete Schedule D, Part II 7 0 Did the organization maintain collections ofworks ofart, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part . 3 0 Did the organization report an amount in Part X, line 21, serve as a custodian for amounts not listed in Part X, or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part I 9 0 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, 10 No permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part Ifthe organization's answerto any ofthe following questions is 'Yes,'then complete Schedule D, Parts VI, VII, IX, or as applicable Did the organization report an amount for land, buildings, and equipment in Part X, |ine107 If "Yes,"complete Schedule D, Part VI 113 es Did the organization report an amount for investments--other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 167 If "Yes,"complete Schedule D, Part VINE 11-5 0 Did the organization report an amount for investments--program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 167 If "Yes,"complete Schedule D, Part 11? 0 Did the organization report an amount for other assets in Part X, line 15 that is 5% or more ofits total assets reported in Part X, line 167 If "Yes," complete Schedule D, Part 11d 0 Did the organization report an amount for other liabilities in Part X, line 257 If "Yes/'complete Schedule D, Part XE Yes 11e Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes/complete NO Schedule D, Part X. Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes,"complete Schedule D, Parts XI, XII, and 12a yes Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and If the organization answered 'No'to line 12a, then completing Schedule D, Parts XI, XII, and IS optional 12b NO Is the organization a school described in section If "Yes/'complete ScheduleE 13 No Did the organization maintain an office, employees, or agents outside ofthe United States? 14a No Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes, complete Schedule F, Part] . 14b N0 Did the organization report on Part IX, column (A), line 3, more than $5,000 ofgrants or assistance to any organization or entity located outside the 7' If "Yes,"complete Schedulel-', Part II and IV . 15 0 Did the organization report on Part IX, column (A), line 3, more than $5,000 ofaggregate grants or assistance to individuals located outside the If "Yes,"complete Schedulel-', Part and IV . 15 0 Did the organization report a total of more than $15,000, ofexpenses for professional fundraising services on 17 No Part IX, column (A), lines 6 and 11e'-' If "Yes," complete Schedule G, Part I Did the organization report more than $15,000 total offundraising event gross income and contributions on Part lines 1c and 8a? If "Yes/complete Schedule G, Part II 18 0 Did the organization report more than $15,000 ofgross income from gaming activities on Part line 9a? If 19 No "Yes, complete Schedule G, Part Did the organization operate one or more hospitals? If "Yes/complete ScheduleH 20a No If"Yes" to line 20a, did the organization attach its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements 20', Form 990 (2011) Form 990 (2011Part II IV Part I and V, line 1 Page 4 Part IV Checklist of Required Schedules (continued) Did the organization report more than $5,000 ofgrants and other assistance to governments and organizations in 21 No the United States on Part IX, column (A), line 1? If "Yes/'complete Schedule I, Parts I and II Did the organization report more than $5,000 ofgrants and other assistance to individuals in the United States 22 on Part IX, column (A), line 2? If "Yes/'complete Schedule I, Parts I and 0 Did the organization answer "Yes" to Part VII, Section A, questions 3, 4, or 5, about compensation ofthe organization's current and former officers, directors, trustees, key employees, and highest compensated 23 0 employees? If "Yes," complete Schedule] . Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as ofthe last day ofthe year, that was issued after December 31, 2002? If "Yes," answer questions 24b--24d and complete Schedule K. If "No, "go to line 25 24a 0 Did the organization invest any proceeds oftax-exempt bonds beyond a temporary period exception? 24b Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? 244: Did the organization act as an "on behalf of" issuerfor bonds outstanding at any time during the year? 24d Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I 25a No Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any ofthe organization's prior Forms 990 or If 25b No "Yes, complete Schedule L, Part I Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as ofthe end ofthe organization's tax year? If "Yes,"complete Schedule L, 26 NO Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If "Yes," 27 N0 complete Schedule L, Part Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions) A current or former officer, director, trustee, or key employee? If "Yes,"complete Schedule L, Part 28a No A family member ofa current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part I . 28b 0 An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If "Yes," complete Schedule L, Part IV . 28C 0 Did the organization receive more than $25,000 in non-cash contributions? If "Yes/complete ScheduleM 29 No Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes/complete ScheduleM 30 0 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes,"complete Schedule N, No 31 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II 32 0 Did the organization own 100% ofan entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-3? If "Yes,"complete Schedule R, PartI 33 0 Was the organization related to any tax-exempt or taxable entity? If "Yes,"complete Schedule R, Parts II, Il/, No 34 Is any related organization a controlled entity ofthe filing organization within the meaning ofsection 512(b)(13)? 