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MENTAL HEALTH SERVICES FOR CLARK CO INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
MENTAL HEALTH SERVICES FOR CLARK CO INC (EIN 31-0787073)
Tax period
2019-07-01 to 2020-06-30
Filed
2021-01-29
IRS object ID
202120299349300502
Schema version
2019v5.1
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)
Return2021-01-29T05:30:32-06:00ReturnTs
Tax Period End2020-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN310800053PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLARK SCHAEFER HACKETT & COBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line114 EAST MAIN ST SUITE 500AddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45502ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN310787073EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MENTAL HEALTH SERVICES FOR CLARK CO INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMENTBusinessNameControlTxt
Phone9373999500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1474 N YELLOW SPRINGS STAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45504ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARY BETH TAYLORPersonNm
Person TitleCFOPersonTitleTxt
Phone9373999500PhoneNum
Signature2021-01-28SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDEVESH KAMAL CPAPreparerPersonNm
PTINP00201226PTIN
Phone9373992000PhoneNum
Preparation2021-01-28PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1MENTAL HEALTH SERVICES FOR CLARK AND MADISON COS INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKELLY RIGGERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1474 N YELLOW SPRINGS STAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45504ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$13,256,562GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MHSCC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1969FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionPROVIDES MENTAL AND BEHAVIORAL HEALTH SERVICES TO RESIDENTS OF CLARK AND MADISON COUNTIES OHIO.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee259TotalEmployeeCnt
Total Volunteers13TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,676,810PYContributionsGrantsAmt
CY Contributions Grants$5,741,122CYContributionsGrantsAmt
PY Program Service Revenue$7,416,374PYProgramServiceRevenueAmt
CY Program Service Revenue$7,226,981CYProgramServiceRevenueAmt
PY Investment Income$248,861PYInvestmentIncomeAmt
CY Investment Income$264,241CYInvestmentIncomeAmt
PY Other Revenue$130,651PYOtherRevenueAmt
CY Other Revenue$24,218CYOtherRevenueAmt
PY Total Revenue$12,472,696PYTotalRevenueAmt
CY Total Revenue$13,256,562CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,182,760PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,261,618CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,048,865PYOtherExpensesAmt
CY Other Expenses$2,770,416CYOtherExpensesAmt
PY Total Expenses$12,231,625PYTotalExpensesAmt
CY Total Expenses$12,032,034CYTotalExpensesAmt
PY Revenues Less Expenses$241,071PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,224,528CYRevenuesLessExpensesAmt
Total Assets BOY$20,786,313TotalAssetsBOYAmt
Total Assets EOY$22,883,008TotalAssetsEOYAmt
Total Liabilities BOY$5,216,012TotalLiabilitiesBOYAmt
Total Liabilities EOY$6,104,425TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,570,301NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$16,778,583NetAssetsOrFundBalancesEOYAmt
MissionTO IMPROVE THE SAFETY AND QUALITY OF LIFE OF THOSE WE SERVEMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$5,835,207ExpenseAmt
Revenue$3,194,775RevenueAmt
DescOUTPATIENT PSYCHIATRIC SERVICES SERVED APPROXIMATELY 5,500 CLIENTS DURING THE FISCAL YEAR FOR YOUTH, ADULT AND GERIATRIC POPULATIONS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$3,096,387ExpenseAmt
Revenue$3,109,229RevenueAmt
DescINPATIENT PSYCHIATRIC SERVICES OFFERING SHORT TERM, MULTIDISCIPLINARY CARE TO TREAT ACUTE EPISODES OF PSYCHOSIS AND DEPRESSIVE DISORDERS. 836 CLIENTS WERE ADMITTED TO INPATIENT FOR ACUTE PSYCHIATRIC CARE DURING THE FISCAL YEAR.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$847,824ExpenseAmt
Revenue$947,195RevenueAmt
DescHOUSING ASSISTANCE SERVICES FOR CLIENTS WITH SEVERE MENTAL DISABILITIES WERE PROVIDED FOR 105 CLIENTS DURING THE FISCAL YEAR.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$9,779,418TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document32IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee259EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARY BETH TAYLORBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9373999500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1474 N YELLOW SPRINGS STAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45504ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
