Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 10-01-2012 , 2012, and ending 09-30-2013
BCheck if applicable:
CName of organization
Child Mind Institute Inc
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
445 Park Avenue
Suite 2ND FL
Room/suite
City or town, state or country, and ZIP + 4
New York, NY10022
D Employer identification number

80-0478843
E Telephone number

G Gross receipts $ 13,066,937
F Name and address of principal officer:
DR HAROLD KOPLEWICZ MD
445 PARK AVENUE
NEW YORK,NY10022
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.childmind.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2009
M State of legal domicile: NY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE ARE DEDICATED TO TRANSFORMING MENTAL HEALTH CARE FOR CHILDREN EVERYWHERE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 30
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 30
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 58
6 Total number of volunteers (estimate if necessary) ............. 6 45
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 9,573,350 12,689,311
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 14,795 15,808
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 14,859 25,279
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 9,603,004 12,730,398
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 368,066 794,884
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 3,739,872 4,440,845
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 76,046 66,500
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,551,933    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 3,065,507 3,736,209
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 7,249,491 9,038,438
19 Revenue less expenses. Subtract line 18 from line 12....... 2,353,513 3,691,960
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 13,612,923 16,714,595
21 Total liabilities (Part X, line 26)............. 1,858,244 1,947,032
22 Net assets or fund balances. Subtract line 21 from line 20..... 11,754,679 14,767,563
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: THE CHILD MIND INSTITUTE IS DEDICATED TO TRANSFORMING MENTAL HEALTH CARE FOR CHILDREN EVERYWHERE. OUR ORGANIZATION IS COMMITTED TO FINDING MORE EFFECTIVE TREATMENTS FOR CHILDHOOD PSYCHIATRIC AND LEARNING DISORDERS, BUILDING THE SCIENCE OF HEALTHY BRAIN DEVELOPMENT, AND EMPOWERING CHILDREN AND THEIR FAMILIES WITH HELP, HOPE, AND ANSWERS.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,469,246 including grants of $   ) (Revenue $   )
PUBLIC EDUCATION: THE CHILD MIND INSTITUTE HAS A PUBLIC EDUCATION MISSION TO PROVIDE AUTHORITATIVE, SCIENCE-BASED INFORMATION AND RESOURCES ABOUT CHILDREN'S MENTAL HEALTH TO PARENTS, EDUCATORS AND OTHER MENTAL HEALTH PROFESSIONALS. CHILDMIND.ORG - THE CHILD MIND INSTITUTE'S WEB SITE CONTAINS A WEALTH OF INFORMATION, NEWS, ADVICE AND STRATEGIES FOR PARENTS, EDUCATORS, AND OTHER PROFESSIONALS DEALING WITH PSYCHIATRIC AND LEARNING DISORDERS IN CHILDREN AND ADOLESCENTS. AN INTERACTIVE SYMPTOM CHECKER AND MENTAL HEALTH GUIDE OFFER THE LATEST THINKING ON COMMON DISORDERS, FROM SYMPTOMS TO TREATMENTS. MENTAL HEALTH EXPERTS FROM INSTITUTIONS AROUND THE COUNTRY OFFER INFORMATION AND INSIGHT ON THEIR SPECIALTIES IN DOZENS OF EDUCATIONAL VIDEOS. FEATURE ARTICLES ADDED AT LEAST WEEKLY DISCUSS ISSUES OF INTEREST TO PARENTS, WHETHER OR NOT THEY HAVE A CHILD WITH A PSYCHIATRIC OR LEARNING DISORDER. THE BRAINSTORM BLOG, OFFERS SUMMARIES OF NEWS, LINKS TO ARTICLES OF INTEREST ELSEWHERE, AND COMMENTARY ON ISSUES RELATED TO CHILDREN'S MENTAL HEALTH. CHILDMIND.ORG HAS PARTNERED WITH DOZENS OF OTHER SITES AND BLOGS TO SHARE CONTENT AND ENLARGE THE FOOTPRINT OF THE ARTICLES AND RESOURCES WE HAVE CREATED, AND A ROBUST SOCIAL MEDIA CAMPAIGN USES FACEBOOK AND TWITTER TO SPREAD THE WORD. SPEAK UP FOR KIDS! - Speak Up for Kids is the Child Mind Institute's national public education campaign held each May to battle the barriers that can prevent kids and families from seeking life-changing treatment. By promoting awareness and engaging a broad coalition of partners, the campaign sparks the kind of national attention that children's mental health truly deserves. Speak Up for Kids features events, influential speakers, more than 100 partner organizations, resources for parents and families, synchronized digital activities, and multi-platform media engagement. ADAM JEFFREY KATZ MEMORIAL LECTURE - DESIGNED TO RAISE AWARENESS AND EDUCATE THE PUBLIC ABOUT childhood psychiatric and learning disorders, THE