35a No Did the organization receive any payment from or engage in any transaction with a controlled entity within the 35b meaning ofsection 51 2(b)(1 If "Yes,"complete Schedule R, Part V, line 2 0 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2 35 0 Did the organization conduct more than 5% of its activities through an entity that IS not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes,"complete Schedule R, Part VI 37 0 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule 0 33 es Form 990 (2011) Form 99o(2o11) Page5 Statements Regarding Other IRS Filings and Tax Compliance Check IfSchedu|e contalns a response to any questlon In thIs Part . . . . . . . . . Yes No 1a Enterthe number reported In Box 3 of Form 1096 Enter-0- If not app|Icab|e 1a 2 Enter the number of Forms W-2G Included In |Ine 1a Enter-0- If not 1 0 the organlzatlon comply wIth backup wIthho|dIng rules for reportable payments to vendors and reportable . . . . . . . . . . . . . . . . . . 1C Yes 2a Enter the number ofemployees reported on Form W-3, of Wage and Tax Statements fI|ed for the calendar year wIth or wIthIn the year covered by thIs 54 Ifat least one Is reported on |Ine 2a, dId the organlzatlon fI|e all requlred federal employment tax returns? 2b Yes Note. Ifthe sum of|Ines 1a and 2a Is greater than 250, you may be requlred to e-fI|e (see Instructlons) 3a the organlzatlon have unrelated buslness gross Income of$1,000 or more durlng the N0 If"Yes," has It fI|ed a Form 990-T forthIs year? If "No,"provtde an explanatIon In Schedule any tIme durlng the calendar year, dId the organlzatlon have an Interest In, or a slgnature or other authorlty over, a fInancIa| account In a forelgn country (such as a bank account or securItIes 43 No If"Yes," enter the name ofthe forelgn country Ir See Instructlons for fI|Ing requlrements for Form TD 90-22 1, Report of Forelgn Bank and FInancIa| Accounts 5a Was the organlzatlon a party to a prohIbIted tax shelter transactlon at any tIme durlng the tax year? . . 5a No any taxable party notIfy the organIzatIon that It was or Is a party to a prohIbIted tax shelter transactlon? 5b No If"Yes" to |Ine 5a or 5b, dId the organlzatlon fI|e Form 5c 6a Does the organlzatlon have annual gross recelpts that are normally greater than $100,000, and dId the 6a No organlzatlon so|IcIt any contrIbutIons that were not tax If"Yes," dId the organIzatIon Include wIth every so|IcItatIon an express statement that such contrIbutIons or gIfts 5b 7 Organizations that may receive deductible contributions under section 170(c). a the organlzatlon recelve a payment In excess of$75 made partly as a contrIbutIon and partly for goods and 7a No servlces provlded to the payor? If"Yes," dId the organIzatIon notIfy the donor ofthe value ofthe goods or servlces provldedthe organIzatIon sell, exchange, or otherwlse dlspose personal property for whIch It was requlred to N0 If"Yes," Indlcate the number of Forms 8282 fI|ed durlng the year . . . . I 7d I the organlzatlon recelve any funds, dlrectly or Indlrectly, to pay premlums on a personal benefit 7e N0 the organIzatIon, durlng the year, pay premlums, dlrectly or Indlrectly, on a personal benefit contract? . . 7f No Ifthe organlzatlon recelved a contrIbutIon ofqua|IfIed Intellectual property, dId the organlzatlon fI|e Form 8899 as 79 N0 Ifthe organlzatlon recelved a contrIbutIon ofcars, boats, alrplanes, or other vehlcles, dId the organlzatlon fI|e a 7h N0 8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. the organIzatIon, or a donor advlsed fund maIntaIned by a sponsorlng organIzatIon, have excess buslness at any tIme durlng the yearSponsoring organizations maintaining donor advised funds. the organlzatlon make any taxable dIstrIbutIons undersectlon 4966the organlzatlon make a dIstrIbutIon to a donor, donor advlsor, or related personSection 501(c)(7) organizations. Enter a InItIatIon fees and capIta| contrIbutIons Included on Part |Ine 12 . . . 10a Gross recelpts, Included on Form 990, Part |Ine 12, for pub|Ic use ofclub 10b facI|ItIes 11 Section 501(c)(12) organizations. Enter a Gross Income from members or shareholders . . . . . . . . . 11a Gross Income from other sources (Do not net amounts due or paId to other sources agalnst amounts due or recelved from them11b 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organlzatlon fI|Ing Form 990 In |Ieu of Form 1041? 12a If"Yes," enter the amount of tax-exempt Interest recelved or accrued durlng the year 12b 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organlzatlon llcensed to Issue qua|IfIed health plans In more than one state? Note. All 501(c)(29) organlzatlons must |Ist In Schedule 0 each state In whIch they are llcensed to Issue qua|IfIed health plans, the amount of reserves requlred by each state, and the amount of reserves the organIzatIon allocated to each state 13a Enter the aggregate amount of reserves the organlzatlon IS requlred to maIntaIn by the states In whIch the organlzatlon IS llcensed to Issue qua|IfIed health plans 13'' Enter the aggregate amount of reserves on hand 13c 14a the organlzatlon recelve any payments for servlces durlng the tax year"Yes," has It filed a Form 720 to report these payments? If "No,"provIde an explanation In Schedule 0 . . 14b Form 990 (2011) Form 990 (2011) Page 5 Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions. Check ifSchedu|e 0 contains a response to any question in this Part VI .I7 Section A. Governing Body and Management Yes No 1a Enter the number ofvoting members ofthe governing body at the end ofthe tax year 1a 11 Enter the number ofvoting members included in line la, above, who are independent 1b 11 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employeeDid the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? . 3 N0 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? N0 5 Did the organization become aware during the year ofa significant diversion of the organization's assets? . 