RICK BRODERICK
CHAIR3.00Yes (X)Yes (X)$0$0$0
BRIAN SMITH
VICE CHAIR3.00Yes (X)Yes (X)$0$0$0
LYNN ROWLAND
TRUSTEE3.00Yes (X)$0$0$0
MARILYN KREIDER
TRUSTEE3.00Yes (X)$0$0$0
DOUG SCHANTZ
TRUSTEE3.00Yes (X)$0$0$0
HORTON HOBBS
TRUSTEE3.00Yes (X)$0$0$0
JEFF HUGHES
TRUSTEE3.00Yes (X)$0$0$0
CHRISTINE ZECHMAN
TRUSTEE3.00Yes (X)$0$0$0
MARY TAYLOR
TRUSTEE3.00Yes (X)$0$0$0
TIM DOTSON
TRUSTEE3.00Yes (X)$0$0$0
ROD BENINGHAUS
TRUSTEE3.00Yes (X)$0$0$0
ALEXIS EVANS COMER
TRUSTEE3.00Yes (X)$0$0$0
NANCY SHANAHAN WOEHRLE
TRUSTEE3.00Yes (X)$0$0$0
KELLY RIGGER
CEO40.00Yes (X)$73,995$0$4,591
MARY BETH TAYLOR
CHIEF FINANCIAL OFFICER40.00Yes (X)$77,230$0$13,651
SUE FRALICK
VP OF ADULT AND YOUTH OUTP40.00Yes (X)$110,827$0$5,990
DR KALPANA VISHNUPAD
PHYSICIAN40.00$254,364$0$16,701Yes (X)
DR FAWZIA TOOR
PHYSICIAN40.00$251,680$0$9,665Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$768,096TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$50,598TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K3IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$2,658FederatedCampaignsAmt
Government Grants$4,423,002GovernmentGrantsAmt
All Other Contributions$1,315,462AllOtherContributionsAmt
Noncash Contributions$480,000NoncashContributionsAmt
Total Contributions$5,741,122TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
TITLE XIX MEDICAID900099$4,853,890$4,853,890
PATIENT SERVICE REVENUES621300$1,679,710$1,679,710
UPL PAYMENTS900099$452,889$452,889
RENTAL REVENUE FROM CLIENT SUPPOR623990$124,559$124,559
TITLE XX900099$115,933$115,933
FieldValueIRS element (for citing)
Total Program Service Revenue$7,226,981TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$173,747TotalRevenueColumnAmt
Exclusion$173,747ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$90,494SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$90,494SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$90,494TotalRevenueColumnAmt
Exclusion$90,494ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER SERVICE REVENUEDesc
Business621300BusinessCd
Total Revenue Column$24,218TotalRevenueColumnAmt
Related Or Exempt Func Income$24,218RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$24,218OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,256,562TotalRevenueColumnAmt
Related Or Exempt Func Income$7,251,199RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$264,241ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$286,284TotalAmt
Program Services$247,031ProgramServicesAmt
Management And General$39,253ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,798,712TotalAmt
Program Services$6,729,409ProgramServicesAmt
Management And General$1,069,303ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$655,757TotalAmt
Program Services$533,441ProgramServicesAmt
Management And General$122,316ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$520,865TotalAmt
Program Services$440,337ProgramServicesAmt
Management And General$80,528ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$610,000TotalAmt
Program Services$308,383ProgramServicesAmt
Management And General$301,617ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$126,140TotalAmt
Program Services$51,395ProgramServicesAmt
Management And General$74,745ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$590,803TotalAmt
Program Services$505,418ProgramServicesAmt
Management And General$85,385ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$60,273TotalAmt
Program Services$51,616ProgramServicesAmt
Management And General$8,657ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$106,803TotalAmt
Program Services$56,286ProgramServicesAmt
Management And General$50,517ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$334,686TotalAmt
Program Services$185,797ProgramServicesAmt
Management And General$148,889ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
OPERATING EXPENSES$536,204$318,881$217,323
OPERATING SUPPLIES$348,364$324,466$23,898
EQUIPMENT EXPENSES$57,143$26,958$30,185

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,032,034TotalAmt
Program Services$9,779,418ProgramServicesAmt
Management And General$2,252,616ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,054,377BOYAmt
EOY$4,267,040EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$903,931BOYAmt
