Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 1,520,172 | 2,000,005 | 2,307,768 | 2,394,915 | 2,418,286 | 10,641,146 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | Total. Add lines 1 through 3.. | 1,520,172 | 2,000,005 | 2,307,768 | 2,394,915 | 2,418,286 | 10,641,146 |
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | 10,641,146 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,520,172 | 2,000,005 | 2,307,768 | 2,394,915 | 2,418,286 | 10,641,146 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 35,410 | 44,392 | 26,072 | 8,215 | 5,686 | 119,775 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | 6,604 | 3,525 | 30,290 | 23,000 | 22,824 | 86,243 |
| 11 | Total support (Add lines 7 through 10). | 10,847,164 | |||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Other income is comprised of a variety of items. In 2010, the Agency entered into a relationship with the local court system to have an Agency employee act as the Drug Court Coordinator for their program. This contract became effective in October of 2010. In 2010 the Agency also hosted a spaghetti dinner and comedy event for the recovery community. Tickets and sponsorships were sold to offset the costs of the event. In 2008 and 2009, the Agency received funding for an Outpatient study to include a national consulting firm. In 2008 we also received special funding for 3 of our clinicians to attend a gambling addiction training so we could begin to provide those services. |
| Software ID: | 10000077 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P06_S0B_L11a | Form 990, Part VI, Section B, Line 11a | The form 990 was prepared by the Agency's Chief Financial Officer. She reviewed the forms in detail with the President/CEO and Finance Committee. Finance Committee then made a recommendation to the full Board to approve the filing of the form 990. All Board members were sent a copy of the form 990 and no concerns were raised. Form 990 was filed. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | The Agency does have a written conflict of interest policy. In accordance with that policy all staff and Board members are required to fill out a Conflict of Interest Disclosure Statement annually. Any conflict of interest disclosures for staff members are reviewed by the President/CEO and CFO to determine if any action or restrictions are necessary. For Board members, any conflict of interest disclosures are taken to the Executive Commitee for review to determine if any action or restriction of activity is warranted. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | The Executive Committee of the Board reviewed the compensation for the President/CEO and CFO in December 2010 to determine compensation levels for 2011. In making their recommendations, the Board members looked at survey data from our region of the country for behavioral health organizations. Based upon this data and discussion of the individuals' performance as well as the agency performance, they made their recommendations for 2011 compensation. These decisions were documented in the minutes for the meeting. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | The Agency's governing documents, policies and financial statements are available to the public upon written request to the address on the Form 990. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | Net unrealized gain on investments |
| Software ID: | 10000077 |
| Software Version: | v1.00 |