KATZ FAMILY LAUNCHED THIS ANNUAL LECTURE IN 2003 AS A LIVING MEMORIAL TO ADAM KATZ, WHO STRUGGLED WITH ADHD and dyslexia. THE TWO-PART PROGRAM IS HELD EVERY MAY, DURING NATIONAL MENTAL HEALTH Awareness MONTH, AND FEATURES A LEADING EXPERT IN THE FIELD, followed by A CANDID CONVERSATION WITH A prominent GUEST ABOUT LIVING WITH A MENTAL HEALTH DISORDER. PAST honorees HAVE INCLUDED ACTOR ORLANDO BLOOM, ACTRESS AND PRODUCER TRUDIE STYLER, PRODUCER BRIAN GRAZER, and Grammy-winning artist Naomi Judd. This year, the event was webcast to thousands as part of the Child Mind Institute's Speak Up for Kids public awareness campaign. ON THE SHOULDER OF GIANTS - EACH YEAR THE CHILD MIND INSTITUTE SCIENTIFIC RESEARCH COUNCIL SELECTS A SCIENTIST TO RECEIVE THE DISTINGUISHED SCIENTIST AWARD FOR HIS OR HER LIFETIME OF RESEARCH AND CONTRIBUTIONS TO THE FIELDS OF CHILD MENTAL HEALTH AND DEVELOPMENTAL NEUROSCIENCE. AT THE ON THE SHOULDERS OF GIANTS SYMPOSIUM, THE AWARDEE IS A FEATURED SPEAKER, ALONG WITH TWO GENERATIONS OF HIS OR HER PROTEGES. THIS PRESENTATION GIVES THE RESEARCH COMMUNITY, AND PARTICULARLY YOUNGER SCIENTISTS, A VIEW INTO THE TRANSFORMATIONAL POWER OF DEDICATION AND COLLABORATION IN SCIENCE. CHILD MIND INSTITUTE STUDENT ART PROJECT - Each year, THE CHILD MIND INSTITUTE INVITES four local PUBLIC AND INDEPENDENT SCHOOLS TO PARTICIPATE in OUR GALLERY PROGRAM DEDICATED TO DISPLAYING WORKS OF ART CREATED BY STUDENT ARTISTS. CRITICAL TO CHILD DEVELOPMENT AND ACADEMIC SUCCESS, art PROMOTEs SELF-ESTEEM AND PROVIDE OPPORTUNITIES FOR SELF-EXPRESSION. Works from the Student Art Project are PROMINENTLY exhibited AT THE CHILD MIND INSTITUTE HEADQUARTERS and LAUNCHED WITH AN OPENING RECEPTION FOR THE STUDENT ARTISTS, THEIR FAMILIES, AND THE ENTIRE SCHOOL COMMUNITY. A VIRTUAL GALLERY IS ALSO AVAILABLE ON CHILDMIND.ORG. PARENT AND EDUCATOR WORKSHOPS ON CLINICAL TOPICS - THE PARENT AND EDUCATOR WORKSHOPS COVER A RANGE OF ISSUES AFFECTING CHILDREN, INCLUDING SELECTIVE MUTISM (SM), ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD), OBSESSIVE-COMPULSIVE DISORDER (OCD), AND OTHERS. THESE EDUCATIONAL WORKSHOPS PROVIDE AN OPPORTUNITY FOR PARENTS, TEACHERS, AND OTHER CARING PROFESSIONALS TO GAIN NEW KNOWLEDGE, INSIGHTS AND SKILLS TO IMPROVE THEIR ABILITY TO PARENT AND NURTURE KIDS WITH THESE DISORDERS AND HELP THEM THRIVE. SESSIONS ARE HELD AT THE CHILD MIND INSTITUTE ABOUT ONE PER WEEK DURING THE SCHOOL YEAR AND ARE ALSO AVAILABLE ONLINE.
4b (Code:   ) (Expenses $ 2,334,489 including grants of $ 213,249 ) (Revenue $   )
SCIENCE AND INNOVATION: The Child Mind Institute (CMI) has a science and innovation mission that underscores the transformative power of collaborative research in the field of child mental health. The Center for the Developing Brain (CDB) at the CMI is dedicated to accelerating the pace of scientific advancement for child mental health through the conduct and promotion of high impact research focused on the developing brain and mental illness. The CDB actively works to innovate models of the neural underpinnings of mental illness, as well as the methodologies employed by investigators to examine them. Additionally, the CDB spearheads a large-scale "open science" initiative that serves to demonstrate the feasibility and value of open data-sharing in the brain imaging community. Known as the "International Neuroimaging Data-sharing Initiative (INDI)", this effort has proven to be a game-changer, giving researchers who once struggled to obtain a few dozen datasets for their work, access to thousands of datasets from clinical and nonclinical populations. CHILD MIND INSTITUTE ENDEAVOR SCIENTIST PROGRAM - THE ENDEAVOR SCIENTIST PROGRAM IS A PIONEERING EFFORT LAUNCHED BY THE CHILD MIND INSTITUTE TO SUPPORT THE DEVELOPMENT OF TALENTED, MULTIDISCIPLINARY SCIENTISTS IN RESEARCH POSITIONS AT ACADEMIC AND MEDICAL INSTITUTIONS AROUND THE GLOBE. RECRUITED FROM VARIOUS FIELDS SUCH AS COMPUTER SCIENCE, ENGINEERING, MATHEMATICS, AND STATISTICS; THESE SCIENTISTS WILL COLLABORATE ON RESEARCH THAT PURSUES A DEEPER UNDERSTANDING OF HUMAN BRAIN DEVELOPMENT. BRINGING DIVERSE THINKERS TOGETHER WILL BRING US CLOSER TO DEVELOPING BETTER INTERVENTIONS, AND EVENTUALLY PREVENTATIVE MEASURES, FOR PSYCHIATRIC AND LEARNING DISORDERS IN CHILDREN AND ADOLESCENTS. HEALTHY BRAIN NETWORK - The Health Brain Network is the Child Mind Institute's unprecedented initiative to collect and share data from developing children with the best research minds all over the world. The initiative will be launched with imaging