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MENTAL HEALTH SERVICES FOR CLARK CO INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
MENTAL HEALTH SERVICES FOR CLARK CO INC (EIN 31-0787073)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-01-29
IRS object ID
201930299349300003
Schema version
2017v2.3
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)
Return2019-01-29T07:57:45-06:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

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 Begin2017-07-01TaxPeriodBeginDt

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)
PersonCURTIS GILLESPIEPersonNm
Person TitleCEOPersonTitleTxt
Phone9373999500PhoneNum
Signature2019-01-26SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMATTHEW SHROYERPreparerPersonNm
PTINP00737986PTIN
Phone9373992000PhoneNum
Preparation2019-01-26PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address74.121.64.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-01-26IPDt
IP Tm08:25:33IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device Id37AE4FB04CC3C859C04812217BCAEDDE34C66B0FAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

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 OfficerCURTIS GILLESPIEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1474 N YELLOW SPRINGS STAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45504ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$12,040,411GrossReceiptsAmt
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 Body14VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee256TotalEmployeeCnt
Total Volunteers14TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,365,278PYContributionsGrantsAmt
CY Contributions Grants$4,825,401CYContributionsGrantsAmt
PY Program Service Revenue$7,986,323PYProgramServiceRevenueAmt
CY Program Service Revenue$6,934,130CYProgramServiceRevenueAmt
PY Investment Income$82,074PYInvestmentIncomeAmt
CY Investment Income$190,334CYInvestmentIncomeAmt
PY Other Revenue$105,493PYOtherRevenueAmt
CY Other Revenue$90,546CYOtherRevenueAmt
PY Total Revenue$12,539,168PYTotalRevenueAmt
CY Total Revenue$12,040,411CYTotalRevenueAmt
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$9,289,107PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,184,144CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,993,126PYOtherExpensesAmt
CY Other Expenses$3,015,533CYOtherExpensesAmt
PY Total Expenses$12,282,233PYTotalExpensesAmt
CY Total Expenses$12,199,677CYTotalExpensesAmt
PY Revenues Less Expenses$256,935PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$159,266CYRevenuesLessExpensesAmt
Total Assets BOY$20,354,449TotalAssetsBOYAmt
Total Assets EOY$20,586,843TotalAssetsEOYAmt
Total Liabilities BOY$5,057,184TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,289,578TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,297,265NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$15,297,265NetAssetsOrFundBalancesEOYAmt
MissionMENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES WILL IMPROVE THE SAFETY AND QUALITY OF LIFE OF THOSE WE SERVE THROUGH PROMOTION OF EMOTIONAL AND BEHAVIORAL HEALTH WELLNESS AND ACCESSIBILITY TO A COMPREHENSIVE CONTINUUM OF BEHAVIORAL HEALTH SERVICES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,906,764ExpenseAmt
Revenue$2,883,552RevenueAmt
DescINPATIENT PSYCHIATRIC SERVICES OFFERING SHORT TERM, MULTIDISCIPLINARY CARE TO TREAT ACUTE EPISODES OF PSYCHOSIS AND DEPRESSIVE DISORDERS. 787 CLIENTS WERE SERVED DURING THE FISCAL YEAR.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$6,068,415ExpenseAmt
Revenue$3,354,713RevenueAmt
DescOUTPATIENT PSYCHIATRIC SERVICES SERVED 5,700 CLIENTS DURING THE FISCAL YEAR FOR YOUTH, ADULT AND GERIATRIC POPULATIONS.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$786,411ExpenseAmt
Revenue$786,411RevenueAmt
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$9,761,590TotalProgramServiceExpensesAmt
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
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
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 Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee256EmployeeCnt