5 Yes Did the organization have members or stockholders? No 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members ofthe governing body? 7a No Are any governance decisions ofthe organization reserved to (or subject to approval by) members, stockholders, 7b No or persons other than the governing body? 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following The governing body? 8a Yes Each committee with authority to act on behalfof the governing body? 8b Yes 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? If"Yes," provide the names and addresses in Schedule . . . . . 9 N0 Section B. Policies (This Section requests information about policies not required by the Internal Revenue Code.) Yes No 10a Did the organization have local chapters, branches, or affiliates? 10a No If"Yes," did the organization have written policies and procedures governing the activities ofsuch chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt lob purposes? 11a Has the organization provided a complete copy ofthis Form 990 to all members ofits governing body before filing the form? 11a Yes Describe in Schedule 0 the process, ifany, used by the organization to review the Form 990 12a Did the organization have a written conflict of interest policy? If "No,"go to /me 13 12a Yes Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? 12b Yes Did the organization regularly and consistently monitor and enforce compliance with the policy? If"Yes," describe in Schedule how this was done 12C Yes 13 Did the organization have a written whistleblower policy? 13 Yes 14 Did the organization have a written document retention and destruction policy? 14 Yes 15 Did the process for determining compensation ofthe following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official 15a Yes Other officers or key employees of the organization 15b Yes If"Yes," to line 15a or 15b, describe the process in Schedule 0 (see instructions) 16a Did the organization invest in, contribute assets to, or participate in a Joint venture or similar arrangement with a taxable entity during the year? 15a N0 If"Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in Joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? 16b Section C. Disclosure 17 18 19 20 List the States with which a copy ofthis Form 990 IS required to be fi|edIrPA Section 6104 requires an organization to make its Form 1023 (or 1024 ifapplicable), 990, and 990-T (501(c) (3)5 only) available for public inspection Indicate how you made these available Check all that apply Own website An0ther's website I7 Upon request Describe in Schedule 0 whether (and ifso, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public See Additional Data Table State the name, physical address, and telephone number ofthe person who possesses the books and records of the organization Ir CHIEF EXECUTIVE OFFICER 1300 WOODBERRY ROAD 17405 (717)792-9702 Form 990 (2011) Form 99o(2o11) Page7 Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check ifSchedu|e 0 contains a response to any question in this Part VII . . . . . . . . . Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons required to be listed Report compensation for the calendar year ending with or within the organization's tax year I List all ofthe organization's current officers, directors, trustees (whether individuals or organizations), regardless ofamount ofcompensation, and current key employees Enter -0- in columns (D), (E), and (F) if no compensation was paid I List all ofthe organization's current key employees, ifany See instructions for definition of "key employee I List the organization's five current highest compensated employees (other than an officer, director, trustee or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations I List all ofthe organization's former officers, key employees, or highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations I List all ofthe organization's former directors or trustees that received, in the capacity as a former director ortrustee ofthe organization, more than $10,000 of reportable compensation from the organization and any related organizations List persons in the following order individual trustees or directors, institutional trustees, officers, key employees, highest compensated employees, and former such persons Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee (A) (B) (C) (D) (E) (F) Name and Title Average Position (do not check Reportable Reportable Estimated hours more than one box, compensation compensation amount of other per unless person IS both from the from related compensation week an officer and a organization (W- organizations from the escribe director/trustee) (W- 2/1099- organization and hours I MISC) related for C, 3 3.): Organizations related organizations 5 PE in 3% 3 3' Schedule (1) MILTON STEINHAUSER PRESIDENT 2 00 0 0 0 (2) ERIC MARKS 1ST VICE PRESIDENT 1 00 0 0 0 (3) HOVE 2ND VICE PRESIDENT 1 00 0 0 0 (4) JOHN HYND TREASURER 50 0 0 0 (5) JULIE PULLO--HESS SECRETARY 1 00 0 0 0 (6) DOUGLAS MEMBER, BOARD OF DIRECTORS 50 0 0 0 (7) LINDA MIDDLETON MEMBER, BOARD OF DIRECTORS 50 0 0 0 (8) CAROL 50 0 0 0 MEMBER, BOARD OF DIRECTORS (9) BETTY CARROLL MEMBER, BOARD OF DIRECTORS 50 0 0 0 (10) VICKI GLATFELTER MEMBER, BOARD OF DIRECTORS 50 0 0 0 SE10) ERNEST A MANUAL 40 00 84,660 0 7,678 Form 990 (2011) Form 99o(2o11) Page8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (A) (B) (C) (D) (E) (F) Name and Title Average Position (do not check Reportable Reportable Estimated hours more than one box, compensation compensation amount of other per unless person is both from the from related compensation week an officer and a organization (W- organizations from the (describe director/trustee) (W- 2/1099- organization and hours I MISC) related for -- 3.1: organizations related 3 EE organizations 5 5 in 3 3' Schedule Sub-Tota| Total from continuation sheets to Part VII, Section A . . . . Total (add lines 84,660 0 7,678 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationIr0 Yes No 3 Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line la? If "Yes," complete ScheduleJforsuch Individual . . . . . . . . . . . . . 