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
Family Guidance Center for Behavioral Healthcare
Employer identification number
44-0666362
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.") ....
329,838
534,830
511,851
389,333
331,640
2,097,492
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..
329,838
534,830
511,851
389,333
331,640
2,097,492
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.
2,097,492
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..
329,838
534,830
511,851
389,333
331,640
2,097,492
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
247,555
34,904
4,007
2,571
1,042
290,079
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..
999
999
11
Total support (Add lines 7 through 10).
2,388,570
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
55,197,569
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
87.810 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.190 %
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
0 %
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
0 %
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
Part II Line 10 In FYE June 2008, the Organization received 999 from the sale of a capital asset.
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000218
Software Version:
2011.0.0
-
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
Family Guidance Center for Behavioral Healthcare
Employer identification number
44-0666362
Identifier
Return Reference
Explanation
Form 990 Part VI
11b
The tax return is reviewed by the Finance Committee of the board of directors with the preparer and the Organizations VP of Finance. After they have reviewed/approved, the return is provided to the entire board of directors for review prior to filing.
Form 990 Part VI
15a
The Executive Committee review salary/benefit information obtained from publicly available sources Guidestar regarding comparative community mental health service orgranizations. The results of their efforts are documented contemporaneously. The President/CEO does not participate in the discussions regarding their compensation.
Form 990 Part VI
15b
The President/CEO review salary/benefit information obtained from publicly available sources Guidestar regrading the compensation arrangements for top financial officers at comparative community mental health service orgranizations. The results of their efforts are documented contemporaneously.
Form 990 Part XI
5
This change in net assets represents the amount of unrealized loss on investments that was excluded from the statement of revenue Form 990, Part VIII but was included in the audited financial statements in accordance with generally accepted accounting principles.
Form 990 Part VI
12c
The Organzation reviews the conflict of interest questionnaire that is prepared annually by each member of the Board of Directors. If a conflict arises the Board of Directors Executive Committee meets with the board member and takes appropriate action, which may include removal from the board.
Form 990 Part III
3
Family Planning of St Joseph, Inc. was established as a separate corporation in February 2011 however, Family Guidance Center for Behavioral Healthcare, the parent company, has been operating the above services for over 40 years. Family Planning was created largely because of billing challenges. When billing services to Medicaid and other insurance companies, it was difficult to explain why a community mental health center Family Guidance Center was billing for reproductive health services. All staff are employed by Family Guidance Center and all bills are paid by Family Guidance Center. Family Planning of St. Joseph, Inc., reimburses Family Guidance Center for all bills and also pays Family Guidance Center for administrative support. Direct Staff for the family planning clinic include a medical director, nurse practitioner, LPNs, office support, and a director. The clinic receives federal Title X funding, and also bills Medicaid and private insurance if allowed by the consumer. The clinic also accepts donations.
Form 990 Part III
3
continued Family Planning of St Joseph, Inc., is a program designed to assist both men and women in the local and surrounding communities with family planning and reproductive health services for both adolescents and adults. The target clientele includes both females and males from all ethnicities from Andrew, Buchanan, Caldwell, Clinton, DeKalb, Gentry, Holt, Nodaway, Platte, and Worth counties. All consumers, regardless of income, may receive family planning services on a sliding fee scale, which is based off the Federal Poverty Guidelines. There are two different family planning clinic sites available that offer non-traditional hours. One site is located in St. Joseph, MO, and the other site is located in Maryville, MO.
Form 990
Sch B, Part II, a - On April 17, 2012, the Missouri Department of Transportation MDOT provided a committment letter which stated that they would donate a handicap accessible bus to the Organization if we paid 20 of the purchase price. We paid our portion on April 17, 2012. Accordingly to the terms of the committment, MDOT would deliver the van on April 30, 2012. Delivery of the van did not occur until September 24, 2012 however, since we satisfied our obligation of the transaction before the fiscal year end, management elected to accrue the revenue in-kind donation for the states portion of the transaction as of June 30, 2012 even though receipt had not occurred just as we do for any other pledge.