and other data from 10,000 young people in the New York metropolitan area. By sharing the information with the global scientific community, we will capture the attention of interdisciplinary researchers, who may never before have studied this type of data, putting child psychiatry at the forefront of scientific inquiry and discovery. Ultimately research from the Healthy Brain Network will lead to improved diagnosis and treatment of childhood mental illness. SCIENTIFIC RESEARCH COUNCIL - COMPRISED OF 13 OF THE NATION'S TOP CHILD MENTAL HEALTH SCIENTISTS FROM 10 OF THE LEADING ACADEMIC INSTITUTIONS, THE SCIENTIFIC RESEARCH COUNCIL BRINGS TOGETHER BASIC SCIENTISTS AND RESEARCH CLINICIANS TO CREATE A GLOBAL INCUBATOR FOR COLLABORATIVE RESEARCH IN CHILD MENTAL HEALTH. FUNCTIONING AS A MULTI-INSTITUTIONAL SCIENTIFIC THINK-TANK, THE COUNCIL INCLUDES DISTINGUISHED SCIENTISTS IN THE FIELD OF CHILD AND ADOLESCENT PSYCHIATRY, PSYCHOLOGY, NEUROSCIENCE, AND NEUROLOGY, AND EXPERTS IN ANXIETY AND MOOD DISORDERS, ATTENTION-DEFICIT HYPERACTIVITY DISORDER, AUTISM SPECTRUM DISORDERS, AND EATING DISORDERS. Stress and Resilience program (new Program)- In 2013, the Child Mind Institute's Stress and Resilience Program provided trauma response services to more than 100 New York City public elementary, intermediate and high schools, as well as children's mental health clinics, serving thousands of students in the NYC neighborhoods. Our services focused on providing psychoeducational workshops, school-based trauma interventions, and consultation to communities affected by Superstorm Sandy, as well as NYC public schools. The overall purpose of the Stress and Resilience Program is to promote healthy child development and resilience, and prevent serious, trauma-related psychological difficulties among children and adolescents. Our goals are to: 1) increase awareness of children's mental health issues, specifically risks related to traumatic events, 2) reduce exposure to stressful/traumatic events, 3) decrease stigma and other barriers to care, 4) facilitate early detection of problematic reactions to stressful/traumatic events, and 5) provide effective treatments to children and families in need. The Stress and Resilience program has particular experience working with military families, particularly those who have difficulties related to trauma exposure or readjustment to life at home and exposure to military stress. The Child Mind Institute supports our troops and their families by addressing the unique needs of U.S. military children, and by lending a hand to military parents as they navigate their life of service and parenthood. We help military parents in two ways: 1) by connecting military kids and their families to important resources that address issues specific to their own readjustment, and 2) by helping military members and spouses to thrive in their roles as parents, and by giving kids in need treatments that will benefit them.
4c (Code:   ) (Expenses $ 1,637,830 including grants of $ 581,635 ) (Revenue $   )
ACCESS TO CLINICAL CARE: THE CHILD MIND INSTITUTE AIMS TO PROVIDE RESOURCES TO CHILDREN, TEENS, AND FAMILIES TO IMPROVE ACCESS TO THE CLINICAL CARE THEY NEED TO LIVE HEALTHY, FULFILLING LIVES. FINANCIAL AID PROGRAM - THE CHILD MIND INSTITUTE LAUNCHED ITS FINANCIAL AID PROGRAM IN AN EFFORT TO HELP CHILDREN AND FAMILIES RECEIVE CARE AND TREATMENT, REGARDLESS OF ECONOMIC STANDING, BY CLINICIANS AT THE CHILD MIND MEDICAL PRACTICE, A MEDICAL PRACTICE FORMED TO SUPPORT THE CLINICAL MISSION OF THE CHILD MIND INSTITUTE. MODELED AFTER GUIDELINES SIMILAR TO THOSE ADOPTED BY DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) PROGRAMS, THE FINANCIAL AID PROGRAM OFFERS ELIGIBLE FAMILIES A FEE DISCOUNT BETWEEN 30% AND 70% OF THE COST OF SERVICES. IT IS DESIGNED IN A WAY THAT ALLOWS PATIENTS FROM LOW-INCOME FAMILIES TO QUALIFY, WHILE ALSO ACCOMMODATING FAMILIES WITH HIGHER THAN AVERAGE INCOME, WHO HAVE OTHER FINANCIAL STRAINS, SUCH AS CHILDREN IN COLLEGE OR OTHER MEDICAL BILLS. SINCE 2011, the Child Mind Institute HAS RAISED A CUMULATIVE TOTAL OF $911,800 FOR FINANCIAL AID. THE CHILD MIND MEDICAL PRACTICE CLINICIANS MATCH THE DONATED SERVICES ON A DOLLAR-FOR-DOLLAR BASIS. THIS ENABLED THE PRACTICE TO OFFER FINANCIAL AID WORTH $1,823,600. THIS PAST YEAR ALONE, THE CLINICIANS PROVIDED CLINICAL CARE WORTH APPROXIMATELY $582,000 IN FINANCIAL AID.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet5,441,565
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions).... Click to see attachment
17
Yes
 