3 No 4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes/'comp/ete Schedu/eJforsuch NO 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If ScheduleJforsuch person . . . . . 5 No Section B. Independent Contractors 1 Complete this table for yourfive highest compensated independent contractors that received more than 100,000 of compensation from the organization Report compensation for the calendar year ending with or within the organization's tax year (A) (B) (C) Name and business address ion of services Com nsation 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 ofcompensation from the organization II-O Form 990 (2011) Form 990 (2011) En" Statement of Revenue Page 9 (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exempt business excluded from function revenue tax under revenue sections 512, 513, or 514 1a Federated campaigns . . 1a 2| Membership dues . . . . 1b we .. Fundraising events . . . . 1c -Lib El: Related organizations . . . 1d Government grants (contributions) 1e All other contributions, gifts, grants, and 1f 6,053 '5 3 similar amounts not included above Noncash contributions included in 12- lines 1a-1f ,5 Total. Add lines la-1f 6.053 Business Code 2a FEES FOR SERVICE 623990 1,380,917 1,380,917 FEES FOR SERVICE -- 621400 420,255 420,255 3 DUI EDUCATION 624100 36,080 36,080 5 CRN EVALUATION 624100 8,350 8,350 ANGER MANAGEMENT 624100 1,755 1,765 All other program service revenue i Total. Add lines 2a--2f . 1,847,367 3 Investment income (including dividends, interest and othersimilaramounts) Income from investment of tax--exempt bond proceeds 5 Royalties . Real (ii) Personal 6a Gross rents Less rental expenses Rental income or(|oss) Net rental income or (loss) Securities (ii) Other Gross amount from sales of assets other than inventory Less cost or other basis and sales expenses Gain or (loss) Net gain or(|oss) . 33 Gross income from fundraising events (not including 3 ofcontributions reported on line 1c) =13 See PartIV,|ine 18 II a Less direct expenses . . . ll-F Net income or (loss) from fundraising events . . 9a Gross income from gaming activities See Part IV, line 19 a Less direct expenses . . . Net income or (loss) from gaming activities . . 10a Gross sales ofinventory, less returns and allowances a Less cost ofgoods sold . . Netincome sales ofinventory . . Miscellaneous Revenue Business Code 11a All other revenue Tota|.Add|ines 11a--11d hr 12 Total revenue. See Instructions Form 990 (2011) Form 990(2011) page 10 Statement of Functional Expenses Section 501(c)(3) and 501(c)(4) organizations must complete all columns All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D) CheckifSchedu|eO containsa response to any questioninthis PartIX . . . Do not include amounts reported on lines 6b, (A) Prog ,ag,3)SeN,Ce Managefizent and Funggaslng 7b! 8b! 9b! and 10b of Part Total expenses expenses general expenses expenses 1 Grants and other assistance to governments and organizations in the United States See Part IV, line 21 2 Grants and other assistance to individuals in the United States See Part IV, line 22 3 Grants and other assistance to governments, organizations, and individuals outside the United States See Part IV, lines 15 and 16 4 Benefits paid to or for members 5 Compensation ofcurrent officers, directors, trustees, and key employees 93,584 70,188 23,396 6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) . 7 Other salaries and wages 868,216 711,949 156,267 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) 11,215 9.084 2,131 9 Other employee benefits 88,222 71,707 16,515 10 Payroll taxes 104,790 85,140 19,650 11 Fees for services (non-employees) a Management Legal Accounting Lobbying Professional fundraising See Part IV, line 17 Investment management fees Other 12 Advertising and promotion 15,250 15,250 13 Office expenses 20,702 16,562 4,140 14 Information technology 15 Royalties 16 Occupancy 104,647 96,275 8,372 17 Travel 6,877 5,777 1,100 18 Payments oftravel or entertainment expenses for any federal, state, or local public officials 19 Conferences, conventions, and meetings 1,843 1,843 20 Interest 21 Payments to affiliates 22 Depreciation, depletion, and amortization 23 Insurance 32,476 24,032 8,444 24 Other expenses Itemize expenses not covered above (List miscellaneous expenses in line 24f Ifline 24famount exceeds 10% of line 25, column (A)amount, list line 24fexpenses on Schedule a FOOD 173,435 173,435 UTILITIES 72,233 63,423 8,860 LOSS FRO THEFT 51,222 51,222 CLIENT EXPENSES - OTHER 48,205 47,491 714 All other expenses 139,203 118,973 20,230 25 Total functional expenses. Add lines 1 through 24f 1,332,170 1,494,035 333,134 0 26 Joint costs. Check here I- iffollowing SOP 98-2 (ASC 958-720) Complete this line only ifthe organization reported in column (B) Joint costs from a combined educational campaign and fundraising solicitation Form 990 (2011) Form 990 (2011) Balance Sheet Page 11 (A) (B) Beginning ofyear End ofyear 1 Cash--non-interest-bearing 235.073 1 163.622 2 Savings and temporary cash investments 2 3 Pledges and grants receivable, net 3 4 Accounts receivable, net 212.341 4 175.948 5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees Complete Part II of Schedule 5 6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) Complete Part II of Schedule 6 7 Notes and loans receivable, net 7 8 Inventories for sale or use 6.434 8 8.036 9 Prepaid expenses and deferred charges 9.998 9 11.925 10a Land, buildings, and equipment cost or other basis