MENTAL HEALTH SERVICES FOR CLARK CO INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MENTAL HEALTH SERVICES FOR CLARK CO INC (EIN 31-0787073)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-13
- IRS object ID
- 201440449349301969
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-02-13T15:25:21-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310800053 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK SCHAEFER HACKETT & CO | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14 E MAIN STREET SUITE 500 | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45502 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310787073 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH SERVICES FOR CLARK AND | BusinessNameLine1 |
| Business Name Line2 | MADISON COUNTIES INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MENT | NameControl |
| Phone | 9373992701 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N YELLOW SPRINGS ST | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45504 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARY BETH TAYLOR | Name |
| Title | VP OF FINANCE | Title |
| Phone | 9373999500 | Phone |
| Date Signed | 2014-02-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEVESH KAMAL CPA | Name |
| PTIN | P00201226 | PTIN |
| Phone | 9373992000 | Phone |
| Date Prepared | 2014-02-13 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARY BETH TAYLOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N YELLOW SPRINGS ST | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45504 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 14203253 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MHSCC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1969 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | PROVIDES MENTAL AND BEHAVIORAL HEALTH SERVICES TO RESIDENTS OF CLARK AND MADISON COUNTIES OHIO. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 283 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 4145915 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4700152 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9757400 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 8499269 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 34342 | InvestmentIncomePriorYear |
| Investment Income Current Year | 15048 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 988784 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 13937657 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14203253 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10235021 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9647547 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2945355 | OtherExpensePriorYear |
| Other Expenses Current Year | 3178599 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13180376 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12826146 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 757281 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1377107 | RevenuesLessExpensesCY |
| Total Assets BOY | 14501030 | TotalAssetsBOY |
| Total Assets EOY | 19667506 | TotalAssetsEOY |
| Total Liabilities BOY | 4405498 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8180114 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10095532 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11487392 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | WE ARE A PRIVATE, NOT FOR PROFIT COMPREHENSIVE BEHAVIORAL HEALTHCARE SYSTEM DEDICATED TO SERVING INDIVIDUALS,FAMILIES, AND OUR COMMUNITY WITH HIGH QUALITY, COST EFFECTIVE CARE. OUR SERVICES ARE INTEGRATED WITH THE HEALTHCARE ENVIRONMENT. WE ARE CHARITABLE TO SERVE THOSE IN NEED WITHIN THE LIMITS OF OUR RESOURCES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2605821 | Expense |
| Revenue | 2239629 | Revenue |
| Description | ADULT CARE, OR INPATIENT PSYCHIATRIC MENTAL HEALTH SERVICES SERVED 794 CLIENTS IN FISCAL YEAR 2013. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 6912029 | Expense |
| Revenue | 7045802 | Revenue |
| Description | OUTPATIENT PSYCHIATRIC SERVICES SERVED 5,730 CLIENTS DURING THE FISCAL YEAR. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 649739 | Expense |
| Revenue | 202622 | Revenue |
| Description | RESIDENTIAL SERVICES FOR CLIENTS WITH SEVERE MENTAL DISABILITIES WERE PROVIDED FOR 96 CLIENTS DURING THE FISCAL YEAR. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 10167589 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 29 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 283 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Form8899 Filed | 0 | Form8899Filed |
| Form1098 C Filed | 0 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY BETH TAYLOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9373999500 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N YELLOW SPRINGS STREET | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45504 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES PERRY PHD | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | X | X | 165687 | 0 | 17220 | |
| DARRELL KITCHEN | |||||||
| CHAIR | 3.00 | X | X | 0 | 0 | 0 | |
| SHAWN TAYLOR | |||||||
| VICE CHAIR | 3.00 | X | X | 0 | 0 | 0 | |
| RICK BRODERICK | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| GEORGE DEGENHART | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| ALEXIS EVANS COMER | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| TOM FRANZEN | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| HORTON HOBBS | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| JEFF HUGHES | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| MARILYN KREIDER | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| LEE ANN LOPEZ | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| SUE MCCLELLAND | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| CHARLIE RINEHART | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| DOUG SCHANTZ | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| JERRY SIMONTON | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| BRIAN SMITH | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| TERRI WYATT | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| DR MARK A SMITH | |||||||
| CHIEF CLINICAL OFFICER | 40.00 | X | X | 262331 | 0 | 20107 | |
| MARRY BETH TAYLOR | |||||||
| VP FINANCE | 40.00 | X | 95713 | 0 | 15140 | ||
| DR KALPANA VISHNUPAD | |||||||
| PHYSICIAN | 40.00 | 210561 | 0 | 18794 | X | ||
| DR YIU-CHUNG CHANG | |||||||
| PHYSICIAN | 40.00 | 193383 | 0 | 18409 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 927675 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 89670 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SPRINGFIELD PSYCHIATRIC ASSOCIATION | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3162 EL CAMINO RD | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45503 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | PHYSICIAN | DescriptionOfServices |
