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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| 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.") .... | 2,741,488 | 2,618,336 | 2,393,866 | 2,320,742 | 2,311,798 | 12,386,230 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | Total. Add lines 1 through 3.. | 2,741,488 | 2,618,336 | 2,393,866 | 2,320,742 | 2,311,798 | 12,386,230 |
| 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. | 12,386,230 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,741,488 | 2,618,336 | 2,393,866 | 2,320,742 | 2,311,798 | 12,386,230 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 37,874 | 10,891 | 10,970 | 11,983 | 29,967 | 101,685 |
| 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.. | 9,647 | 22,099 | 6,984 | 10,309 | 8,293 | 57,332 |
| 11 | Total support (Add lines 7 through 10). | 12,545,247 | |||||






| 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.) | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Line 10 Other Income: Collections Paid - 5132, Quality Review for State by Staff - 1500, Fees for Medical Record Copies - 842, Employee Jury Duty -0 420, Payroll Adjustments - 400 |
| Software ID: | 11000129 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P03_S00_L02 | Form 990, Part III, Line 2 | We received additional funds from the Department of Health to provide Intensive Outpatient Treatment (IOT) for Substance Abuse in the amount of $108000. |
| F990_P03_S00_L03 | Form 990, Part III, Line 3 | The Department of Health took over the Substance Abuse Prevention and Tobacco Prevention programs. The three employees were terminated and the programs closed. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | We intended to have the Board of Directors review the Form 990 this year, however, do to installation of a new electronic billing system with required training and learning curve, the Controller was unable to complete the Form in time for the April Board meeting. Last year's 990 was reviewed in detail with the Board of Directors, and the same will happen this year at the May 15th meeting. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Our of Directors meet in a special meeting in July and review all of the agency's policies and procedures. Each Director reads and signs a Conflict of Interest Disclosure. The Members are then expected to annouce at meetings throughout the year if any transaction might cause a conflict of interst, then recuse themselves during the voting. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Currently the Form 990 is available on our website and on the Guidestar website. Our Form 990 is also available to the public at our administration office. We do not have a copy of a Form 1023. Since we started our oganization in 1959, that form may not have been used at that time. Our other documents, financial statements and conflict of interest policy are not currently available. |
| Software ID: | 11000129 |
| Software Version: | v1.00 |