Complete 1.639.731 Part VI of Schedule 10a Less accumulated depreciation 10b 919.029 548.685 10c 720.702 11 Investments--pub|ic|y traded securities 11 12 Investments--other securities See Part IV, line 11 12 13 Investments--program-related See Part IV, line 11 13 14 Intangible assets 14 15 Other assets See Part IV, line 11 277 15 81 16 Total assets. Add lines 1 through 15 (must equal line 34) 1.012.808 16 1.080.314 17 Accounts payable and accrued expenses 99.999 17 118.195 18 Grants payable 18 19 Deferred revenue 19 20 Tax-exempt bond liabilities 20 21 Escrow or custodial account liability CompletePart IVofScheduleD 21 22 Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons Complete Part II of Schedule 4.817 22 23 Secured mortgages and notes payable to unrelated third parties 346.202 23 440.285 24 Unsecured notes and loans payable to unrelated third parties 24 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24) Complete Part ofSchedu|e 38,135 25 26,660 26 Total liabilities. Add lines 17 through 25 489.153 26 585.140 an Organizations that follow SFAS 117, check here II- |7 and complete lines 27 3 through 29, and lines 33 and 34. 27 Unrestricted net assets 523.655 27 495.174 28 Temporarily restricted net assets 28 29 Permanently restricted net assets 29 If Organizations that do not follow SFAS 117, check here Ir and complete :5 lines 30 through 34. 30 Capital stock or trust principal, or current funds 30 31 Paid-in or capital surp|us,or|and, building or equipment fund 31 32 Retained earnings, endowment, accumulated income, or other funds 32 33 Total net assets orfund balances 523.655 33 495.174 2 34 Total liabilities and net assets/fund balances 1,012,808 34 1,080,314 Form 990 (2011) Form 990(2011) Page 12 Reconcilliation of Net Assets Check ifSchedu|e 0 contains a response to any question in this Part XI 1 Total revenue (must equal Part column (A), line 12) 1 1,853,420 2 Total expenses (must equal Part IX, column (A), line 25) 2 1,832,170 3 Revenue less expenses Subtract line 2 from line 1 3 21,250 4 Net assets orfund balances at beginning ofyear (must equal Part X, line 33, column 4 523,655 5 Other changes in net assets orfund balances (explain in Schedule 0) 5 -49,731 6 Net assets orfund balances at end ofyear Combine lines 3, 4, and 5 (must equal Part X, line 33, column . . . . . . 5 495,174 Financial Statements and Reporting Check ifSchedu|e 0 contains a response to any question in this Part XII .I-- Yes No 1 Accounting method used to prepare the Form 990 Cash I7 Accrual ther Ifthe organization changed its method ofaccounting from a prior year or checked "Other," explain in Schedule 0 2a Were the organization's financial statements compiled or reviewed by an independent accountant? 2a No Were the organization's financial statements audited by an independent accountant? 2b Yes If"Yes," to 2a or 2b, does the organization have a committee that assumes responsibility for oversight ofthe audit, review, or compilation ofits financial statements and selection ofan independent accountant? Ifthe organization changed either its oversight process or selection process during the tax year, explain in Schedule 0 2c yes If"Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both I7 Separate basis Consolidated basis Both consolidated and separated basis 3a As a result ofa federal award, was the organization required to undergo an audit or audits as set forth in the Single AuditAct and OMB 33 N0 If"Yes," did the organization undergo the required audit or audits? Ifthe organization did not undergo the required 3b audit or audits, explain why in Schedule 0 and describe any steps taken to undergo such audits Form 990 (2011) Iefile GRAPHIC print - DO NOT PROCESS |As Filed Data - SCHEDULE A (Form 990 or 990EZ) Department of the Treasury lniemal Revenue Service OMB No 1545-0047 2011 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. Open to Public Inspection Attach to Form 990 or Form 990-EZ. See separate instruct ions. Name of the organization COLONIAL HOUSE INC Employer identification number 23-1713846 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 A church, convention ofchurches, or association ofchurches section 2 A school described in section (Attach Schedule 3 A hospital or a cooperative hospital service organization described in section 4 A medical research organization operated in conjunction with a hospital described in section Enter the hospital's name, city, and state 5 An organization operated for the benefit ofa college or university owned or operated by a governmental unit described in section (Complete Part II 6 A federal, state, or local government or governmental unit described in section 7 I7 An organization that normally receives a substantial part ofits support from a governmental unit orfrom the general public descnbedin section 170(b)(1)(A)(vi) (Complete Part II 8 A community trust described in section 170(b)(1)(A)(vi) (Complete Part II 9 An organization that normally receives (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions--sub]ect 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 afterJune 30, 1975 See section 509(a)(2). (Complete Part 10 An organization organized and operated exclusively to test for public safety Seesection 509(a)(4). 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) See section 509(a)(3). Check the box that describes the type ofsupporting organization and complete lines 1 1e through 1 1h a Type I I-- Type II I-- Type - Functionally integrated I-- Type - Other 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) Ifthe organization received a written determination from the IRS that it is a Type I, Type II or Type supporting organization, check this box I- Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? a person who directly or indirectly controls, either alone or together with persons described in (ii) Yes No and below, the governing body ofthe the supported organization? 