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
SOUTHWEST ARKANSAS COUNSELING & MENTAL HEALTH CENTER INC
Employer identification number
71-0526149
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.") ....
13,260,655
12,730,627
12,036,298
11,317,441
10,761,226
60,106,247
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
13,260,655
12,730,627
12,036,298
11,317,441
10,761,226
60,106,247
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)..
0
6
Public Support. Subtract line 5 from line 4.
60,106,247
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..
13,260,655
12,730,627
12,036,298
11,317,441
10,761,226
60,106,247
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
188,452
124,212
71,150
36,561
14,972
435,347
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
-6,262
-94,253
-100,515
11
Total support (Add lines 7 through 10).
60,441,079
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
6,831,085
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
99.450 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.020 %
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:
11000144
Software Version:
2011v1.5
-
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
SOUTHWEST ARKANSAS COUNSELING & MENTAL HEALTH CENTER INC
Employer identification number
71-0526149
Identifier
Return Reference
Explanation
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
UTILITIES: Column (A) - Total = $168936; Column (B) - Program Services = $154986; Column (C) - Management & General = $13950; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
SMALL FURNITURE & APPLIANCES: Column (A) - Total = $14877; Column (B) - Program Services = $14877; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
REPAIRS & MAINTENANCE: Column (A) - Total = $68275; Column (B) - Program Services = $68275; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
RENT-LEASE PAYMENTS: Column (A) - Total = $43365; Column (B) - Program Services = $43365; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
RECRUITMENT AND TRAINING: Column (A) - Total = $21197; Column (B) - Program Services = $21197; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
RECREATION & RE-SOCIALIZATION: Column (A) - Total = $18208; Column (B) - Program Services = $18208; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
Printing and Publications: Column (A) - Total = $1826; Column (B) - Program Services = $1826; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
Postage and Shipping: Column (A) - Total = $44946; Column (B) - Program Services = $44178; Column (C) - Management & General = $768; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
MISCELLANEOUS: Column (A) - Total = $184910; Column (B) - Program Services = $184910; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
JOINT VENTURE DISBURSEMENT: Column (A) - Total = $207828; Column (B) - Program Services = $207828; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
JANITORIAL: Column (A) - Total = $137617; Column (B) - Program Services = $137617; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
FOOD: Column (A) - Total = $185963; Column (B) - Program Services = $185963; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
DUES AND PUBLICATIONS: Column (A) - Total = $28410; Column (B) - Program Services = $28410; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
DRUG EXPENSE: Column (A) - Total = $39711; Column (B) - Program Services = $39711; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
DATA PROCESSING EXPENSE: Column (A) - Total = $103583; Column (B) - Program Services = $103583; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
CLINICAL EXPENSE: Column (A) - Total = $3035; Column (B) - Program Services = $3035; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
CLIENT TRANSPORTATION: Column (A) - Total = $122589; Column (B) - Program Services = $122589; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
CLIENT MEDICAL EXPENSE: Column (A) - Total = $112202; Column (B) - Program Services = $112202; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
BOARD EXPENSE: Column (A) - Total = $7585; Column (B) - Program Services = $7585; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part IX, Line 24e
Form 990, Part IX, Line 24e: Other Expenses
AUTO EXPENSE: Column (A) - Total = $37066; Column (B) - Program Services = $37066; Column (C) - Management & General = $0; Column (D) - Fundraising = $0
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
THE ORGANIZATION MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AS REQUESTED.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
THE COMPENSATION OF THE EXECUTIVE DIRECTOR WAS DETERMINED BY THE BOARD OF DIRECTORS. THE COMPENSATION LEVEL WAS ESTABLISHED USING THE EXECUTIVE DIRECTOR'S PREDECESSORS PACKAGE AS A BASELINE. DELIBERATION AND DECISION WAS DOCUMENTED IN THE MINUTES OF THE BOARD MEETING.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
The Center and its employees will avoid potential conflicts of interest. If apotential conflict is identified, it will be disclosed immediately and reportedto the Corporate Compliance Officer (CCO). The CCO will utilize theCorporate Compliance Procedures to investigate the potential conflict.As a generalprinciple, no employee of Southwest Arkansas Counseling and Mental HealthCenter, Inc. will make any decision on behalf of the company that wouldrepresent, result in or give the appearance of personal gain or benefit, howeverslight. In such cases, employees are enjoined to discuss the situation with theExecutive Director or Corporate Compliance Officer prior to making any decisionthat would represent a commitment of the Center's assets, obligate the companyin any way and/or have the potential to give the appearance of impropriety orconflict of interest. The organization specifically prohibits contracts that might pose a conflict of interest for either party and/or which might ultimately result in a violation of the Center's ethical standards. As a way to insure that all contracts are appropriate and consistent with the spirit and intent of this policy, all proposed contracts must be approved by the Executive Director.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
THE 990 WILL BE REVIEWED BY THE CENTER'S EXECUTIVE DIRECTOR AND ACCOUNTANT PRIOR TO APPROVAL.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: YOUTH SERVICES OTHER PROGRAM SERVICES 5: MENTORING PROGRAM OTHER PROGRAM SERVICES 6: SUBSTANCE ABUSE OTHER PROGRAM SERVICES 7: FOSTER CARE OTHER PROGRAM SERVICES 8: ACUTE CARE OTHER PROGRAM SERVICES 9: RIVER RIDGE TREATMENT PROGRAM OTHER PROGRAM SERVICES 10:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.