MENTAL HEALTH SERVICES FOR CLARK CO INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- MENTAL HEALTH SERVICES FOR CLARK CO INC (EIN 31-0787073)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-02-09
- IRS object ID
- 201820409349300307
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-02-09T09:06:56-06:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 310800053 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark Schaefer Hackett & Co | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 East Main St Suite 500 | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45502 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310787073 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mental Health Services for Clark Co Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MENT | BusinessNameControlTxt |
| Phone | 9373999500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N Yellow Springs St | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45504 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Curtis Gillespie | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9373999500 | PhoneNum |
| Signature | 2018-02-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Matthew Shroyer | PreparerPersonNm |
| PTIN | P00737986 | PTIN |
| Phone | 9373992000 | PhoneNum |
| Preparation | 2018-02-06 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 174.233.15.24 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-02-06 | IPDt |
| IP Tm | 13:28:07 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 37AE4FB04CC3C859C04812217BCAEDDE34C66B0F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mental Health Services for Clark and Madison Cos Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Curtis Gillespie | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N Yellow Springs St | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45504 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,468,778 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MHSCC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1969 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | PROVIDES MENTAL AND BEHAVIORAL HEALTH SERVICES TO RESIDENTS OF CLARK AND MADISON COUNTIES OHIO. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 255 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,476,261 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,365,278 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $8,902,838 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $7,986,323 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,220 | PYInvestmentIncomeAmt |
| CY Investment Income | $82,074 | CYInvestmentIncomeAmt |
| PY Other Revenue | $33,768 | PYOtherRevenueAmt |
| CY Other Revenue | $105,493 | CYOtherRevenueAmt |
| PY Total Revenue | $13,418,087 | PYTotalRevenueAmt |
| CY Total Revenue | $12,539,168 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,206,741 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,289,107 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,338,042 | PYOtherExpensesAmt |
| CY Other Expenses | $2,993,126 | CYOtherExpensesAmt |
| PY Total Expenses | $12,544,783 | PYTotalExpensesAmt |
| CY Total Expenses | $12,282,233 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $873,304 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $256,935 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,458,783 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,354,449 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,628,344 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,057,184 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,830,439 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $15,297,265 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Mental 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,725,976 | ExpenseAmt |
| Revenue | $2,770,290 | RevenueAmt |
| Desc | Acute inpatient psychiatric behavoral health services; served 723 patients in the fiscal year. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,369,703 | ExpenseAmt |
| Revenue | $4,399,152 | RevenueAmt |
| Desc | OUTPATIENT PSYCHIATRIC SERVICES SERVED 5,700 CLIENTS DURING THE FISCAL YEAR FOR YOUTH, ADULT AND Geriatric POPULATIONS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $734,345 | ExpenseAmt |
| Revenue | $922,374 | RevenueAmt |
| Desc | RESIDENTIAL SERVICES FOR CLIENTS WITH SEVERE MENTAL DISABILITIES WERE PROVIDED FOR 105 CLIENTS DURING THE FISCAL YEAR. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $9,830,024 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 23 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 255 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY BETH TAYLOR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9373999500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N YELLOW SPRINGS ST | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45504 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| rick broderick | |||||||
| Chair | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| doug schantz | |||||||
| Vice Chair | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Henry Comer | |||||||
| tRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Horton Hobbs | |||||||
| TRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Lynn Rowland | |||||||
| trUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| sue MCCLELLAND | |||||||
| tRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Brian smith | |||||||
| trUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| jeff hughes | |||||||
| TRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Kelly Snyder | |||||||
| tRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Mary Taylor | |||||||
| TRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Diane Turner-Sharazz | |||||||
| trustEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Chris zechman | |||||||
| TRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Sherry Nelson | |||||||
| tRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Marilyn Kreider | |||||||
| TRUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| alexis evans comer | |||||||
| trUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Lori Dodge Dorsey | |||||||
| trUSTEE | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Curtis Gillespie | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $110,454 | $0 | $15,135 | ||
| Mary beth taylor | |||||||
| Vp fINANCE | 40.00 | Yes (X) | $74,059 | $0 | $14,375 | ||
| dr mark a smith | |||||||
| chief clinical officer | 40.00 | Yes (X) | $268,633 | $0 | $17,535 | ||
| DR KALPANA VISHNUPAD | |||||||
| PHYSICIAN | 40.00 | $217,079 | $0 | $16,788 | Yes (X) | ||
| DR YIU-CHUNG CHAN | |||||||
| PHYSICIAN | 40.00 | $215,537 | $0 | $16,737 | Yes (X) | ||
| Dr Fawzia Toor | |||||||
| PHYSICIAN | 40.00 | $187,087 | $0 | $5,223 | Yes (X) | ||
| Dr Sunita Agarwal | |||||||
| phYSICIAN | 40.00 | $155,220 | $0 | $3,584 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,228,069 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $89,377 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $18,646 | FederatedCampaignsAmt |
| Government Grants | $4,153,594 | GovernmentGrantsAmt |
| All Other Contributions | $193,038 | AllOtherContributionsAmt |
| Total Contributions | $4,365,278 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| TITLE XIX MEDICAID | 900099 | $5,560,944 | $5,560,944 |