11g(i) (ii) a family member ofa person described in (I) above? 11g(ii) a 35% controlled entity ofa person described in (I) or (ii) above? Provide the following information about the supported organization(s) (iv) Type of I5 the (V)tf th Iwtliz I ou no I (I) organization Organization In (vii) Name of (H) (described on I I organization In organization In C0 (I) lste In I I Amount of supported EIN lines 1- 9 above co me your C0 (I)organI2e governing .) .2 support'? organization section document-, SUPPOIT In 9 (see instructionsTotal For Paperwork Reduction Act Notice, see the Instructions for Form 990 Cat No 11285F ScheduleA(Form 990or990-EZ)2011 Schedule A (Form 990 or 990-EZ) 2011 Page 2 i Support Schedule for Organizations Described in IRC 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 PartI or if the organization failed to qualify under Part If the organization fails to qualify under the tests listed below, please complete Part Section A. Public Support Calendar year (or fiscal year beginning 1 6 2007 2008 (C) 2009 2010 2011 (f)Tota| in) Gifts, grants, contributions, and membership fees received (Do not include any "unusual grants") 1,378,042 1,499,597 1,735,123 1,866,592 1,813,352 8,292,706 Tax revenues levied forthe organization's benefit and either paid to or expended on its behalf The value ofservices or facilities furnished by a governmental unit to the organization without charge Add ||ne5 1 through 3 1,378,042 1,499,597 1,735,123 1,866,592 1,813,352 8,292,706 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% ofthe amount shown on line 1 1, column Public Support. Subtract line 5 8,292,706 fro line 4 Section B. Total Support Calendar year 7 8 10 11 12 13 (or fiscal year beginningin) 2007 2008 (c)2009 2010 2011 Total A mounts from ||ne 4 1,378,042 1,499,597 1,735,123 1,866,592 1,813,352 8,292,706 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Net income from unrelated business activities, whether or not the business IS regularly carried on Other income (Explain in Part IV )Do not include gain or loss from the sale ofcapital assets Total support (Add lines 7 8,292,706 through 1 0) Gross receipts from related activities, etc (See instructions) 12 First Five YearsIfthe Form 990 is for the organization's first, second, third, fourth, orfifth tax year as a 501(c)(3) organization, check this box and stop here FI- Section C. Computation of Public Support Percentage 14 15 16a 17a 18 Public Support Percentage for 2011 (line 6 column divided by line 11 column 14 100 000 0/0 Public SupportPercentage for201O Schedule A,PartII,|ine 14 15 100 000 0/0 33 1/3?/o support test--2011.Ifthe 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 FI7 33 1/3?/o support test--2010.Ifthe organization did not check the 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 FI- organization did not check a box on line 13, 16a, or 16b and line 14 IS 10% or more, and ifthe 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 FI- organization did not check a box on line 13, 16a, 16b, or 17a and line 15 is 10% or more, and ifthe 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 Private Foundation Ifthe organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see instructions irl' Schedule A (Form 990 or 990-EZ) 2011 Schedule A (Form 990 or 990-EZ) 2011 Page 3 Support Schedule for Organizations Described in IRC 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 1 7a 8 (or fiscal year beginning In) (a)2007 2008 (c)2009 2010 2011 Total Gifts, grants, contributions, and membership fees received (Do not include any "unusual grants Gross receipts from admissions, merchandise sold or services performed, orfacilities furnished in any activity that IS related to the organization's tax-exempt purpose Gross receipts from activities that are not an unrelated trade or business under section 513 Tax revenues levied forthe organization's benefit and either paid to or expended on its behalf The value ofservices orfacilities furnished by a governmental unit to the organization without charge Tota|.Add lines 1 through 5 Amounts included on lines 1, 2, and 3 received from disqualified persons Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of$5,000 or 1% ofthe amount on line 13 for the year Add lines 7a and 7b Public Support (Subtract line 7c from line 6 Section B. Total Support Calendar year (or fiscal year beginning 9 10a 11 12 13 14 2007 2008 (c)2009 2010 2011 (f)Tota| in) Amounts from line 6 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 Add lines 10a and 10b Net income from unrelated business activities not included in line 10b, whether or not the business IS regularly carried on Other income Do not include gain or loss from the sale of capital assets (Explain in Part IV Total support (Add lines 9, 10c, 11 and 12 First Five Years Ifthe Form 990 IS for the organization's first, second, third, fourth, orfifth tax year as a 501(c)(3) organization, check this box and stop here irl' Section C. Computation of Public Support Percentage 15 Public Support Percentage for 2011 (line 8 column divided by line 13 column 15 16 Public support percentage from 2010 Schedule 15 15 Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2011 (line 10c column divided by line 13 column 17 18 Investment income percentage from 2010 Schedule A, Part line 17 13 19a 33 1/3?/o support tests--2011.Ifthe 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 check this box and stop here. The organization qualifies as a publicly supported organization PI- 33 1/3?