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................
34
 
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
51
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
58
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
30
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
30
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
AL , AZ , CA , CT , DC , GA , IL , ME , MD , MA , MI , MN , NH , NJ , NY , NC , OH , OR , PA , RI , SC , VA , WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletDAVID RIVERA DIR OF FINANCE445 PARK AVENUE 2ND FLOORNEW YORKNY10022 (212) 308-3118
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) BROOKE GARBER NEIDICH........................................................................
CHAIR AND DIRECTOR
 6.0
.......................   		X   X       0 0 0
(2) DEBRA PERELMAN........................................................................
VICE CHAIR AND DIRECTOR
 6.0
.......................   		X   X       0 0 0
(3) ELIZABETH FASCITELLI........................................................................
SECRETARY AND DIRECTOR
 1.0
.......................   		X   X       0 0 0
(4) ANNE WELSH MCNULTY........................................................................
TREASURER AND DIRECTOR
 1.0
.......................   		X   X       0 0 0
(5) ARTHUR ALTSCHUL JR........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(6) RANDOLPH COWEN........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(7) MARK DOWLEY........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(8) MEGAN DOWLEY........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(9) MICHAEL FASCITELLI........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(10) GIDEON GIL........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(11) PHYLLIS GREEN........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(12) MARGARET GRIEVE........................................................................
DIRECTOR
 6.0
.......................   		X           0 0 0
(13) GEORGE HALL........................................................................
DIRECTOR (TO 9/19/13)
 1.0
.......................   		X           0 0 0
(14) CRAIG HATKOFF........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(15) JOSEPH HEALEY........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(16) Ellen Katz........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(17) HOWARD KATZ........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) PREETHI KRISHNA........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(19) CHRISTINE MACK........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(20) RICHARD MACK........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(21) STEVEN MARCUS........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(22) JULIE MINSKOFF........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(23) MARCIA MISHAAN........................................................................
DIRECTOR (TO 4/13/13)
 1.0
.......................   		X           0 0 0
(24) RICHARD MISHAAN........................................................................
DIRECTOR (TO 4/13/13)
 1.0
.......................   		X           0 0 0
(25) VALERIE MNUCHIN........................................................................
DIRECTOR (AS OF 9/23/13)
 1.0
.......................   		X           0 0 0
(26) DANIEL NEIDICH........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(27) AMY PHELAN........................................................................
DIRECTOR (AS OF 4/13/13)
 1.0
.......................   		X           0 0 0
(28) JOHN PHELAN........................................................................
DIRECTOR (AS OF 4/13/13)
 1.0
.......................   		X           0 0 0
(29) JANE ROSENTHAL........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(30) JORDAN SCHAPS........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(31) LINDA SCHAPS........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(32) RAM SUNDARAM........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(33) CLAUDE WASSERSTEIN........................................................................
DIRECTOR
 1.0
.......................   		X           0 0 0
(34) DR HAROLD KOPLEWICZ........................................................................
PRESIDENT
 40.0
.......................   		    X       679,214 0 268,984
(35) SHERINE KHALIL........................................................................
CHIEF OPERATING OFFICER
 40.0
.......................   		    X       276,343 0 20,746
(36) ELIZABETH PLANET........................................................................
EXECUTIVE VP & CSO
 40.0
.......................   		    X       56,383 0 1,311
(37) DAVID RIVERA........................................................................
DIRECTOR OF FINANCE
 40.0
.......................   		    X       72,965 0 2,094
(38) DAWN THOMSEN........................................................................
CHIEF OUTREACH OFFICER
 40.0
.......................   		        X   127,609 0 17,163
(39) ILEAN HELLAND........................................................................
ASSISTANT TO THE PRESIDENT
 40.0
.......................   		        X   108,071 0 17,706
(40) MICHAEL MILHAM........................................................................
DIR. CTR. DEV. BRAIN
 40.0
.......................   		        X   195,133 0 23,164
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,515,718 0 351,168
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet5
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
42ND STREET LESSEE, 110 EAST 42ND STREETNEW YORKNY10017 EVENT VENUE 267,886
COMMUNITY COUNSELING SERVICE CO L, PB BOX 27462NEW YORKNY100877462 FUNDRAISING 439,750
EPSTEIN BECKER GREEN PC, 250 PARK AVENUENEW YORKNY101771211 LEGAL SERVICES 142,870
MADISON TECHNOLOGY, 575 LEXINGTON AVENUE 4TH FLOORNEW YORKNY10022 OUTSOURCED IT 105,367
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet4
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 5,830,996
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		6,858,315
g Noncash contributions included in lines
1a-1f:$ 		268,664
h Total. Add lines 1a-1f.......MediumBullet 12,689,311
Program Service Revenue Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 0
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 15,049     15,049
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 69,411  
b Less: cost or other basis and sales expenses 68,652  
c Gain or (loss) 759  
d Net gain or (loss)..........MediumBullet 759     759
8a Gross income from fundraising events (not including
$ 5,830,996
of contributions reported on line 1c). See Part IV, line 18 ..
a 267,887
b Less: direct expenses ...b 267,887
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a MISCELLANEOUS REVENUE 900099 25,279     25,279
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 25,279
12 Total revenue. See Instructions......MediumBullet 12,730,398     41,087
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 213,249 213,249
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 581,635 581,635
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,175,832 423,212 413,527 339,093
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 2,355,875 1,816,793 384,298 154,784
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 208,589 86,948 103,555 18,086
9 Other employee benefits ....... 472,418 196,921 234,535 40,962
10 Payroll taxes ........... 228,131 95,094 113,257 19,780
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 75,182   75,182  
c Accounting ........... 111,504   111,504  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 66,500 66,500
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 888,734 240,595 150,032 498,107
12 Advertising and promotion .... 43,312 38,887 500 3,925
13 Office expenses ....... 50,766 26,284 10,958 13,524
14 Information technology ...... 186,348 142,050 19,504 24,794
15 Royalties .. 0      
16 Occupancy ........... 324,581 187,397 79,943 57,241
17 Travel ............ 167,517 76,090 47,516 43,911
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 6,475 3,722 570 2,183
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 603,879 436,741 103,741 63,397
23 Insurance .............. 51,011 13,882 33,046 4,083
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a SUB-CONTRACTORS 473,296 471,546 1,750  
b MARKETING CONSULTANTS 190,928 103,482 21,957 65,489
c COMPUTERS & EQUIPMENT 177,710 101,904 55,103 20,703
d PAYROLL PROCESSING FEES 111,104 85,661 18,110 7,333
e All other expenses 273,862 99,472 66,352 108,038
25 Total functional expenses. Add lines 1 through 24e 9,038,438 5,441,565 2,044,940 1,551,933
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 777,697 1 105,790
2 Savings and temporary cash investments ......... 5,871,763 2 7,189,945
3 Pledges and grants receivable, net ........... 2,821,575 3 4,349,179
4 Accounts receivable, net ............. 0 4 26,729
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 214,562 9 346,960
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 3,559,015
b Less: accumulated depreciation ..... 10b 1,413,114 2,701,228 10c 2,145,901
11 Investments—publicly traded securities .......... 327,901 11 858,079
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 898,197 15 1,692,012
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 13,612,923 16 16,714,595
Liabilities 17 Accounts payable and accrued expenses ......... 1,015,269 17 527,126
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 842,975 25 1,419,906
26 Total liabilities. Add lines 17 through 25......... 1,858,244 26 1,947,032
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 8,574,646 27 7,863,450
28 Temporarily restricted net assets ........... 3,180,033 28 6,904,113
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 11,754,679 33 14,767,563
34 Total liabilities and net assets/fund balances ........ 13,612,923 34 16,714,595
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
12,730,398
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
9,038,438
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
3,691,960
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
11,754,679
5
Net unrealized gains (losses) on investments ...............
5
107,647
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
-786,723
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
14,767,563
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
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
f
g
(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 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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....   8,570,923 8,975,012 9,573,350 12,689,311 39,808,596
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   8,570,923 8,975,012 9,573,350 12,689,311 39,808,596
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)..           5,845,283
6 Public support. Subtract line 5 from line 4.           33,963,313
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..   8,570,923 8,975,012 9,573,350 12,689,311 39,808,596
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...   2,513 11,131 14,795 15,049 43,488
9 Net income from unrelated business activities, whether or not the business is regularly carried on..           0
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..     16,971 14,859 25,279 57,109
11 Total support (Add lines 7 through 10).           39,909,193
12
12
 