Form 990 Part VI
19
These documents are maintained at the Organizations corporate office see mailing address and made available to requesting parties upon request.
Form 990 Part III
4a
This return was amended because the attachment for the Program Service Accomplishments was omitted by the organization.
Form 990 Part VI Section B Line 11b The tax return is reviewed by the Finance Committee of the board of directors with the preparer and the Organizations VP of Finance. After they have reviewed/approved, the return is provided to the entire board of directors for review prior to filing. Form 990 Part VI Section B Line 15a The Executive Committee review salary/benefit information obtained from publicly available sources Guidestar regarding comparative community mental health service orgranizations. The results of their efforts are documented contemporaneously. The President/CEO does not participate in the discussions regarding their compensation. Form 990 Part VI Section B Line 15b The President/CEO review salary/benefit information obtained from publicly available sources Guidestar regrading the compensation arrangements for top financial officers at comparative community mental health service orgranizations. The results of their efforts are documented contemporaneously. Form 990 Part XI Line 5 This change in net assets represents the amount of unrealized loss on investments that was excluded from the statement of revenue Form 990, Part VIII but was included in the audited financial statements in accordance with generally accepted accounting principles. Form 990 Part VI Section B Line 12c The Organzation reviews the conflict of interest questionnaire that is prepared annually by each member of the Board of Directors. If a conflict arises the Board of Directors Executive Committee meets with the board member and takes appropriate action, which may include removal from the board. Form 990 Part III Line 3 Family Planning of St Joseph, Inc. was established as a separate corporation in February 2011 however, Family Guidance Center for Behavioral Healthcare, the parent company, has been operating the above services for over 40 years. Family Planning was created largely because of billing challenges. When billing services to Medicaid and other insurance companies, it was difficult to explain why a community mental health center Family Guidance Center was billing for reproductive health services. All staff are employed by Family Guidance Center and all bills are paid by Family Guidance Center. Family Planning of St. Joseph, Inc., reimburses Family Guidance Center for all bills and also pays Family Guidance Center for administrative support. Direct Staff for the family planning clinic include a medical director, nurse practitioner, LPNs, office support, and a director. The clinic receives federal Title X funding, and also bills Medicaid and private insurance if allowed by the consumer. The clinic also accepts donations. Form 990 Part III Line 3 continued Family Planning of St Joseph, Inc., is a program designed to assist both men and women in the local and surrounding communities with family planning and reproductive health services for both adolescents and adults. The target clientele includes both females and males from all ethnicities from Andrew, Buchanan, Caldwell, Clinton, DeKalb, Gentry, Holt, Nodaway, Platte, and Worth counties. All consumers, regardless of income, may receive family planning services on a sliding fee scale, which is based off the Federal Poverty Guidelines. There are two different family planning clinic sites available that offer non-traditional hours. One site is located in St. Joseph, MO, and the other site is located in Maryville, MO. Form 990 Sch B, Part II, a - On April 17, 2012, the Missouri Department of Transportation MDOT provided a committment letter which stated that they would donate a handicap accessible bus to the Organization if we paid 20 of the purchase price. We paid our portion on April 17, 2012. Accordingly to the terms of the committment, MDOT would deliver the van on April 30, 2012. Delivery of the van did not occur until September 24, 2012 however, since we satisfied our obligation of the transaction before the fiscal year end, management elected to accrue the revenue in-kind donation for the states portion of the transaction as of June 30, 2012 even though receipt had not occurred just as we do for any other pledge. Form 990 Part VI Section C Line 19 These documents are maintained at the Organizations corporate office see mailing address and made available to requesting parties upon request. Form 990 Part III Line 4a This return was amended because the attachment for the Program Service Accomplishments was omitted by the organization.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.