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.") ....
8,157,717
10,301,807
29,525,816
29,055,946
25,250,913
102,292,199
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..
8,157,717
10,301,807
29,525,816
29,055,946
25,250,913
102,292,199
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.
102,292,199
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..
8,157,717
10,301,807
29,525,816
29,055,946
25,250,913
102,292,199
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
186,178
90,892
102,296
110,966
86,559
576,891
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..
324,337
101,511
201,104
440,642
331,825
1,399,419
11
Total support (Add lines 7 through 10).
104,268,509
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
55,649,436
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
98.100 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
98.060 %
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.
THE ORGANIZATION IS ORGANIZED AS A NONPROFIT CORPORATION WITH A SOLE MEMBER, SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC. D/B/A REGIONAL MENTAL HEALTH CENTER
FORM 990, PART VI, SECTION A, LINE 7A
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC. D/B/A REGIONAL MENTAL HEALTH CENTER, THE CORPORATE MEMBER, MAY APPOINT ALL OFFICERS, DIRECTORS, OR ANYONE ELSE TO ACT ON ITS BEHALF IN THE CAPACITY OF CORPORATE MEMBER OF GEMINUS.
FORM 990, PART VI, SECTION A, LINE 7B
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER, INC. D/B/A REGIONAL MENTAL HEALTH CENTER, THE CORPORATE MEMBER, RESERVES TO AND REQUIRES APPROVAL FOR THE FOLLOWING: 1. APPROVE, INTERPRET, AND CHANGE ANY STATEMENT OF MISSION, PHILOSOPHY, ROLE, OR PURPOSE OF GEMINUS. 2. APPROVE AND AMEND THE BYLAWS AND ARTICLES OF INCORPORATION OF THE CORPORATION. 3. FIX THE NUMBER, APPOINT, AND REMOVE WITH OR WITHOUT CAUSE, ANY APPOINTED DIRECTOR OF GEMINUS. 4. APPROVE THE MERGER, DISSOLUTION, CONSOLIDATION, OR REORGANIZATION OF GEMINUS. 5. APPROVE THE FORMATION OF OTHER ENTITIES BY GEMINUS. 6. APPROVE THE ACQUISITION, SALE, LEASE, TRANSFER, OR OTHER ALIENATION OF PROPERTY OF GEMINUS, OTHER THAN IN THE USUAL AND REGULAR COURSE OF BUSINESS. 7. APPROVE THE DISPOSITION OF ASSETS OF GEMINUS AT THE TIME OF DISSOLUTION.
FORM 990, PART VI, SECTION B, LINE 11
THE PROCESS FOR REVIEWING THE FORM 990 ENTAILS A DETAIL REVIEW BY GEMINUS'S CFO. IN ADDITION A COPY OF THE FORM 990 IS PRESENTED/PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C
BOARD IS EDUCATED ABOUT POLICY AT ANNUAL COMBINED BOARD RETREAT. ALL BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. MEMBERS ARE ASKED TO RECUSE THEMSELVES IF THEY ARE IN ANY CONFLICT WITH THE MATTER BEING REVIEWED.
FORM 990, PART VI, SECTION B, LINE 15
THE PRESIDENT IS EVALUATED BY THE BOARD OF DIRECTORS EVALUATION COMMITTEE. INFORMATION ABOUT PERFORMANCE, COMPARABLE DATA AND ANY OTHER INFORMATION REQUESTED IS PROVIDED. THE COMMITTEE RECOMMENDATION IS REVIEWED AND ACTED UPON BY THE FULL BOARD AT THE NEXT REGULAR MEETING. OTHER EMPLOYEES HAVE JOB DESCRIPTIONS AND ANNUAL REVIEWS BY THEIR SUPERVISOR, WHICH ARE DOCUMENTED IN EACH EMPLOYEE'S PERSONNEL FILE.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION WILL MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
BOARD CHAIR HOURS PER WEEK
FORM 990, PART VII, LINE 1A
ROBERT D. KRUMWIED IS THE CHAIRMAN OF THE BOARD FOR SOUTHLAKE/TRI-CITY MANAGEMENT CORPORATION, DBA GEMINUS CORPORATION. HE VOLUNTEERS AN AVERAGE OF 2.0 HOURS PER WEEK AS CHAIRMAN OF THE BOARD FOR WHICH HE RECEIVES NO COMPENSATION FROM GEMINUS CORPORATION. THE REMAINING 40.0 HOURS AND RELATED ORGANIZATION WAGES LISTED IN PART VII ARE SPENT WORKING AS CEO OF REGIONAL MENTAL HEALTH CENTER, A RELATED ORGANIZATION.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 96,417.
OVERSIGHT OF AUDIT
FORM 990, PART XI, LINE 2C
THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.