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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
Section C. Computation of Public Support Percentage
15
15
0 %
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Child Mind Institute Inc
  		Employer identification number

80-0478843
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Child Mind Institute Inc
  		Employer identification number

80-0478843
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Child Mind Institute Inc
  		Employer identification number

80-0478843
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
36,692
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
36,692
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
PART II-B, LINE 1, LOBBYING ACTIVITIES:   Advocating for funding to support services for Superstorm Sandy recovery programs. Advocating for expansion of law providing access to mental health care services to veterans only to include their family members. Advising members of the House Energy and Commerce Committee and staff of the House and Senate Labor, HHS and Education Appropriations Subcommittees on approaches to improving and expanding mental health services for children. Raising awareness of children's mental health issues by promoting Speak Up for Kids with the DEPARTMENT OF HEALTH AND HUMAN SERVICES. Direct lobbying- $36,692
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............   1,765,525 317,055 1,448,470
d Equipment ................   1,009,452 434,197 575,255
e Other .................   784,038 661,862 122,176
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 2,145,901
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) PRACTICE FOR FINANCIAL AID 53,871
(2) PRACTICE FOR SHARED SERVICES 1,638,141







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 1,692,012
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DEFERRED RENT LIABILITY 974,087
DEFERRED COMPENSATION LIABILITY 445,819







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,419,906
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 13,043,208
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 107,647
b Donated services and use of facilities ......... 2b 205,163
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e 312,810
3 Subtract line 2e from line 1..................... 3 12,730,398
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 12,730,398
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 9,243,601
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a 205,163
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e 205,163
3 Subtract line 2e from line 1..................... 3 9,038,438
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 9,038,438
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
PART X, LINE 2   THE TEXT OF THE FOOTNOTE TO CMI'S AUDITED FINANCIAL STATEMENTS THAT REPORTS CMI'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC TOPIC 740) IS AS FOLLOWS: CMI is subject to the provisions of the Financial Accounting Standards Board's (the "FASB") Accounting Standards Codification ("ASC") Topic 740-10-05 relating to accounting and reporting for uncertainty in income taxes. Because of CMI's general tax-exempt status, ASC Topic 740-10-05 has not had, and is not anticipated to have, a material impact on CMI's financial statements.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
EVENT ASSOCIATES
162 WEST 56TH ST
 
NEW YORK, NY10019 		FUNDRAISING FOR GALA   No 6,098,883 54,000 6,044,883
EVENT ASSOCIATES
162 WEST 56TH ST
 
NEW YORK, NY10019 		OTHER FUNDRAISING   No 2,139,475 12,500 2,126,975
             
             
             
             
             
             
             
             
Total .................right arrow 8,238,358 66,500 8,171,858
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
AL, CA, CT, DC, GA, IL, LA, ME, MD, MA, MN, NH, NY, NC, OR, PA, VA, WI
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GALA EVENT
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