/o support tests--2010.Ifthe 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 check this box and stop here. The organization qualifies as a publicly supported organization FI- 2O Private Foundation Ifthe organization did not check a box on line 14, 19a or 19b, check this box and see instructions FI- Schedule A (Form 990 or 990-EZ) 2011 Schedu|eA (Form 990 or990-EZ)2011 Page4 Part IV Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part line 12. Also complete this part for any additional information. (See instructions). Facts And Circumstances Test Explanation Schedule A (Form 990 or 990-EZ) 2011 Additional Data Software ID: Software Version: EIN: 23--1713846 Name: COLONIAL HOUSE INC Form 990, Special Condition Description: Special Condition Description Iefile GRAPHIC print - Do NOT PROCESS IAs Filed Data - DLN: 93493318010302] OMB No 1545-0047 99?' Supplemental Financial Statements 1 Ir Complete if the organization answered "Yes," to Form 990, DePal1mEURnT0fTheTlea3UW Part IV, line 6, 7, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b lntemal Revenue Seniice Name of the organization COLONIAL HOUSE INC Open to Public Inspection Employer identification number Ir Attach to Form 990. hr See separate instruct ions. 23-1713846 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6. (.11-BUJNI-I Donor advised funds Funds and other accounts Total number at end of year Aggregate contributions to (during year) Aggregate grants from (during year) Aggregate value at end ofyear Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control? Yes l_ N0 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be used only for charitable purposes and not for the benefit ofthe donor or donor advisor, or for any other purpose conferring impermissible private benefit V85 l_ N0 Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7. 1 O.fiU'fll Purpose(s) ofconservation easements held by the organization (check all that apply) Preservation ofland for public use (e recreation or pleasure) Protection of natural habitat I-- Preservation ofan historically importantly land area I-- Preservation ofa certified historic structure Preservation ofopen space Complete lines 2a--2d ifthe organization held a qualified conservation contribution in the form ofa conservation easement on the last day ofthe tax year Held at the End of the Year Total number ofconservation easements 2a Total acreage restricted by conservation easements 2b Number ofconservation easements on a certified historic structure included in 2c Number ofconservation easements included in acquired after 8/17/06 2d Number ofconservation easements modified, transferred, released, extinguished, or terminated by the organization during the taxable year Ir Number ofstates where property subject to conservation easement IS located I- Does the organization have a written policy regarding the periodic monitoring, inspection, handling ofviolations, and enforcement ofthe conservation easements it holds? YES N0 Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year F- Amount ofexpenses incurred in monitoring, inspecting, and enforcing conservation easements during the year Does each conservation easement reported on line 2(d) above satisfy the requirements ofsection 170(h)(4)(B)(i)and 170(h)(4)(B)(ll)7 |--Yes l_No In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, ifapplicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered "Yes" to Form 990, Part IV, line 8. 1a Ifthe organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service, provide, in Part XIV, the text ofthe footnote to its financial statements that describes these items [3 Ifthe organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works ofart, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items Revenues included in Form 990, Part line 1 Ir (")Assets includedin Form 990,PartX hr$ 2 Ifthe organization received or held works ofart, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under SFAS 116 relating to these items a Revenues included in Form 990, Part line 1 hr$ '3 Assets includedin Form 990,PartX For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990 Cat No 52283D Schedule D(Form 990) 2011 Schedule (Form 990)2011 Page 2 anizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (Continued) 3 Using the organization's accession and other records, check any of the following that are a significant use of its collection items (check all that apply) a public exhibition Loan orexchange programs Scholarly research Other Preservation forfuture generations 4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIV 5 During the year, did the organization solicit or receive donations ofart, historical treasures or other similar assets to be sold to raise funds ratherthan to be maintained as part ofthe organization's collection? Yes N0 Part IV Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. 1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990,Part If "Yes," explain the arrangement in Part XIV and complete the following table Amount Beginning balance Additions during the year 9 Distributions during the year Ending balance 2a Did the organization include an amount on Form 990,Part X,|ine 21? I_Yes If"Yes," explain the arrangement in Part XIV Part Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10. (a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back 1a Beginning ofyearbalance Contributions Investment earnings or losses Grants or scholarships mo.no' Other expenditures for facilities and programs Administrative expenses End ofyear balance 2 Provide the estimated percentage ofthe year end balance held as a Board designated or quasi-endowment Ir Permanent endowment Ir Term endowment F- 3a Are there endowment funds not in the possession ofthe organization that are held and administered for the organization by Yes No unrelated organizations . . . . . . . . . . . . . . . . . . . . . . . . 3a(i) (ii) related organizations . . . . . . . . . . . . . . . . . . . . . . . . If"Yes" to 3a(ii), are the related organizations listed as required on Schedule . . . . . . . . . 