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
2011
Open to Public Inspection
Name of the organization
LITTLE ROCK COMMUNITY MENTAL HEALTH
Employer identification number
71-0726492
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.") ....
3,298,968
3,298,968
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..
3,298,968
3,298,968
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.
3,298,968
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
3,298,968
3,298,968
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).
3,298,968
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13,248,839
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
100.000 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
100.000 %
16a
33 1/3% support test—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
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
2011
Open to Public Inspection
Name of the organization
LITTLE ROCK COMMUNITY MENTAL HEALTH
Employer identification number
71-0726492
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
THE PURPOSE OF THE CORPORATION IS TO PROVIDE, PLAN, DEVELOP AND MAKE AVAILABLE HIGH QUALITY MENTAL HEALTH SERVICES THAT ARE ASSESSIBLE AND AFFORDABLE TO THE RESIDENTS OF GREATER LITTLE ROCK, ARKANSAS. SERVICES WERE PROVIDED TO 2,713 CLIENTS INCLUDING 55845 1/4-HOUR UNITS OF SERVICE TO OUT PATIENT SERVICES AND 515,799 1/4-HOUR UNITS OF DAY TREATMENT SERVICE. IN KIND SALARIES AND FRINGE BENEFITS OF 246,071 WERE RECEIVED FROM THE STATE OF ARKANSAS.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
MENTAL HEALTH SERVICES
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
NO REVIEW WAS OR WILL BE CONDUCTED.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
BOARD OF DIRECTORS APPROVAL
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
APPROVAL OF EXECUTIVE DIRECTOR
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
NO DOCUMENTS AVAILABLE TO THE PUBLIC
OTHER EXPENSES
FORM 990, PART IX, LINE 24E
HUMAN RESOURCES CONTRACT 345,861 INPATIENT CARE 273,395 JOSEPH EXPENSE 229,650 FOOD EXPENSE 198,336 CONTRACT LABOR 180,885 HPRP OTHER EXPENSE 122,856 JERICHO GRANT EXPENSES - 107,465 COMPUTER HDW MAIN 102,375 CLIENT ASSIST- EMERG SERV 94,080 CHILD BLOCK GRANT EXPENSE 88,647 COMPUTER SOFTWARE MAIN 86,938 INTERDEPARTMENT PHARMACEU 85,257 INTEREST CHARGES 83,987 CASSP EXPENSES 64,312 DEPRECIATION 43,918 ACCOUNTS RECEIVABLE CONTR 37,620 OFFICE SUPPLIES 29,630 HEART EXPENSE 29,569 CELLULAR TELEPHONE 28,070 SPENDOWN WORKER 23,127 COPY MACH LEASE & MAINT 22,408 STORAGE RENT 20,437 TELEPHONE EXPENSE 18,625 AUTO OPERATION 17,395 TELEPHONE LINE 16,769 SUPPORTIVE HOUSING-HUD TR 16,711 MHC OF ARK-ANNUAL DUES 16,000 ELECTRICITY 15,988 EMERGENCY SERVICES 14,863 CONTRACTED BEDS 13,224 PROGRAM SUPPLIES 13,144 INPATIENT DETOXIFICATION 13,050 LINEN SERVICE 12,400 MEDICAL SUPPLIES 12,201 POSTAGE 11,366 PROFESSIONAL EDUCATION 11,171 INTERDEPARTMENT MED SUPPL 10,998 LAB SERVICES 8,935 IN SERVICE TRAINING 8,280 WASTE DISPOSAL 7,999 PAYROLL CONTRACT 7,800 ELECTRONIC CLAIMS PROCESS 7,110 MISC EXP 6,970 BANK CHARGES 6,542 EMPLOYMENT EXPENSE 6,408 ADVERTISING 6,350 ANNUAL MENT INSTITUTE 4,918 INTERPRETER 4,812 CONSULTANTS 4,800 PINNACLE HOUSE DONATION E 4,694 AUTO REPAIR 4,598 PHARMACY SUPPLIES 4,565 GAS 4,225 COMPUTER SOFTWARE PURCHAS 4,207 EMPLOYEE RECOGNITION 3,153 FOOD-MEETINGS 3,145 WATER 3,144 EMPLOYMENT ADVERTISING 2,798 GROUNDS MAINTENANCE 2,753 FURNITURE & EQUIP <500 2,573 FREIGHT/SHIPPING 2,514 PRINTING 1,838 PERMITS, TITLES, SURVEY F 1,328 MEMBERSHIP DUES 1,300 OTHER PHARMACEUTICALS 1,195 BOARD MEETING EXPENSE 1,122 COMPUTER HDW PURCHASE 1,081 DONATIONS 1,000 CARF EXPENSE 972 BANK CREDIT CARD FEES 771 SPECIAL EVENTS 544 PORTAGE HOUSE OVERSEER 270 KATHLEEN PEEK APTS EXP 270 NAMHI - ANNUAL DUES 250 PROFESSIONAL FEES 215 SMALL EQUIP LEASE & MAINT 197 SUBSCRIPTIONS & PUBLICATI 156
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.