0
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 6,098,883     6,098,883
2 Less: Contributions . . 5,830,996     5,830,996
3 Gross income (line 1
minus line 2) . . . 		267,887     267,887
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages .        
8 Entertainment . . .        
9 Other direct expenses . 267,887     267,887
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 267,887
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow  
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
SCHEDULE G, PART I, LINE 2B COLUMN (V)   The amount paid to the professional fundraising company, event associates, represents fees paid for the planning of CMI's December 2012 annual benefit dinner and for other fundraising activities. The total amount paid to event associates for the planning of the December 2012 ANNUAL DINNER WAS $65,231, WHICH INCLUDED $54,000 IN CONTRACT FEES AND $11,231 IN REIMBURSABLE EXPENSES. CMI PAID $13,193 FOR OTHER FUNDRAISING ACTIVITES, $12,500 in fees and $693 of reimbursable expenses in FISCAL YEAR 2013. CMI PAID $32,000 in the previous FISCAL YEAR as a deposit for the December 2012 annual dinner. In December 2012, CMI contracted with Event associates for the December 2013 event, and a $43,000 deposit towards that contract was paid in fiscal year 2013.
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number
80-0478843
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) RESEARCH FOUNDATION FOR MENTAL HYGIENE
150 BROADWAY SUITE 301
MENANDS,NY12204 		14-1410842 501(C)(3) 213,249       SEE PART IV






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) SEE PART IV 273 581,636      












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
SCHEDULE I, PART I, LINE 2   THE GRANT WAS MADE FOLLOWING A WRITTEN GRANT AGREEMENT STIPULATING THE PURPOSES OF THE GRANT AND REQUIRING REGULAR REPORTING ON THE USE OF THE GRANT FUNDS. CMI RECEIVES EXPENSE REPORTS ON A QUARTERLY BASIS FROM GRANTEE TO ENSURE THAT THE GRANT FUNDS ARE USED FOR THE INTENDED PURPOSES BASED ON THE APPROVED GRANT APPLICATION AND BUDGET.
SCHEDULE I, PART II, LINE 1A   THE CHILD MIND INSTITUTE AWARDED A ONE YEAR GRANT, RENEWABLE FOR THREE YEARS, TO THE RESEARCH FOUNDATION FOR MENTAL HYGIENE (RFMH) FOR THE PROJECT, "DISCOVERY SCIENCE OF HUMAN BRAIN FUNCTION ACROSS THE LIFESPAN: PROTOCOL ENHANCEMENT" TO FURTHER THE WORK DONE BY DR. MICHAEL MILHAM, DIRECTOR OF THE CENTER FOR THE DEVELOPING BRAIN AT CMI. THE GRANT WAS AWARDED TO DR. MILHAM IN HIS OTHER CAPACITY AS A PRINCIPAL INVESTIGATOR AT RFMH TO CONTINUE AND EXPAND THE SCOPE OF HIS ORIGINATING RESEARCH STUDY AT THE NATHAN S. KLINE INSTITUTE FOR PSYCHIATRIC RESEARCH (NKI), AND TO FOSTER COLLABORATION BETWEEN NKI AND CMI.
SCHEDULE I, PART III, LINE 1A   THE CHILD MIND INSTITUTE PROVIDES A FINANCIAL AID PROGRAM THAT OFFERS ELIGIBLE FAMILIES A FEE DISCOUNT FOR DIAGNOSTIC EVALUATIONS AND ONGOING TREATMENT FOR CHILDREN WITH MENTAL HEALTH DISORDERS. THE PROGRAM IS DESIGNED TO ALLOW PATIENTS FROM LOW-INCOME FAMILIES TO QUALIFY, WHILE ALSO ACCOMODATING FAMILIES WITH HIGHER THAN AVERAGE INCOME, WHO HAVE OTHER FINANCIAL STRAINS, SUCH AS CHILDREN IN COLLEGE OR OTHER MEDICAL BILLS. IN FY 2013 A TOTAL OF 273 PATIENTS RECEIVED $581,636 IN FINANCIAL AID FOR CUSTOMIZED CARE SERVICES PROVIDED BY THE CHILD MIND MEDICAL PRACTICE PLLC. THE CLINICIANS ALSO MATCH THE FINANCIAL AID DOLLAR FOR DOLLAR BY DONATING THEIR SERVICES, MAKING THE TOTAL CONTRIBUTION $1,163,272 OF SUPPORT TOWARDS CLINICAL SERVICES.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)DR HAROLD KOPLEWICZPRESIDENT (i)
(ii)		 499,214
0 		180,000
0 		 
0 		124,000
  		144,984
  		948,198
0 		0
 
