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? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 3,574,033 | 2,047,736 | 1,487,886 | 1,790,242 | 1,629,095 | 10,528,992 |
| 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...... | 171,926 | 171,926 | ||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 10,107 | 10,107 | ||||
| 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. | 3,574,033 | 2,047,736 | 1,487,886 | 1,790,242 | 1,811,128 | 10,711,025 |
| 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.) | 10,711,025 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 3,574,033 | 2,047,736 | 1,487,886 | 1,790,242 | 1,811,128 | 10,711,025 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 147 | 44 | 1 | 2 | 53,574 | 53,768 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 147 | 44 | 1 | 2 | 53,574 | 53,768 |
| 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.). | 3,574,180 | 2,047,780 | 1,487,887 | 1,790,244 | 1,864,702 | 10,764,793 |




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 - ORGANIZATION'S MISSION | TO WORK FOR THE PROMOTION OF MENTAL WELLNESS AND THE PREVENTION OF MENTAL AND ADDICTIVE DISORDERS. TO EDUCATE THE PUBLIC ABOUT THE CARE AND TREATMENT FOR PEOPLE WITH MENTAL AND ADDICTIVE DISORDERS AND TO WORK FOR THE IMPROVEMENT OF AND THE ACCESS TO TREATMENT. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE RETURN WAS PROVIDED TO THE PRESIDENT OF MENTAL HEALTH AMERICA OF INDIANA, INC. WHERE IT WAS REVIEWED IN DETAIL BEFORE SIGNING AND FILING WITH THE IRS. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | IN THE CASE OF A CONFLICT OF INTEREST, THE MEMBER WITH THE CONFLICT IS EXCUSED FROM THE VOTING PROCESS FOR THAT ISSUE. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION FOR THE OFFICERS ARE SUBJECT TO THE LOCAL BOARD OF DIRECTORS REVIEW POLICY. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION IS APPROVED BY THE BOARD. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | UPON REQUEST |
| GROUP RETURN METHOD | FORM 990, PAGE 7, PART VII | PARENT ORGANIZATION HAS FILED A SEPARATE RETURN |
| GROUP RETURN EXPLANATION | FORM 990, PAGE 7, PART VII | THE GROUP RETURN IS COMPRISED OF CHAPTERS THAT HAVE PROVIDED INFORMATION TO THE MENTAL HEALTH AMERICA OF INDIANA, INC. THAT DO NOT MEET THE POST CARD FILING REQUIREMENTS. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | MENTAL HEALTH AMERICA OF INDIANA, INC. PROVIDES SUPPORT TO THE CHAPTERS, HOLDING EDUCATIONAL MEETINGS TO ASSIST THEM IN SUPPORT OF THE CHAPTERS. |
| CHANGE IN FINANCIAL REVIEW PROCESS | FORM 990, PAGE 12, PART XII, LINE 2C | THE MENTAL HEALTH AMERICA OF LAKE COUNTY WAS REQUIRED TO HAVE AN AUDIT OF ITS FINANCIAL STATEMENTS AND AN AUDIT PERFORMED UNDER THE SINGLE AUDIT ACT, A-133. THE OTHER CHAPTERS INCLUDED IN THE GROUP RETURN WERE NOT REQUIRED TO HAVE AN INDEPENDENT AUDIT OF THEIR FINANCIAL STATEMENTS. THE AUDITED FINANCIAL STATEMENTS WERE REVIEWED AS REQUIRED BY THE MENTAL HEALTH AMERICA OF LAKE COUNTY BOARD OF DIRECTORS' POLICIES. |
| Software ID: | |
| Software Version: |
| Name | Address | EIN | Name control |
|---|---|---|---|
| MHA LAKE COUNTY |
9722 PARKWAY DRIVE HIGHLAND, IN 46322 |
35-1014213 |
MENT |
| MHA CASS COUNTY |
421 12TH STREET LAKE CICOTT, IN 46942 |
35-1062868 |
MENT |
| MHA BOONE COUNTY |
1122 N LEBANON STREET LEBANON, IN 46052 |
35-1078402 |
MENT |
| MHA VANDERBURGH COUNTY |
P O BOX 3207 EVANSVILLE, IN 47731 |
35-1016901 |
MENT |