| Compensation | 118085 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Federated Campaigns | 10701 | FederatedCampaigns |
| Government Grants | 4432527 | GovernmentGrants |
| All Other Contributions | 256924 | AllOtherContributions |
| Total Contributions | 4700152 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| TITLE XIX MEDICAID | 900099 | 5375371 | 5375371 |
| PATIENT SERVICE REVENUES | 621300 | 1826680 | 1826680 |
| MEDICAID PAYBACK | 900099 | 1019979 | 1019979 |
| RENTAL REVENUE FROM CLIENT SUPPOR | 623990 | 158093 | 158093 |
| TITLE XX | 900099 | 119146 | 119146 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 8499269 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15048 | TotalRevenueColumn |
| Exclusion | $15,048 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER SERVICE REVENUE | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 988784 | TotalRevenueColumn |
| Related Or Exempt Function Income | 988784 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 988784 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14203253 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9488053 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $15,048 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 932577 | Total |
| Program Services | 737988 | ProgramServices |
| Management And General | 194589 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7011322 | Total |
| Program Services | 5918473 | ProgramServices |
| Management And General | 1092849 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1164139 | Total |
| Program Services | 960740 | ProgramServices |
| Management And General | 203399 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 539509 | Total |
| Program Services | 445245 | ProgramServices |
| Management And General | 94264 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 188087 | Total |
| Program Services | 85347 | ProgramServices |
| Management And General | 102740 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 660440 | Total |
| Program Services | 575334 | ProgramServices |
| Management And General | 85106 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 160004 | Total |
| Program Services | 136022 | ProgramServices |
| Management And General | 23982 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 217212 | Total |
| Program Services | 146413 | ProgramServices |
| Management And General | 70799 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| OPERATING EXPENSES | 690130 | 356709 | 333421 |
| PURCHASED SERVICES | 659204 | 269001 | 390203 |
| OPERATING SUPPLIES | 372636 | 342085 | 30551 |
| EQUIPMENT EXPENSES | 131608 | 94954 | 36654 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99278 | Total |
| Program Services | 99278 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12826146 | Total |
| Program Services | 10167589 | ProgramServices |
| Management And General | 2658557 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5703660 | BOY |
| EOY | 5324719 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2906037 | BOY |
| EOY | 1625196 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2157798 | BOY |
| EOY | 2002960 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7653 | BOY |
| EOY | 7004 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 179927 | BOY |
| EOY | 172322 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15342898 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4866515 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3501786 | BOY |
| EOY | 10476383 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43169 | BOY |
| EOY | 57922 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1000 | BOY |
| EOY | 1000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14501030 | BOY |
| EOY | 19667506 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4327685 | BOY |
| EOY | 4601100 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50000 | BOY |
| EOY | 3553076 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27813 | BOY |
| EOY | 25938 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4405498 | BOY |
| EOY | 8180114 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10095532 | BOY |
| EOY | 11487392 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10095532 | BOY |
| EOY | 11487392 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14501030 | BOY |
| EOY | 19667506 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1377107 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 14753 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 7599005 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6076093 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6139730 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4145915 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4700152 | CurrentTaxYear |
| Total | 28660895 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 7599005 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6076093 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6139730 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4145915 | CurrentTaxYearMinus1Year |
| Current Tax Year | 4700152 | CurrentTaxYear |
| Total | 28660895 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 28660895 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 191932 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 115956 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 49647 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 34342 | CurrentTaxYearMinus1Year |
| Current Tax Year | 15048 | CurrentTaxYear |
| Total | 406925 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1141233 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 941326 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1188031 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1836521 | CurrentTaxYearMinus1Year |
| Current Tax Year | 988784 | CurrentTaxYear |
| Total | 6095895 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 35163715 | TotalSupport |
| Gross Receipts From Admissions Etc | 32781405 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.81510 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.82480 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1560377 | OtherCostOrOtherBasis |
| Book Value | 1560377 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9633358 | OtherCostOrOtherBasis |
| Depreciation | 1169312 | Depreciation |
| Book Value | 8464046 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1823992 | OtherCostOrOtherBasis |
| Depreciation | 1795827 | Depreciation |
| Book Value | 28165 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2109709 | OtherCostOrOtherBasis |
| Depreciation | 1706000 | Depreciation |
| Book Value | 403709 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 215462 | OtherCostOrOtherBasis |
| Depreciation | 195376 | Depreciation |