(2)SHERINE KHALILCHIEF OPERATING OFFICER (i)
(ii)		 276,343
0 		 
0 		 
0 		10,000
  		10,746
  		297,089
0 		 
 
(3)MICHAEL MILHAMDIR. CTR. DEV. BRAIN (i)
(ii)		 195,133
0 		 
0 		 
0 		9,730
  		13,434
  		218,297
0 		 
 
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
PART I, LINE 4B   THE AMOUNT SHOWN IN SCHEDULE J, PART II, LINE 1, COLUMN (C) REPRESENTS AN ACCRUAL TOWARDS A NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR THE PRESIDENT OF CHILD MIND INSTITUTE UNDER INTERNAL REVENUE CODE SECTION 457(F). THIS PLAN IS DESIGNED TO SERVE AS A RETENTION INCENTIVE. AMOUNTS WILL BE PAID OUT UNDER THIS PLAN ONLY IF THE PRESIDENT CONTINUES TO BE EMPLOYED AT THE CHILD MIND INSTITUTE AS OF CERTAIN DATES IN FUTURE YEARS.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) CHILD MIND MEDICAL PRACTICE PLLC SEE PART V 1,692,012 SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
SCHEDULE L PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS   (A) NAME OF ENTITY: CHILD MIND MEDICAL PRACTICE, PLLC (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: DR. HAROLD KOPLEWICZ, THE PRESIDENT OF THE CHILD MIND INSTITUTE ("CMI"), IS A MEMBER OF THE CHILD MIND MEDICAL PRACTICE, PLLC ("PRACTICE"} WITH A 99% OWNERSHIP INTEREST. CMI FACILITATED THE CREATION OF THE PRACTICE TO PROVIDE CLINICAL CARE AND TREATMENT DIRECTLY TO CHILDREN AND ADOLESCENTS; AND IN CONNECTION WITH CMI'S RESEARCH IN BRAIN DEVELOPMENT, WHICH UNDER APPLICABLE LAW, CMI COULD NOT DIRECTLY PROVIDE. SUCH CLINICAL CARE AND TREATMENT IS CRITICAL TO THE FULFILLMENT OF CMI'S MISSION TO TRANSFORM MENTAL HEALTH CARE FOR CHILDREN EVERYWHERE BY FINDING MORE EFFECTIVE TREATMENTS FOR CHILDHOOD PSYCHIATRIC AND LEARNING DISORDERS, BUILDING THE SCIENCE OF HEALTHY BRAIN DEVELOPMENT, AND EMPOWERING CHILDREN AND THEIR FAMILIES WITH HELP, HOPE AND ANSWERS. (C) DESCRIPTION OF TRANSACTIONS: (1) BACKGROUND OVERVIEW. UNDER APPLICABLE LAW , ONLY PERSONS WHO ARE LICENSED TO PRACTICE MEDICINE MAY HOLD AN OWNERSHIP INTEREST IN AN ENTITY FORMED TO PROVIDE CLINICAL CARE AND TREATMENT. CMI, AS A NOT-FOR-PROFIT CORPORATION, IS NOT LEGALLY PERMITTED TO HOLD AN OWNERSHIP INTEREST IN THE PRACTICE. IN FURTHERANCE OF FULFILLING CMI'S MISSION, PROTECTING ITS ASSETS TO THE EXTENT USED TO SUPPORT RELATED CLINICAL AND RESEARCH ACTIVITIES CONDUCTED BY THE PRACTICE, AND COMPLYING WITH THE FOREGOING OWNERSHIP REQUIREMENT, DR. KOPLEWICZ, THE PRESIDENT OF CMI AND A LICENSED PHYSICIAN, BECAME THE CONTROLLING MEMBER OF THE PRACTICE. HOWEVER, THE MEMBERSHIP INTERESTS IN THE PRACTICE (I.E., DR. KOPLEWICZ'S 99% MEMBERSHIP INTEREST AND OF THE OTHER MEMBER, DR. RONALD STEINGARD'S 1% MEMBERSHIP INTEREST) HAVE BEEN STRUCTURED SO THAT NEITHER CAN RECEIVE, OR OTHERWISE REALIZE, ANY ECONOMIC BENEFIT FROM HOLDING THESE MEMBERSHIP INTERESTS OR FROM THE SALE OR OTHER DISPOSITION OF SUCH MEMBERSHIP INTERESTS. BOTH MEMBERS OF THE PRACTICE HAVE ENTERED INTO A BUY/SELL AGREEMENT WITH THE PRACTICE PURSUANT TO WHICH THEY HAVE AGREED NOT TO SELL THEIR INTERESTS TO ANY PARTY OTHER THAN THE PRACTICE, WHICH MAY RE-PURCHASE THEIR MEMBERSHIP INTERESTS FROM THEM FOR AN AMOUNT NOT TO EXCEED THE NOMINAL AMOUNT THAT SUCH MEMBERS PAID IN CONNECTION WITH THE ACQUISITION OF THEIR MEMBERSHIP INTERESTS. FURTHER, THE PRACTICE'S ARTICLES OF ORGANIZATION PROVIDE THAT THE PRACTICE IS TO BE OPERATED SOLELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES IN FURTHERANCE AND SUPPORT OF CMI'S CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES TO THE EXTENT NOT INCONSISTENT WITH RELEVANT NEW YORK LAW AND NONE OF ITS ASSETS, NET EARNINGS, INCOME OR PROFIT MAY BE DISTRIBUTED TO ANY MEMBER, MANAGER, OFFICER OR EMPLOYEE OF THE PRACTICE OR OTHER PRIVATE PERSON. THE PRACTICE'S ARTICLES OF ORGANIZATION PROVIDE THAT IF THE PRACTICE IS EVER DISSOLVED, ITS ASSETS AND PROPERTY MUST BE DISTRIBUTED TO A CHARITABLE