| PATIENT SERVICE REVENUES | 621300 | $1,504,145 | $1,504,145 |
| UPL Payments | 900099 | $697,364 | $697,364 |
| TITLE XX | 900099 | $116,402 | $116,402 |
| Rental revenue from client suppor | 623990 | $107,468 | $107,468 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $7,986,323 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,684 | TotalRevenueColumnAmt |
| Exclusion | $11,684 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$70,390 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $70,390 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $70,390 | TotalRevenueColumnAmt |
| Exclusion | $70,390 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER SERVICE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $105,493 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $105,493 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $105,493 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,539,168 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,091,816 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $82,074 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $500,191 | TotalAmt |
| Program Services | $425,162 | ProgramServicesAmt |
| Management And General | $75,029 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,289,588 | TotalAmt |
| Program Services | $6,124,761 | ProgramServicesAmt |
| Management And General | $1,164,827 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $980,155 | TotalAmt |
| Program Services | $805,335 | ProgramServicesAmt |
| Management And General | $174,820 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $519,173 | TotalAmt |
| Program Services | $432,715 | ProgramServicesAmt |
| Management And General | $86,458 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $637,260 | TotalAmt |
| Program Services | $317,605 | ProgramServicesAmt |
| Management And General | $319,655 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,551 | TotalAmt |
| Program Services | $59,057 | ProgramServicesAmt |
| Management And General | $83,494 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $567,974 | TotalAmt |
| Program Services | $504,164 | ProgramServicesAmt |
| Management And General | $63,810 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,095 | TotalAmt |
| Program Services | $81,208 | ProgramServicesAmt |
| Management And General | $14,887 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,859 | TotalAmt |
| Program Services | $111,587 | ProgramServicesAmt |
| Management And General | $41,272 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,927 | TotalAmt |
| Program Services | $252,773 | ProgramServicesAmt |
| Management And General | $111,154 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Operating Expenses | $554,378 | $299,715 | $254,663 |
| OPerating SUPPLIES | $330,984 | $310,343 | $20,641 |
| EQUIPMENT EXPENSES | $120,632 | $79,133 | $41,499 |
| Bad Debts | $26,466 | $26,466 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,282,233 | TotalAmt |
| Program Services | $9,830,024 | ProgramServicesAmt |
| Management And General | $2,452,209 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,378,122 | BOYAmt |
| EOY | $2,693,207 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,493,064 | BOYAmt |
| EOY | $880,634 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,046,463 | BOYAmt |
| EOY | $2,033,518 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,225 | BOYAmt |
| EOY | $3,654 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,906 | BOYAmt |
| EOY | $187,851 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,040,692 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,530,839 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,769,455 | BOYAmt |
| EOY | $9,509,853 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,574,548 | BOYAmt |
| EOY | $5,044,732 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,000 | BOYAmt |
| EOY | $1,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,458,783 | BOYAmt |
| EOY | $20,354,449 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,203,853 | BOYAmt |
| EOY | $1,931,052 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,312 | BOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,404,179 | BOYAmt |
| EOY | $3,126,132 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,628,344 | BOYAmt |
| EOY | $5,057,184 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,830,439 | BOYAmt |
| EOY | $15,297,265 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,830,439 | BOYAmt |
| EOY | $15,297,265 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,458,783 | BOYAmt |
| EOY | $20,354,449 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $256,935 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $209,891 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,700,152 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,882,789 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,480,188 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,476,261 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,365,278 | CurrentTaxYearAmt |
| Total | $22,904,668 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,700,152 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,882,789 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,480,188 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,476,261 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,365,278 | CurrentTaxYearAmt |
| Total | $22,904,668 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $22,904,668 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $15,048 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $6,178 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,571 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,066 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,684 | CurrentTaxYearAmt |
| Total | $47,547 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $104,412 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $64,831 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $128,926 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $33,768 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $105,493 | CurrentTaxYearAmt |
| Total | $437,430 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $23,389,645 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $44,482,512 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97930 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98260 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,510,601 | BeginningYearBalanceAmt |
| Contributions | $250 | ContributionsAmt |
| Investment Earnings Or Losses | $27,761 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $17,160 | AdministrativeExpensesAmt |
| End Year Balance | $2,521,452 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $2,500,000 | ContributionsAmt |
| Investment Earnings Or Losses | $14,933 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $4,332 | AdministrativeExpensesAmt |
| End Year Balance | $2,510,601 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,560,377 | OtherCostOrOtherBasisAmt |
| Book Value | $1,560,377 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,508,736 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,929,669 | DepreciationAmt |
| Book Value | $7,579,067 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $543,953 | OtherCostOrOtherBasisAmt |
