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
BLUEGRASS REGIONAL PSYCHIATRIC SERVICES INC
Employer identification number
61-1286230
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.") .
1,500
1,500
3,000
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......
34,965,623
35,975,603
35,339,373
36,339,373
37,639,373
180,259,345
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.
34,965,623
35,975,603
35,340,873
36,340,873
37,639,373
180,262,345
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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..
0
8
Public Support (Subtract line 7c from line 6.)
180,262,345
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...
34,965,623
35,975,603
35,340,873
36,340,873
37,639,373
180,262,345
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
269,182
248,584
69,896
47,949
40,329
675,940
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
269,182
248,584
69,896
47,949
40,329
675,940
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.)
14,852
16,426
76,850
108,128
13
Total support (Add lines 9, 10c, 11 and 12.).
35,234,805
36,224,187
35,425,621
36,405,248
37,756,552
181,046,413
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
99.570 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.510 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.370 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.470 %
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
BLUEGRASS REGIONAL PSYCHIATRIC SERVICES INC
Employer identification number
61-1286230
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
JOSEPH A. TOY AND SHANNON P. WARE - FAMILY RELATIONSHIP
FORM 990, PART VI, SECTION B, LINE 11
A DRAFT OF THE RETURN IS REVIEWED FIRST BY INTERNAL MANAGEMENT. AFTER INTERNAL MANAGEMENT HAS REVIEWED THE RETURN AND ANY CHANGES ARE MADE, A DRAFT IS MADE AVAILABLE FOR REVIEW AND PRESENTATION TO THE ORGANIZATION'S AUDIT/FINANCE COMMITTEE AND CFO. FINALLY, THE AUDIT/FINANCE COMMITTEE AND CFO MEET WITH THE INDEPENDENT TAX PREPARER TO REVIEW FORM 990 AND MAKE ANY FINAL CHANGES PRIOR TO ITS FILING. A DRAFT IS ALSO MADE AVAILABLE FOR THE BOARD OF DIRECTORS TO REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C
EACH BOARD MEMBER SIGNS THE CONFLICT OF INTEREST STATEMENT ANNUALLY AND HAS A BRIEF OVERVIEW OF THE REQUIREMENT TO DISCLOSE. THE ORGANIZATION DOES NOT PERMIT BOARD MEMBERS TO HAVE A CONFLICT OF INTEREST. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE ASKED TO RESIGN FROM THE BOARD. NEW BOARD MEMBERS HAVE AN ORIENTATION WHICH INCLUDES DETAILS OF THE POLICY. KEY EMPLOYEES HAVE BEEN GIVEN A REVIEW OF THE POLICY ANNUALLY AND NEW KEY EMPLOYEES ARE EDUCATED ON THE POLICY IN A TWO DAY ORIENTATION.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION OF THE CEO IS REVIEWED AT INITIAL APPOINTMENT AND ANNUALLY THEREAFTER. INITIAL SALARIES ARE DETERMINED THROUGH THE USE OF NATIONWIDE SURVEYS WHICH INCLUDE THE STATE OF KENTUCKY AND OTHER NOT FOR PROFITS. THE BOARD OF DIRECTORS ARE GIVEN THIS INFORMATION TO REVIEW AND DISCUSS AND THEY DETERMINE THE SALARY OF THE CEO. FOR OTHER OFFICERS OR KEY EMPLOYEES, NATIONAL AND LOCAL SALARY INFORMATION IS REVIEWED BY THE HR DIRECTOR IN DETERMINING SALARIES. IN ADDITION, WHEN BROAD SALARY ADJUSTMENTS ARE DEEMED NECESSARY IN ORDER TO BE IN LINE WITH LOCAL MARKETS, THE INFORMATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19
AUDITED FINANCIAL STATEMENTS ARE SUBMITTED TO BOTH THE COMMONWEALTH OF KENTUCKY AS REQUIRED BY CONTRACT AND TO THE FEDERAL CLEARINGHOUSE AS REQUIRED. GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE CORPORATE LOCATION.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
FUNDING FROM BLUEGRASS REGIONAL MENTAL HEALTH-MENTAL RETARDATION BOARD 173,892. TOTAL TO FORM 990, PART XI, LINE 5: 173,892.
AUDITED FINANCIAL STATEMENTS
FORM 990, PAGE 12, PART XI LINE 2C
BLUEGRASS REGIONAL PSYCHIATRIC SERVICES, INC. IS AUDITED AS PART OF THE BLUEGRASS REGIONAL MENTAL HEALTH-MENTAL RETARDATION BOARD, INC. CONSOLIDATED GROUP. BLUEGRASS REGIONAL PSYCHIATRIC SERVICES, INC IS INCLUDED IN THE BLUEGRASS REGIONAL MENTAL HEALTH-MENTAL RETARDATION BOARD, INC. AND AFFILIATES CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION HAS AN AUDIT/FINANCE COMMITTEE THAT OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT AUDITOR. THERE WAS NO CHANGE IN PROCESS FROM LAST YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.