| Book Value | 20086 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10476383 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 14218006 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 14753 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 14753 | RevenueNotRptdF990 |
| Revenue Subtotal | 14203253 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 14203253 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 12826146 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 12826146 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 12826146 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE AGENCY'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THOSE PROVISIONS CLARIFY THE ACCOUNTING AND RECOGNITION FOR INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN AGENCY'S ANNUAL REPORTING RETURNS. THE AGENCY'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. OPEN AUDIT PERIODS ARE 2009-2011. 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. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 175.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1079744 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 748711 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 331033 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02580 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1079744 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 748711 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 331033 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02580 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1079744 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 748711 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 331033 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02580 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $92,047 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 782324 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 861486 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -79162 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH SERVICES | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 474 N YELLOW SPRINGS STREET | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45504 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | 16 BED PSYCHIATRIC HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Develop Community Plan | X | DevelopCommunityPlan |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 175.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 250.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (5 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: MENTAL HEALTH SERVICES OF CLARK AND MADISON COUNTIES, INC. SCREENS ALL PATIENTS FOR CHARITY CAREELIGIBILITY BASED ON THEIR INCOME AND CURRENT FEDERAL POVERTY LEVEL GUIDELINES. IN ADDITION, SELF-PAY PATIENTS AND PATIENTS WITH OUTSTANDING MEDICAL EXPENSES THAT EXCEED $5,000 ARE ELIGIBLE FOR A 30% DISCOUNT. | |
| PART V, SECTION B, LINE 14G: THE BILLING CLERK PROVIDES INFORMATION TO PATIENTS ON OUR CHARITY CARE PROGRAMS. | MENTAL HEALTH SERVICES |
| PART VI, LINE 2: IN RELATION TO THE NEEDS OF THE COMMUNITY, WE ALSO SEEK THE INPUT OF THE COMMUNITY DURING THE STRATEGIC PLANNING PROCESS BASED ON ACCUMULATED DATA AND FEEDBACK. FOR 2012, A COMMUNITY NEEDS ASSESSMENT WAS PERFORMED AS PART OF OUR STRATEGIC PLANNING PROCESS USING FOCUS GROUPS OF OUR CLIENTS AND COMMUNITY MEMBERS TO IDENTIFY PROGRAMMING 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. | |
| 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 | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES PERRY PHD | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | 165687 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 17220 | 0 | 182907 | 0 | 0 | 0 |
| DR MARK A SMITH | ||||||||||||||
| CHIEF CLINICAL OFFICER | 262331 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 20107 | 0 | 282438 | 0 | 0 | 0 |
| DR KALPANA VISHNUPAD | ||||||||||||||
| PHYSICIAN | 210561 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18794 | 0 | 229355 | 0 | 0 | 0 |
| DR YIU-CHUNG CHANG | ||||||||||||||
| PHYSICIAN | 193383 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18409 | 0 | 211792 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 316000132 | IssuerEIN |
| CUSIP Number | 999999999 | CUSIPNumber |
| Date Issued | 2011-12-28 | DateIssued |
| Issue Price | 5000000 | IssuePrice |
| Description Of Purpose | CONSTRUCTING INPATIENT AND OUTPATIENT FACILITY FOR MENTAL HEALTH SERVICES | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 5000000 | TotalProceeds |
| Issuance Costs From Proceeds | 50000 | IssuanceCostsFromProceeds |
| Capital Expenditures | 3503076 | CapitalExpenditures |
| Amount Unspent | 1446924 | AmountUnspent |
| Year Of Subst Completion | 2013 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 1 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART III, LINE 9; PART IV, LINE 7; AND PART V: | Identifier |
| Explanation | MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES, INC. IS CURRENTLY IN THE PROCESS OF ESTABLISHING 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. ACCORDINGLY, IT EXPECTS THAT IT WILL BE ABLE TO CHECK "YES" FOR THESE ITEMS IN ITS 2014 SCHEDULE K FILING. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH RECOVERY BOARD OF CLARK GREENE AND MADISON COUNTIES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Purpose Of Loan | DEFERRED LOAN FOR HOUSING FOR MENTALLY ILL | PurposeOfLoan |
| Loan To Organization | X | LoanToOrganization |
| Original Principal | $75,000 | OriginalPrincipalAmount |
| Balance Due | 25938 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 25938 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | 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. |
| 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
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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) | N/A | 0 |
| 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) | N/A | 0 |
| RESTAN CORP | ||||||||||
| 601 N FOUNTAIN AVE | SPRINGFIELD | OH | 45503 | 311368099 | AFFORDABLE HOUSING FOR THE DISABLED | OH | 501(C)(3) | 509(A)(2) | N/A | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JANI-TURF MAINTENENCE SERVICE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 112 LOHNES AVE | AddressLine1 |
| City | SPRINGFIELD | City |
| State | OH | State |
| ZIP Code | 45504 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311331268 | EIN |
| Primary Activity | JANITORIAL AND PROPERTY MAINTENECE SERVICES | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 2725 | ShareOfTotalIncome |
| Share Of EOY Assets | 98418 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| JANI-TURF MAINTENANCE SERVICES INC | |
| M | 28694 |
| CLEANERS EXTRAORDINAIRE INC | |
| M | 115715 |
| RESOURCE CENTER APARTMENTS INC | |
| Q | 4600 |
| RESTAN CORP | |
| L | 5046 |