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
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 (20 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
DOUG SCHANTZ
VICE CHAIR3.00Yes (X)Yes (X)$0$0$0
HORTON HOBBS
TRUSTEE3.00Yes (X)$0$0$0
LYNN ROWLAND
TRUSTEE3.00Yes (X)$0$0$0
MARILYN KREIDER
TRUSTEE3.00Yes (X)$0$0$0
SUE MCCLELLAND
TRUSTEE3.00Yes (X)$0$0$0
BRIAN SMITH
TRUSTEE3.00Yes (X)$0$0$0
JEFF HUGHES
TRUSTEE3.00Yes (X)$0$0$0
KELLY SNYDER
TRUSTEE3.00Yes (X)$0$0$0
CHRIS ZECHMAN
TRUSTEE3.00Yes (X)$0$0$0
MARY TAYLOR
TRUSTEE3.00Yes (X)$0$0$0
ALEXIS EVANS COMER
TRUSTEE3.00Yes (X)$0$0$0
CURTIS GILLESPIE
CHIEF EXECUTIVE OFFICER40.00Yes (X)$124,298$0$15,285
MARY BETH TAYLOR
VP FINANCE40.00Yes (X)$77,682$0$14,476
SUE FRALICK
VP OF ADULT AND YOUTH OUTPATIENT SERVICES40.00Yes (X)$99,583$0$14,303
DR MARK A SMITH
CHIEF CLINICAL OFFICER40.00Yes (X)$272,512$0$17,635
DR KALPANA VISHNUPAD
PHYSICIAN40.00$223,048$0$16,907Yes (X)
DR YIU-CHUNG CHANG
PHYSICIAN40.00$218,727$0$16,821Yes (X)
DR FAWZIA TOOR
PHYSICIAN40.00$239,474$0$7,778Yes (X)
DR SUNITA AGARWAL
PHYSICIAN40.00$152,085$0$3,522Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,407,409TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$106,727TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$7,875FederatedCampaignsAmt
Government Grants$4,150,616GovernmentGrantsAmt
All Other Contributions$666,910AllOtherContributionsAmt
Total Contributions$4,825,401TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
TITLE XIX MEDICAID900099$4,403,328$4,403,328
PATIENT SERVICE REVENUES621300$1,624,890$1,624,890
UPL PAYMENTS900099$677,732$677,732
TITLE XX900099$115,357$115,357
RENTAL REVENUE FROM CLIENT SUPPOR623990$112,823$112,823
FieldValueIRS element (for citing)
Total Program Service Revenue$6,934,130TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,195TotalRevenueColumnAmt
Exclusion$9,195ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$181,139SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$181,139SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$181,139TotalRevenueColumnAmt
Exclusion$181,139ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER SERVICE REVENUEDesc
Business621300BusinessCd
Total Revenue Column$90,546TotalRevenueColumnAmt
Related Or Exempt Func Income$90,546RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$90,546OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,040,411TotalRevenueColumnAmt
Related Or Exempt Func Income$7,024,676RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$190,334ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$635,774TotalAmt
Program Services$540,408ProgramServicesAmt
Management And General$95,366ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$7,178,622TotalAmt
Program Services$6,077,481ProgramServicesAmt
Management And General$1,101,141ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$892,408TotalAmt
Program Services$726,824ProgramServicesAmt
Management And General$165,584ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$477,340TotalAmt
Program Services$393,871ProgramServicesAmt
Management And General$83,469ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$620,732TotalAmt
Program Services$339,148ProgramServicesAmt
Management And General$281,584ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$122,776TotalAmt
Program Services$64,351ProgramServicesAmt
Management And General$58,425ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$593,193TotalAmt
Program Services$491,567ProgramServicesAmt
Management And General$101,626ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$92,355TotalAmt
Program Services$76,170ProgramServicesAmt
Management And General$16,185ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$119,424TotalAmt
Program Services$62,937ProgramServicesAmt
Management And General$56,487ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$359,216TotalAmt
Program Services$206,249ProgramServicesAmt
Management And General$152,967ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
OPERATING SUPPLIES$595,966$327,011$268,955
OPERATING EXPENSES$340,977$320,822$20,155
EQUIPMENT EXPENSES$135,345$99,202$36,143
BAD DEBTS$35,549$35,549