| Depreciation | $518,146 | DepreciationAmt |
| Book Value | $25,807 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,210,565 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,873,964 | DepreciationAmt |
| Book Value | $336,601 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $217,061 | OtherCostOrOtherBasisAmt |
| Depreciation | $209,060 | DepreciationAmt |
| Book Value | $8,001 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,509,853 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| Other Investments | $2,268,110 | F |
| Interest in assets held by Community Foundation | $2,776,622 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $5,044,732 | TotalBookValueSecuritiesAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,749,059 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $209,891 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $209,891 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,539,168 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $12,539,168 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,282,233 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,282,233 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,282,233 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | The 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,112,617 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $500,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $611,735 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04980 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,112,617 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $500,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $611,735 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04980 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,112,617 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $500,882 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $611,735 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04980 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $26,016 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $445,218 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $376,984 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $68,234 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 North Yellow Springs Street | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45504 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | 16 BED PSYCHIATRIC HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.mhscc.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.MHSCC.org | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.mhscc.org | FAPAvailableOnWebsiteURLTxt |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MENTAL HEALTH SERVICES | Part V, Section B, Line 5: Mental Health Services management staff participated in the community health assessment performed by the Clark County combined health district in 2015 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 perfromed community focus group sessions with out outpatient program and NAMI program to obtain feedback and information from patients, family members and consumer advocates to assist us in the community health needs assessment process. |
| MENTAL HEALTH SERVICES | Part 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 SERVICES | Part 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | MENTAL HEALTH SERVICES OF CLARK AND MADISON COUNTIES, INC. SCREENed all admissions and, for 2016, provided financial assistance to 70% of all inpatient admissions. |
| Part VI, Line 2: | mental health services management staff participated in the 2015 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 performed 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 2016 we were able to provide financial assistance to 70% 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| dr mark a smith | ||||||||||||||
| chief clinical officer | $268,633 | $0 | $0 | $0 | $0 | $0 | $5,300 | $0 | $12,235 | $0 | $286,168 | $0 | $0 | $0 |
| DR KALPANA VISHNUPAD | ||||||||||||||
| PHYSICIAN | $217,079 | $0 | $0 | $0 | $0 | $0 | $4,553 | $0 | $12,235 | $0 | $233,867 | $0 | $0 | $0 |
| DR YIU-CHUNG CHAN | ||||||||||||||
| PHYSICIAN | $215,537 | $0 | $0 | $0 | $0 | $0 | $4,502 | $0 | $12,235 | $0 | $232,274 | $0 | $0 | $0 |
| Dr Fawzia Toor | ||||||||||||||
| PHYSICIAN | $187,087 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $5,223 | $0 | $192,310 | $0 | $0 | $0 |
| Dr Sunita Agarwal | ||||||||||||||
| phYSICIAN | $155,220 | $0 | $0 | $0 | $0 | $0 | $3,584 | $0 | $0 | $0 | $158,804 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clark County Ohio | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 316000132 | BondIssuerEIN |
| CUSIP | 999999999 | CUSIPNum |
| Bond Issued | 2011-12-28 | BondIssuedDt |
| Issue Price | $5,000,000 | IssuePriceAmt |
| Purpose | Constructing Inpatient and Outpatient Facility for Mental Health Services | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | $5,000,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $50,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $4,215,532 | CapitalExpendituresAmt |
| Unspent | $734,468 | UnspentAmt |
| Substantial Completion | 2013 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART III, LINE 9; PART IV, LINE 7; AND PART V: | FormAndLineReferenceDesc |
| Explanation | MENTAL 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 ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | THE BOARD OF TRUSTEES AUDIT COMMITTEE REVIEWS THE FORM 990 AND APPROVES IT BEFORE FILING. |
| Form 990, Part VI, Section B, line 12c | BOARD 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 15 | THE 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 18 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST OF THE ORGANIZATION. |
| Form 990, Part VI, Section C, line 19 | FORM 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/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Cleaners Extraordinaire INC | ||||||||||
| 112 Lohnes Ave | Springfield | OH | 45504 | 311110016 | Job training for individuals with disabilites | OH | 501(c)(3) | 170(b)(1)(A)(vi) | MENTAL HEALTH SERVICES | Yes (1) |
| Resource Center Apartments INC | ||||||||||
| 601 N Fountain Ave | Springfield | OH | 45503 | 311307922 | Affordable Housing for the disabled | OH | 501(c)(3) | 170(b)(1)(A)(vi) | MENTAL HEALTH SERVICES | Yes (1) |
| Restan Corp | ||||||||||
| 601 N Fountain Ave | springfield | OH | 45503 | 311368099 | affordable housing for the disabled | OH | 501(c)(3) | 509(a)(2) | MENTAL HEALTH SERVICES | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Jani-Turf Maintenence Service Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 Lohnes Ave | AddressLine1Txt |
| City | Springfield | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 45504 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311331268 | EIN |
| Primary Activities | Janitorial and Property Maintenece Services | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $17,760 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $126,872 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| JANI-TURF MAINTENANCE SERVICES INC | |
| M | $14,143 |
| Cleaners Extraordinaire Inc | |
| K | $34,467 |
| Resource Center Apartments Inc | |
| O | $59,628 |
| RESTAN Corp | |
| L | $788 |