Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NORTH SUFFOLK MENTAL HEALTH ASSOC INC
Employer identification number
04-2317215
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(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
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
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.") ....
22,729,595
22,852,892
22,841,532
24,661,410
24,162,630
117,248,059
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
22,729,595
22,852,892
22,841,532
24,661,410
24,162,630
117,248,059
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.
117,248,059
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
22,729,595
22,852,892
22,841,532
24,661,410
24,162,630
117,248,059
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
194,080
163,170
79,843
32,016
25,538
494,647
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
140,910
164,845
26,453
30,013
36,198
398,419
11
Total support (Add lines 7 through 10).
118,141,125
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
54,338,944
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
99.240 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.080 %
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
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.)
Section B. Total Support
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.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NORTH SUFFOLK MENTAL HEALTH ASSOC INC
Employer identification number
04-2317215
Identifier
Return Reference
Explanation
NEW PROGRAM SERVICES
FORM 990, PART III, LINE 2
STEPBOSTON 131 BEVERLY ST. EXT., BOSTON, MA 02114 STEP'S SERVICES ARE OFFERED IN BOTH ENGLISH AND SPANISH AND ARE DESIGNED TO CREATE OPTIMUM CONDITIONS FOR SUBSTANCE USERS SEEKING RECOVERY. SERVICES ARE AVAILABLE ON A WALK-IN BASIS AND BY APPOINTMENT AND INCLUDE CASE MANAGEMENT, REFERRAL, AND ADVOCACY, RECOVERY SUPPORT, CRISIS INTERVENTION, AND PSYCHO-EDUCATIONAL GROUPS. THE 20-WEEK VIP PROGRAM BLENDS ADDICTION/ RECOVERY EDUCATION WITH VIOLENCE PREVENTION INFORMATION AND TARGETS COURT-MANDATED CLIENTS. STEP CURRENTLY OFFERS 4 VIP GROUPS, ALONG WITH ADDITIONAL SELF-HELP, REINTEGRATION AND EARLY RECOVERY GROUPS. THESE GROUPS ARE FUNDED THROUGH THE BUREAU OF SUBSTANCE ABUSE SERVICES (BSAS) PSYCHO-EDUCATIONAL FUNDS. STAFF AT THIS LOCATION ALSO NOW PROVIDE DROP-IN CASE MANAGEMENT AS A SATELLITE OF OUR COMMUNITY SUPPORT PROGRAM (CSP). THE FUNDING FOR THE CASE MANAGEMENT/CSP SERVICES IS THROUGH MASSHEALTH AND A FY12 CDBG (COMMUNITY DEVELOPMENTAL BLOCK GRANT) FUNDS WILL SUPPORT THESE SERVICES FOR ABOUT 160 LOW AND MODERATE INCOME BOSTON RESIDENTS WHO ARE NOT ELIGIBLE FOR MASSHEALTH. IN ADDITION ON-SITE FELLOWSHIP MEETINGS WILL CONTINUE TO BE OFFERED AT THIS LOCATION UNTIL FURTHER NOTICE. STEPROX RECOVERY SUPPORT CENTER 9 PALMER STREET, ROXBURY, MA 02119 THE STEPROX RECOVERY SUPPORT CENTER FUNDED THROUGH THE BUREAU OF SUBSTANCE ABUSE SERVICES (BSAS) PROVIDES A SAFE PLACE FOR THE RECOVERY COMMUNITY TO MEET AND ENGAGE IN ACTIVITIES THAT PROMOTE COMMUNITY PARTICIPATION THROUGH PEER LEADERSHIP. THOSE INVOLVED MAKE A DIRECT CONTRIBUTION TO THE COMMUNITY BY PROVIDING GUIDANCE AND DIRECTION TO THE COMMUNITY THROUGH ADVOCACY, SOCIAL ACTIVITIES, EDUCATIONAL GROUPS, SUPPORT MEETINGS, AND TRAINING.
FORM 990, PART VI, SECTION A, LINE 4
ON APRIL 29, 2011, THE AGENCY MERGED WITH STEP, INC. ANOTHER NON-PROFIT. ARTICLES OF MERGER WERE FILED AND APPROVED.
FORM 990, PART VI, SECTION B, LINE 11
PRIOR TO FILING THE FORM 990, THE AUDIT FIRM OF ALEXANDER, ARONSON, FINNING & C.O., P.C. WILL PRESENT THE FORM 990 TO THE AUDIT COMMITTEE AND THE BOARD OF DIRECTORS IS PROVIDED A COPY BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C
NORTH SUFFOLK MENTAL HEALTH ASSOCIATION HAS VARIOUS MECHANISMS TO MONITOR AND ENFORCE COMPLIANCE, SUCH AS INTERNAL AND EXTERNAL AUDITING SYSTEMS FOR FINANCIAL OPERATIONS AND CONTRACTS MANAGEMENT; A COMPLIANCE HOTLINE AND ALTERNATIVE VENUES FOR REPORTING CONCERNS; AND AN INVESTIGATIONS PROCESS FOR ALLEGED FRAUD, ABUSE AND WASTE.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD COMPENSATION COMMITTEE REVIEWS THE CEO SALARY USING THE FOLLOWING PROCEDURE AND THE CEO USES THE SAME PROCEDURE TO DETERMINE KEY EMPLOYEES COMPENSATION: 1) THE COMMITTEE REVIEWS WRITTEN EVALUATION, REVIEWS GOALS AND OBJECTIVES, AND MEASURES FINANCIAL GOALS AGAINST FINAL RESULTS. 2) THE COMMITTEE REVIEWS SALARIES OF SIMILAR AGENCIES WITHIN THE SAME INDUSTRY AND MAKES SALARY DECISIONS WITH CONSIDERATION FOR THE AGENCY'S OVERALL ECONOMIC AND COMPETITIVE POSITION. 3) THE BOARD VOTES FINAL COMPENSATION PACKAGE.
FORM 990, PART VI, SECTION C, LINE 19
THE PUBLIC MAY ACCESS NSMHA'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THROUGH GUIDESTAR AND UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
UNREALIZED GAIN ON CARRYING VALUE OF INTEREST RATE SWAP CONTRACT 3,689. CONTRIBUTION INCOME - MERGER 491,122. TOTAL TO FORM 990, PART XI, LINE 5: 494,811.
FORM 990, PART XII, LINE 2C:
NSMHA'S AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.