EOY$1,221,990EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,161,706BOYAmt
EOY$1,067,593EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$6,920BOYAmt
EOY$7,792EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$176,102BOYAmt
EOY$183,869EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$14,935,692LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$5,476,132LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,032,412BOYAmt
EOY$9,459,560EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$6,449,865BOYAmt
EOY$6,674,164EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,000BOYAmt
EOY$1,000EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$20,786,313BOYAmt
EOY$22,883,008EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,614,000BOYAmt
EOY$2,220,720EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$2,602,012BOYAmt
EOY$2,399,055EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$1,484,650EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,216,012BOYAmt
EOY$6,104,425EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,570,301BOYAmt
EOY$16,778,583EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,570,301BOYAmt
EOY$16,778,583EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,786,313BOYAmt
EOY$22,883,008EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,224,528ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$16,246NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,476,261CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,365,278CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,825,401CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,676,810CurrentTaxYearMinus1YearAmt
Current Tax Year$5,213,183CurrentTaxYearAmt
Total$23,556,933TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,476,261CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,365,278CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,825,401CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,676,810CurrentTaxYearMinus1YearAmt
Current Tax Year$5,213,183CurrentTaxYearAmt
Total$23,556,933TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$23,556,933PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$8,066CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$11,684CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$9,195CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$111,015CurrentTaxYearMinus1YearAmt
Current Tax Year$173,747CurrentTaxYearAmt
Total$313,707TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$33,768CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$105,493CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$90,456CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$97,865CurrentTaxYearMinus1YearAmt
Current Tax Year$24,218CurrentTaxYearAmt
Total$351,800TotalAmt
FieldValueIRS element (for citing)
Total Support$24,222,440TotalSupportAmt
Gross Receipts Rltd Activities$38,547,371GrossReceiptsRltdActivitiesAmt
Public Support CY1700.97250PublicSupportCY170Pct
Public Support PY1700.97430PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,139,122BeginningYearBalanceAmt
Investment Earnings Or Losses$95,201InvestmentEarningsOrLossesAmt
Administrative Expenses$20,953AdministrativeExpensesAmt
End Year Balance$3,213,370EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,969,311BeginningYearBalanceAmt
Investment Earnings Or Losses$188,973InvestmentEarningsOrLossesAmt
Administrative Expenses$19,162AdministrativeExpensesAmt
End Year Balance$3,139,122EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,776,622BeginningYearBalanceAmt
Contributions$75ContributionsAmt
Investment Earnings Or Losses$210,551InvestmentEarningsOrLossesAmt
Administrative Expenses$17,937AdministrativeExpensesAmt
End Year Balance$2,969,311EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,510,601BeginningYearBalanceAmt
Contributions$250ContributionsAmt
Investment Earnings Or Losses$282,931InvestmentEarningsOrLossesAmt
Administrative Expenses$17,160AdministrativeExpensesAmt
End Year Balance$2,776,622EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$2,500,000ContributionsAmt
Investment Earnings Or Losses$14,933InvestmentEarningsOrLossesAmt
Administrative Expenses$4,332AdministrativeExpensesAmt
End Year Balance$2,510,601EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,071,230OtherCostOrOtherBasisAmt
Book Value$2,071,230BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,841,771OtherCostOrOtherBasisAmt
Depreciation$2,654,441DepreciationAmt