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$12,199,677TotalAmt
Program Services$9,761,590ProgramServicesAmt
Management And General$2,438,087ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,693,207BOYAmt
EOY$2,810,962EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$880,634BOYAmt
EOY$888,909EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,033,518BOYAmt
EOY$1,215,282EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,654BOYAmt
EOY$5,415EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$187,851BOYAmt
EOY$179,488EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$14,157,126LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,856,551LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,509,853BOYAmt
EOY$9,300,575EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$5,044,732BOYAmt
EOY$6,185,212EOYAmt

Other Assets Total OtherAssetsTotalGrp

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

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$20,354,449BOYAmt
EOY$20,586,843EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,931,052BOYAmt
EOY$2,408,636EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$3,126,132BOYAmt
EOY$2,880,942EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,057,184BOYAmt
EOY$5,289,578EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,297,265BOYAmt
EOY$15,297,265EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,297,265BOYAmt
EOY$15,297,265EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,354,449BOYAmt
EOY$20,586,843EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$159,266ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$159,266NetUnrlzdGainsLossesInvstAmt
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$4,882,789CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,480,188CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,476,261CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,365,278CurrentTaxYearMinus1YearAmt
Current Tax Year$4,825,401CurrentTaxYearAmt
Total$23,029,917TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,882,789CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4,480,188CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$4,476,261CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,365,278CurrentTaxYearMinus1YearAmt
Current Tax Year$4,825,401CurrentTaxYearAmt
Total$23,029,917TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$23,029,917PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,178CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,571CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,066CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$11,684CurrentTaxYearMinus1YearAmt
Current Tax Year$9,195CurrentTaxYearAmt
Total$41,694TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$64,831CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$128,926CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$33,768CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$105,493CurrentTaxYearMinus1YearAmt
Current Tax Year$90,456CurrentTaxYearAmt
Total$423,474TotalAmt
FieldValueIRS element (for citing)
Total Support$23,495,085TotalSupportAmt
Gross Receipts Rltd Activities$42,033,001GrossReceiptsRltdActivitiesAmt
Public Support CY1700.98020PublicSupportCY170Pct
Public Support PY1700.97930PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

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 Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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 Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

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$1,560,377OtherCostOrOtherBasisAmt
Book Value$1,560,377BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,578,365OtherCostOrOtherBasisAmt
Depreciation$2,146,484DepreciationAmt
Book Value$7,431,881BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$564,474OtherCostOrOtherBasisAmt
Depreciation$529,438DepreciationAmt
Book Value$35,036BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,236,849OtherCostOrOtherBasisAmt
Depreciation$1,969,080DepreciationAmt
Book Value$267,769BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$217,061OtherCostOrOtherBasisAmt
Depreciation$211,549DepreciationAmt
Book Value$5,512BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,300,575TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
OTHER INVESTMENTS$3,215,901F
INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION$2,969,311F
FieldValueIRS element (for citing)
Total Book Value Securities$6,185,212TotalBookValueSecuritiesAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$12,199,677TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$159,266NetUnrealizedGainsInvstAmt
Revenue Not Reported$159,266RevenueNotReportedAmt
Revenue Subtotal$12,040,411RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$12,040,411TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$12,199,677TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$12,199,677ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$12,199,677TotalExpensesPerForm990Amt

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. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS AS THE AGENCY HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION.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$907,725TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$490,672DirectOffsettingRevenueAmt
Net Community Benefit Expns$417,053NetCommunityBenefitExpnsAmt
Total Expense0.03420TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$907,725TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$490,672DirectOffsettingRevenueAmt
Net Community Benefit Expns$417,053NetCommunityBenefitExpnsAmt
Total Expense0.03420TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$907,725TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$490,672DirectOffsettingRevenueAmt
Net Community Benefit Expns$417,053NetCommunityBenefitExpnsAmt
Total Expense0.03420TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$23,212BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$361,961ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$301,840CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$60,121MedicareSurplusOrShortfallAmt

