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
CHRISTIAN PSYCHOLOGICAL CENTER INC
Employer identification number
62-1011188
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.") ....
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..
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.
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..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
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..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
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
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
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.") .
183,622
112,802
98,970
23,608
52,000
471,002
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......
1,465,234
1,423,263
1,488,202
1,670,582
1,727,518
7,774,799
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.
1,648,856
1,536,065
1,587,172
1,694,190
1,779,518
8,245,801
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
10,000
53,305
38,750
21,250
51,000
174,305
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.
0
c
Add lines 7a and 7b..
10,000
53,305
38,750
21,250
51,000
174,305
8
Public Support (Subtract line 7c from line 6.)
8,071,496
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...
1,648,856
1,536,065
1,587,172
1,694,190
1,779,518
8,245,801
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
7,248
5,312
10,002
19,657
5,263
47,482
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
7,248
5,312
10,002
19,657
5,263
47,482
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.)
4,323
4,323
13
Total support (Add lines 9, 10c, 11 and 12.).
1,656,104
1,541,377
1,597,174
1,718,170
1,784,781
8,297,606
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
97.270 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
97.680 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.570 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.590 %
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
CHRISTIAN PSYCHOLOGICAL CENTER INC
Employer identification number
62-1011188
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
BASED ON INFORMATION FURNISHED TO THE ORGANIZATIONS' BOARD OF TRUSTEES FOR THE YEARLY AUDIT REVIEW, THE BOARD APPROVES THE YEARLY AUDIT. THIS INFORMATION IS THEN UTILIZED BY THE AUDITORS TO COMPLETE THE YEARLY FORM 990. THE COMPLETED FORM 990 IS SIGNED BY THE EXECUTIVE DIRECTOR AND MAILED BY CERTIFIED MAIL TO THE IRS BY THE BUSINESS ADMINISTRATOR. THE FORM 990 IS AVAILABLE TO BOARD OF TRUSTEES UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 12C
SHOULD ANY SITUATIONS OCCUR THE CPC BOARD OF TRUSTEES, AS PER THE BY-LAWS, WILL SEEK BOARD DIRECTION AND VOTE REGARDING THE SITUATION.
FORM 990, PART VI, SECTION B, LINE 15
CLINICAL STAFF EMPLOYEES ARE PAID UNDER ONE OF THE THREE SALARY ARRANGEMENTS: (1) 65/35 PACKAGE; OF INCOME RECEIVED FROM SERVICES BILLED, 35% IS DESIGNATED TO OFFSET CPC OPERATIONAL EXPENSES. THE SALARY PAID IS INCOME RECEIVED LESS 35% AND LESS PERSONAL/DIRECT EXPENSES. PAYROLL TAXES ARE PAID BY CPC OUT OF THE 35% ASSESSMENT. (2) SALARIED CLINICAL STAFF: OF INCOME RECEIVED FROM SERVICES BILLED, DEDUCTION IS MADE FOR PERSONAL/DIRECT EXPENSES AND CPC OPERATIONAL EXPENSES; THE REMAINING FUNDS ARE PAID TO CLINICAL STAFF AS SALARY. (3) SPLIT OF OPERATIONAL EXPENSES: AFTER OPERATIONAL EXPENSE REDUCTION BY OTHER TWO PLANS, THE REMAINING OPERATIONAL EXPENSES ARE DIVIDED BETWEEN THE REMAINING CLINICAL STAFF BASED ON FORMULA OF PERCENTAGE OF SERVICES BILLED. AFTER OPERATIONAL EXPENSES ARE ACCESSED TO CLINICAL STAFF, THEIR PAYROLL IS CALCULATED BY TAKING TOTAL REVENUE LESS OPERATIONAL EXPENSES LESS PERSONAL EXPENSES. THE OPERATIONS COMMITTEE & CLINICAL STAFF HAVE SET THE FEE PAID FOR SERVICES RENDERED BY THE EXECUTIVE DIRECTOR AT $12,000 ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19
AVAILABLE UPON REQUEST
CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC
FORM 990, PART VII
DOUGLAS J. HART - 3950 CENTRAL AVENUE, MEMPHIS, TN 38111. PAUL J. NEAL - 3950 CENTRAL AVENUE, MEMPHIS, TN 38111. BRENT E. STENBERG - 3950 CENTRAL AVENUE, MEMPHIS, TN 38111. FRANCES COWAN - 2432 ESPALIER COVE, MEMPHIS, TN 38119. ROY CAMPBELL - P. O. BOX 111164, MEMPHIS, TN 38111. HOWARD EDDINGS - 1548 POPLAR AVENUE, MEMPHIS, TN 38104. MARY ELIZABETH JONES - 8547 TIMBER RUN COVE, CORDOVA, TN 38018. KATHY KELLY - 942 HARBOR VIEW DRIVE, MEMPHIS, TN 38103. KIRBY MAY - 6894 SUGAR MAPLE COVE, MEMPHIS, TN 38119. W. PRICE MORRISON, JR. - 2238 GREEN SHADOWS COVE, MEMPHIS, TN 38119. ANDY WELLS - EX-OFFICIO - 5420 SUGGS COVE, MEMPHIS, TN 38120. JOHN ALEXANDER - 4541 SEQUOIA ROAD, MEMPHIS, TN 38117. JACK DEWALD - 10305 SHREWSBURY RUN WEST, COLLIERVILLE, TN 38107. CHARLES GAUSHELL - 2430 WENDY OAKS DRIVE, GERMANTOWN, TN 38139. CHIP MARSTON - 8534 HUNTLEIGH WAY, GERMANTOWN, TN 38138. LINDA MCVEAN - 396 HOLMES CIRCLE, MEMPHIS, TN 38111. ALBERT THROCKMORTON - 231 RIDGEFIELD ROAD, MEMPHIS, TN 38111. BILL WEBER - 4107 LANGSTON COVE, MEMPHIS, TN 38117. CHRISTOPHER R. PEKARY - 3950 CENTRAL AVENUE, MEMPHIS, TN 38111. CHERYL BEARD - 1548 POPLAR AVENUE, MEMPHIS, TN 38105. BRAXTON BRADY - 3181 ALLISON, MEMPHIS, TN 38112. ROBB ROATEN - 4983 BROOKWOOD COVE, MEMPHIS, TN 38117.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 12,716.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.