Book Value$7,187,330BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$564,474OtherCostOrOtherBasisAmt
Depreciation$548,429DepreciationAmt
Book Value$16,045BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,241,156OtherCostOrOtherBasisAmt
Depreciation$2,058,996DepreciationAmt
Book Value$182,160BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$217,061OtherCostOrOtherBasisAmt
Depreciation$214,266DepreciationAmt
Book Value$2,795BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,459,560TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
OTHER INVESTMENTS$3,460,794F
INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION$3,213,370F
FieldValueIRS element (for citing)
Total Book Value Securities$6,674,164TotalBookValueSecuritiesAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescREFUNDABLE ADVANCEDesc
Amt$1,484,650Amt
FieldValueIRS element (for citing)
Total Liability$1,484,650TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$13,240,316TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$16,246NetUnrealizedGainsInvstAmt
Revenue Not Reported-$16,246RevenueNotReportedAmt
Revenue Subtotal$13,256,562RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$13,256,562TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,032,034TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$12,032,034ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$12,032,034TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE AGENCY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE AGENCY'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE AGENCY'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,059,632TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$742,295DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,317,337NetCommunityBenefitExpnsAmt
Total Expense0.10950TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,059,632TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$742,295DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,317,337NetCommunityBenefitExpnsAmt
Total Expense0.10950TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,059,632TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$742,295DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,317,337NetCommunityBenefitExpnsAmt
Total Expense0.10950TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$8,185BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$255,380ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$209,165CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$46,215MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MENTAL HEALTH SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1474 NORTH YELLOW SPRINGS STREETAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45504ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
Other16 BED PSYCHIATRIC HOSPITALOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MENTAL HEALTH SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.MHSCC.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt18ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLWWW.MHSCC.ORGStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.MHSCC.ORGFAPAvailableOnWebsiteURLTxt
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
MENTAL HEALTH SERVICESPART V, SECTION B, LINE 5: MENTAL HEALTH SERVICES MANAGEMENT STAFF PARTICIPATES IN THE COMMUNITY HEALTH ASSESSMENT PROCESS PERFORMED BY THE CLARK COUNTY COMBINED HEALTH DISTRICT WITH OTHER COMMUNITY MEMBERS INCLUDING THE LOCAL HOSPITAL SYSTEM, OUR LOCAL ALCOHOL/DRUG TREATMENT PROGRAM, POLICE, FIRE AND ADMHS BOARD STAFF. IN ADDITION, MENTAL HEALTH SERVICES PERFORMS COMMUNITY FOCUS GROUP SESSIONS TO OBTAIN FEEDBACK AND INFORMATION FROM PATIENTS, FAMILY MEMBERS AND CONSUMER ADVOCATES TO ASSIST US IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS.
MENTAL HEALTH SERVICESPART V, SECTION B, LINE 11: BASED ON KEY ASSESSMENT DATA FROM THE CLARK COUNTY COMBINED HEALTH DISTRICT, MENTAL HEALTH SERVICES PROVIDES AN ONLINE DEPRESSION SCREENING FOR ADOLESCENTS AND ADULTS TO IDENTIFY DEPRESSION AND RISK OF SUICIDE. MENTAL HEALTH SERVICES PROVIDES WALK IN COUNSELING AS A PART OF OUR MENTAL HEALTH RECOVERY BOARD CONTRACT. IN ADDITION, MENTAL HEALTH SERVICES IS IMPLEMENTING EVIDENCE BASED PROGRAMMING IN THE LOCAL SCHOOLS TO REDUCE THE INCIDENCE OF SUICIDAL IDEATION AMONG MIDDLE SCHOOL AGE CHILDREN IN CLARK COUNTY. WE PARTICIPATE IN THE UPCOMING CLARK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE COMBINED HEALTH DISTRICT AND OTHER COMMUNITY ORGANIZATIONS TO EVALUATE THE COMMUNITY NEEDS.