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 Conducted16CHNAConductedYr
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 Adpt16ImplementationStrategyAdptYr
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 ARE PART OF THE CLARK COUNTY COMBINED HEALTH DISTRICT ADULT MENTAL HEALTH TASK FORCE TO ASSIST PART OF THE CLARK COUNTY COMBINED HEALTH DISTRICT ADULT MENTAL HEALTH TASK FORCE TO ASSIST IN THE REDUCTION OF SQUAD RUNS FOR MENTAL HEALTH ISSUES IN THE COMMUNITY.
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 OF CLARK AND MADISON COUNTIES, INC. SCREENED ALL ADMISSIONS AND, FOR 2017, PROVIDED FINANCIAL ASSISTANCE TO 64% 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 MEDICAID REFERRAL COUNSELOR WHO ASSISTS CLIENTS WITH COMPLETION OF MEDICAID AND PRESCRIPTION DRUG ASSISTANCE APPLICATIONS. FOR THOSE CLIENTS OF CLARK OR MADISON COUNTY WITHOUT HEALTH INSURANCE, WE OFFER A 100% CHARITY CARE PROGRAM. IN 2017 WE WERE ABLE TO PROVIDE FINANCIAL ASSISTANCE TO 64% OF ALL ADMISSIONS.
PART VI, LINE 4:CLARK AND MADISON COUNTIES ARE LOCATED IN SOUTHWEST OHIO WITH AN AREA POPULATION OF APPROXIMATELY 181,000. 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 (5 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 MARK A SMITH
CHIEF CLINICAL OFFICER$272,512$0$0$0$0$0$5,400$0$12,235$0$290,147$0$0$0
DR KALPANA VISHNUPAD
PHYSICIAN$223,048$0$0$0$0$0$4,672$0$12,235$0$239,955$0$0$0
DR YIU-CHUNG CHANG
PHYSICIAN$218,727$0$0$0$0$0$4,586$0$12,235$0$235,548$0$0$0
DR FAWZIA TOOR
PHYSICIAN$239,474$0$0$0$0$0$3,555$0$4,223$0$247,252$0$0$0
DR SUNITA AGARWAL
PHYSICIAN$152,085$0$0$0$0$0$3,522$0$0$0$155,607$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
Current Refunding0CurrentRefundingInd
Advance Refunding0AdvanceRefundingInd
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 O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD OF TRUSTEES AUDIT COMMITTEE REVIEWS THE FORM 990 AND APPROVES IT BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CBOARD OF TRUSTEES 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 TRUSTEES 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.
FORM 990, PART XII, LINE 2C:THE 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
112 LOHNES AVESPRINGFIELDOH45504311110016JOB TRAINING FOR INDIVIDUALS WITH DISABILITESOH501(C)(3)170(B)(1)(A)(VI)MENTAL HEALTH SERVICESYes (1)
RESOURCE CENTER APARTMENTS INC
601 N FOUNTAIN AVESPRINGFIELDOH45503311307922AFFORDABLE HOUSING FOR THE DISABLEDOH501(C)(3)170(B)(1)(A)(VI)MENTAL HEALTH SERVICESYes (1)
RESTAN CORP
601 N FOUNTAIN AVESPRINGFIELDOH45503311368099AFFORDABLE 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 Line1112 LOHNES AVEAddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45504ZIPCd
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$3,833ShareOfTotalIncomeAmt
Share Of EOY Assets$155,041ShareOfEOYAssetsAmt
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$14,556
CLEANERS EXTRAORDINAIRE INC
K$14,400
RESOURCE CENTER APARTMENTS INC
Q$65,282
RESTAN CORP
L$6,276