3b 4 Describe in Part XIV the intended uses of the organization's endowment funds Land, Buildings, and Equipment. See Form 990, Part X, line 10. or Book 1a Land . . . . . . . . . . . . . . . . . 41,340 41,340 Buildings . . . . . . . . . . . . . . . . 1,318,651 707,566 611,085 Leasehold improvements Equipment . . . . . . . . . . . . . . . . 279,740 211,463 68,277 Other . . . . . . . . . . . . . . . Total. Add lines 1a-1e (Column should equal Form 990, Part X, column (B), line . . . . . . . . Ir 720,702 Schedule (Form 990) 2011 Schedule (Form 990) 201 1 Investments--Other Securities. See Form 990, Part X, line 12. Page 3 Description ofsecurity or category (including name ofsecurity) (b)Book value Method ofvaluation Cost or end-of-year market value (1 )Financial derivatives (2 losely-held equity interests Other Total. (Column should equal Fomi 990, Part)(, col (B) line 12) Investments--Pro ram Related. See Form 990, Part X, line 13. Description of investment type Book value Method ofvaluation Cost or end-of-year market value Total. (Column should equal Form 990, PartX, col (3) line 13) Other Assets. See Form 990, Part X, line 15. Description Book value Total. (Column should equal Form 990, Part X, col.(B) line 15.) Other Liabilities. See Form 990, Part X, line 25. 1 Description of Liability Amount Federal Income Taxes DEFERRED COMPENSATION PAYABLE 23,000 CAPITAL LEASE OBLIGATION 3,660 Total. (Column should equal Form 990, PartX, col (3) line 25) p. 25,550 2. Fin 48 (ASC 740) Footnote In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740) Schedule (Form 990) 2011 Schedule (Form 990)2011 Page4 Reconciliation of Change in Net Assets from Form 990 to Financial Statements 1 Totalrevenue (Form 12) 1 2 Totalexpenses (Form 990,PartIX,co|umn 25) 2 1:332:170 3 Excess or (deficit) for the year Subtract line 2 from line 1 3 21.250 4 Net unrealized gains (losses) on investments 4 5 Donated services and use of facilities 5 5 Investment expenses 5 7 Prior period adjustments 7 '49:731 3 Other (Describe in Part XIV) 3 9 Total adjustments (net) Add lines 4 - 8 9 '49:731 10 Excess or (deficit) for the year perfinancial statements Combine lines 3 and 9 10 '23/'31 Reconciliation of Revenue per Audited Financial Statements With Revenue er Return Total revenue, gains, and other support per audited financial statements 1 1,853,420 2 Amounts included on line 1 but not on Form 990, Part line 12 a Net unrealized gains on investments 2a Donated services and use offacilities 2b Recoveries of prior year grants 2c Other (Describe in Part XIV) 2d Add lines 2a through 2d 2e 0 3 Subtract line 2e from line 1 3 1,853,420 4 Amounts included on Form 990, Part line 12, but not on line 1 Investment expenses not included on Form 990, Part line 7b 4a Other (Describe in Part XIV) 4b Add|ines4aand 4b 4c 0 5 Tota|Revenue Addlines 3and 4c. (This should equa|Form 990,PartI,|ine 12 . . . . 5 1,853,420 @5111 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return 1 Total expenses and losses per audited financial 1,832,170 statements . 1 2 Amounts included on line 1 but not on Form 990, Part IX, line 25 a Donated services and use offacilities 2a Prior year adjustments 2b Other losses 2c Other(Describe in Part XIV) 2d Add lines 2a through 2d 2e 0 3 Subtract line 2e from line 1 3 1,832,170 4 Amounts included on Form 990, Part IX, line 25, but not on line 1: Investment expenses not included on Form 990, Part line 7b 4a Other(Describe in Part XIV) 4b Add|ines4aand 4b 4c 0 5 Totalexpenses Addlines 3and 4-c. (This should equa|Form 990,PartI,|ine 18) 5 1,832,170 Part XIV Supplemental Information Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9, Part lines 1a and 4, Part IV, lines 1b and 2b, Part V, line 4, Part X, Part XI, line 8, Part XII, lines 2d and 4b, and Part lines 2d and 4b Also complete this part to provide any additional information Identifier Return Reference Explanation Schedule (Form 990) 2011 OMB No 1545-0047 2011 Open to Public Iefile GRAPHIC print - DO NOT PROCESS |As Filed Data - SCHEDULE 0 (Form 990 or 990-EZ) 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. Department of the Treasury lntemal Revenue Service Inspection Name of the organization Employer identification number COLONIAL HOUSE INC 23-1713846 Identifier Return Reference Explanation AUDIT RESULTS REFLECTED AN UNUSUAL FLUCTUATION BETWEEN THE BILLING SYSTEM AND THE GENERAL LEDGER INVESTIGATION BY COLONIAL HOUSE STAFF REVEALED THAT EMBEZZLEMENT OF CASH FUNDS WAS OCCURING THE GOVERNING BOARD, WORKING WITH ITS ATTORNEYS, HAVE REPORTED THE MATTER TO LAW ENFORCEMENT FOR INVESTIGATION, AND IF APPROPRIATE CRIMINAL CHARGES INSURANCE COVERAGE EXISTS FOR A PORTION OF THE LOSS FORM 990, PART VI, SECTION A, LINE 5 THE FULL BOARD IS PROVIDED A COPY OF THE FORM 990 FOR APPROVAL IT IS FORWARDED TO THE FINANCE COMMITTEE FOR REVIEW AND COMMENT THE ACCOUNTANTS PRESENT THE FORM 990 AND FINANCIAL STATEMENTS TO THE FULL BOARD AT A REGULAR BOARD MEETING FORM 990, PART VI, SECTION B, LINE CONFLICT OF INTEREST POLICY IS UPDATED AND DISTRIBUTED ANNUALLY TO BOARD MEMBERS BOARD MEMBERS MUST DISCLOSE ANY CONFLICTS OF INTEREST AND SIGN OFF ON IT ANNUALLY FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART AT THE REQUEST OF THE BOARD, THE ADMINISTRATOR DIRECTOR OF RESIDENTIAL VI, SECTION B, LINE SERVICES WILL RESEARCH SALARIES UTILIZING THE DEPARTMENT OF LABOR WEBSITE AND USING OTHER TREATMENT CENTERS AS A RESOURCE FOR SALARY COMPARISONS ALL PROPOSALS FOR SALARIES AND BENEFITS ARE PRESENTED TO THE BOARD FOR APPROVAL FORM 990, PART VI, SECTION C, LINE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND FORM 990 ARE AVAILABLE UPON REQUEST AT THE ADMINISTRATION OFFICE OF COLONIAL HOUSE THE AVAILABILITY OF THESE DOCUMENTS IS NOTED ANNUALLY IN A LOCAL NEWSPAPER ADVERTISEMENT CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 PRIOR PERIOD ADJUSTMENTS -49,731