MENTAL HEALTH SERVICESPART V, SECTION B, LINE 13B: THE BILLING CLERK PROVIDES INFORMATION TO PATIENTS ON OUR CHARITY CARE PROGRAM. WE HAVE INFORMATION POSTED ON THE INPATIENT UNIT BULLETIN AREA AND ALSO HAVE A NOTICE ON THE PATIENT STATEMENT ALONG WITH THE BILLING CLERK PHONE NUMBER. OUR FINANCIAL ASSISTANCE COLLECTION POLICY IS POSTED ON OUR WEBSITE. FOR RESIDENTS OF CLARK AND MADISON COUNTIES WITHOUT INSURANCE, WE PROVIDE FREE INPATIENT CARE. WE OFFER A 30% DISCOUNT FOR UNINSURED OUT OF COUNTY CLIENTS AS WELL AS CLIENTS WHO HAVE OUTSTANDING MEDICAL EXPENSES EXCEEDING $5,000.

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:MENTAL HEALTH SERVICES SCREENED ALL ADMISSIONS AND, FOR 2019, PROVIDED FINANCIAL ASSISTANCE TO 50% OF ALL INPATIENT ADMISSIONS.
PART VI, LINE 2:MENTAL HEALTH SERVICES MANAGEMENT STAFF PARTICIPATES IN THE CLARK COUNTY COMBINED HEALTH DISTRICT COMMUNITY HEALTH ASSESSMENT ALONG WITH OTHER COMMUNITY MEMBERS INCLUDING THE LOCAL HOSPITAL SYSTEM, OUR LOCAL ALCOHOL/DRUG TREATENT PROVIDER, POLICE, FIRE, AND LOCAL ALCOHOL/DRUG MENTAL HEALTH RECOVERY BOARD STAFF. IN ADDITION, MENTAL HEALTH SERVICES PERFORMS COMMUNITY FOCUS GROUP SESSIONS TO OBTAIN FEEDBACK ON SERVICE NEEDS.
PART VI, LINE 3:THE INPATIENT BILLING CLERK MEETS WITH THE PATIENT, THE PATIENTS FAMILY OR ANOTHER AUTHORIZED GUARDIAN OR REPRESENTATIVE TO DISCUSS CLIENT CARE PROGRAMS. IN ADDITION, WE HAVE A PHARMACY PROGRAM THAT PROVIDES PATIENTS THEIR MEDICATION AT NO COST FOR PATIENTS WITHOUT INSURANCE. FOR THOSE PATIENTS OF CLARK OR MADISON COUNTY WITHOUT HEALTH INSURANCE, WE OFFER A 100% CHARITY CARE PROGRAM. IN FY 2020 WE WERE ABLE TO PROVIDE FINANCIAL ASSISTANCE TO 50% OF ALL ADMISSIONS.
PART VI, LINE 4:CLARK AND MADISON COUNTIES ARE LOCATED IN SOUTHWEST OHIO WITH AN AREA POPULATION OF APPROXIMATELY 179,000. THE PERCENTAGE OF HOUSEHOLDS UNDER THE FEDERAL POVERTY GUIDELINES IS 15%. THE CLIENTS THAT WE SERVE ARE TYPICALLY ELIGIBLE FOR MEDICAID, MEDICARE OR OTHER FEDERAL ASSISTANCE PROGRAMS. THIS ELIGIBILITY IS USUALLY A FUNCTION OF OUR CLIENTS PSYCHIATRIC DISABILTIIES.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR KALPANA VISHNUPAD
PHYSICIAN$254,364$0$0$0$0$0$5,327$0$11,374$0$271,065$0$0$0
DR FAWZIA TOOR
PHYSICIAN$251,680$0$0$0$0$0$5,074$0$4,591$0$261,345$0$0$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CLARK COUNTY OHIOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN316000132BondIssuerEIN
CUSIP999999999CUSIPNum
Bond Issued2011-12-28BondIssuedDt
Issue Price$5,000,000IssuePriceAmt
PurposeCONSTRUCTING INPATIENT AND OUTPATIENT FACILITY FOR MENTAL HEALTH SERVICESPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds$5,000,000TotalProceedsAmt
Issuance Costs From Proceeds$50,000IssuanceCostsFromProceedsAmt
Capital Expenditures$4,215,532CapitalExpendituresAmt
Unspent$734,468UnspentAmt
Substantial Completion2013SubstantialCompletionYr
Refunding Tax Exempt Bonds0RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation Made0FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd0ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due YetYes (1)RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor Reqs0WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective Action0ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART III, LINE 9; PART IV, LINE 7; AND PART V:FormAndLineReferenceDesc
ExplanationMENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES, INC. HAS ESTABLISHED WRITTEN PROCEDURES (A) TO ENSURE THAT ALL NON-QUALIFIED BONDS OF AN ISSUE ARE REMEDIATED IN ACCORDANCE WITH REGULATIONS SECTIONS 1.141-12 AND 1.145-2, (B) TO MONITOR THE REQUIREMENTS OF SECTION 148 OF THE INTERNAL REVENUE CODE, AND (C) TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS.ExplanationTxt

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercialGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$480,000NoncashContributionsRptF990Amt
Method Of Determining RevenuesAPPRAISALMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD OF DIRECTORS AUDIT COMMITTEE REVIEWS THE FORM 990 AND APPROVES IT BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CBOARD OF DIRECTORS REVIEW THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS AND COMPLETE SURVEY AND STATEMENT OF UNDERSTANDING.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD REFERENCES VARIOUS INDUSTRY COMPENSATION STUDIES AND SALARY SCHEDULES OF COMPARABLE ORGANIZATIONS. THE HUMAN RESOURCES DIRECTOR REPORTS TO THE BOARD OF DIRECTORS REGARDING MATTERS OF COMPENSATION LEVELS AND RESULTS OF SUCH STUDIES.
FORM 990, PART VI, SECTION C, LINE 18GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST OF THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19FORM 1023 AND FORM 990 ARE MADE AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST OF THE ORGANIZATION.
PART XII, LINE 2CTHE ORGANIZATION DID NOT CHANGE ITS ACCEPTANCE PROCEDURES FOR THE FINANCIAL STATEMENTS FROM THE PRIOR PERIOD METHOD. MANAGEMENT REVIEWS THE AUDITED FINANCIAL STATEMENTS AND PRESENTS THEM TO THE BOARD FOR APPROVAL.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
CLEANERS EXTRAORDINAIRE INC
128 EAGLE CITY ROADSPRINGFIELDOH45502311110016JOB TRAINING FOR INDIVIDUALS WITH DISABILITESOH501(C)(3)170(B)(1)(A)(VI)MENTAL HEALTH SERVICESYes (1)
RESOURCE CENTER APARTMENTS INC
1086 MOUND STSPRINGFIELDOH45505311307922AFFORDABLE HOUSING FOR THE DISABLEDOH501(C)(3)170(B)(1)(A)(VI)MENTAL HEALTH SERVICESYes (1)
RESTAN CORP
1086 MOUND STSPRINGFIELDOH45505311368099AFFORDABLE HOUSING FOR THE DISABLEDOH501(C)(3)509(A)(2)MENTAL HEALTH SERVICESYes (1)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1JANI-TURF MAINTENENCE SERVICE INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1128 EAGLE CITY ROADAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45502ZIPCd
FieldValueIRS element (for citing)
EIN311331268EIN
Primary ActivitiesJANITORIAL AND PROPERTY MAINTENECE SERVICESPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1MENTAL HEALTH SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Share Of Total Income-$3,286ShareOfTotalIncomeAmt
Share Of EOY Assets$139,769ShareOfEOYAssetsAmt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (1)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmt
JANI-TURF MAINTENANCE SERVICES INC
M$23,814
CLEANERS EXTRAORDINAIRE INC
K$16,102
RESOURCE CENTER APARTMENTS INC
Q$71,696
RESTAN CORP
L$2,131