ORGANIZATION QUALIFYING FOR EXEMPTION FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IN SPITE OF THIS, THE PRACTICE DOES NOT FALL UNDER THE DEFINITION OF A "RELATED ORGANIZATION" TO CMI UNDER THE FORM 990 INSTRUCTIONS. (2)RESTRICTED GRANT AGREEMENT BETWEEN CMI AND THE PRACTICE. TO FACILITATE THE FORMATION OF THE PRACTICE AND THE CONDUCT BY THE PRACTICE OF RESEARCH PROGRAMS AND SERVICES THAT FURTHER CMI'S CHARITABLE, SCIENTIFIC AND EDUCATIONAL MISSION, CMI ENTERED INTO A RESTRICTED GRANT AGREEMENT WITH THE PRACTICE PURSUANT TO WHICH CMI AGREED TO MAKE SPECIAL PURPOSE RESTRICTED GRANTS TO THE PRACTICE UP TO THE AGGREGATE AMOUNT OF $1,750,000 TO SUPPORT THE CONDUCT OF SUCH RESEARCH. THE RESTRICTED GRANT AGREEMENT PROVIDES, AMONG OTHER THINGS, THAT (A) THE PRACTICE IS REQUIRED TO OPERATE IN A MANNER THAT IS, AND LIMITS ITS ACTIVITIES TO THOSE THAT ARE CONSISTENT WITH AND FURTHER THE CHARITABLE, SCIENTIFIC AND EDUCATIONAL MISSION OF CMI, (B) THE GRANT MUST BE USED BY THE PRACTICE EXCLUSIVELY IN CONNECTION WITH THE CONDUCT OF ACTIVITIES THAT FURTHER AND SUPPORT CMI'S CHARITABLE, SCIENTIFIC AND EDUCATIONAL MISSIONS, AND (C) THE PRACTICE MUST OBSERVE VARIOUS REPORTING, BUDGETARY AND OTHER FINANCIAL REQUIREMENTS AND ITS AUDITORS MUST BE ACCEPTABLE TO CMI. IF THE PRACTICE FAILS TO OBSERVE THE REQUIREMENTS OF THE RESTRICTED GRANT AGREEMENT, THE AGREEMENT MAY BE TERMINATED, UNSPENT FUNDS MUST BE RETURNED TO CMI AND DAMAGES MAY BE DUE. TO DATE, THE PRACTICE HAS RECEIVED GRANTS IN THE AGGREGATE AMOUNT OF $690,000, ALL OF WHICH WERE MADE BY CMI TO THE PRACTICE PRIOR TO FY2012. CMI'S FINANCE COMMITTEE MONITORS GRANTS MADE TO THE PRACTICE. (3) ADMINISTRATIVE SERVICES AGREEMENT. PURSUANT TO AN ADMINISTRATIVE SERVICES AGREEMENT BETWEEN CMI AND THE PRACTICE, CMI PROVIDES CERTAIN ADMINISTRATIVE SERVICES TO THE PRACTICE FOR WHICH THE PRACTICE COMPENSATES CMI. CONSISTENT WITH CMI'S INTERNAL POLICIES AND PROCEDURES, THE FEE PAID BY THE PRACTICE TO CMI IS BASED ON THE FAIR MARKET VALUES OF THE PROVIDED SERVICES DETERMINED UNDER AN ARM'S LENGTH PROCESS BASED ON GUIDANCE BY EXTERNAL INDEPENDENT ADVISORS. THE PRACTICE'S PAYMENT OBLIGATION TO CMI FOR SERVICES PROVIDED UNDER THE ADMINISTRATIVE SERVICES AGREEMENT IS CURRENTLY REFLECTED AS A RECEIVABLE ON CMI'S FINANCIAL STATEMENTS IN THE AMOUNT OF $1,638,141, AS REFLECTED IN PART X OF THIS FORM 990. DURING FISCAL-YEAR 2013, CMI INCURRED $958,992 OF COSTS ASSOCIATED WITH PROVIDING ADMINISTRATIVE SERVICES TO PRACTICE, OF WHICH $100,000 HAS BEEN REIMBURSED IN FISCAL-YEAR 2013. (4) LICENSE AGREEMENT. PURSUANT TO A LICENSE AGREEMENT BETWEEN CMI AND THE PRACTICE, CMI GRANTED A ROYALTY-FREE LICENSE OF CERTAIN OF ITS TRADEMARKS AND DOMAIN NAMES TO THE PRACTICE SUBJECT TO CERTAIN TERMS AND CONDITIONS, INCLUDING THE TERMINATION OF THE LICENSE AGREEMENT IN THE EVENT OF THE PRACTICE'S BREACH OF THE TERMS AND CONDITIONS OF THE RESTRICTED GRANT AGREEMENT. (5)SUB-CONTRACTING. CMI HAS RECEIVED CONTRIBUTIONS AND GRANTS THAT REQUIRE SERVICES THAT IT IS UNABLE TO PROVIDE. IN THESE INSTANCES, CMI SUB-CONTRACTS WITH VARIOUS AGENCIES, INCLUDING THE PRACTICE, TO PERFORM THESE SERVICES. CMI DISCLOSES TO ITS DONORS AND GRANTORS THAT THOSE FUNDS RECEIVED WILL BE SUB-CONTRACTED TO SATISFY THE DONOR'S AND GRANTOR'S REQUESTS. DURING FISCAL-YEAR 2013, SUB-CONTRACTED AMOUNTS PAID TO THE PRACTICE IN PERFORMANCE OF THESE REQUESTS AMOUNTED TO $258,325.
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 5 268,664 fmv
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
 
No
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2012)
Schedule M (Form 990) (2012)
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) (2012)
Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Child Mind Institute Inc
 
Employer identification number

80-0478843
Identifier Return Reference Explanation
CMI MISSION AND PROGRAM SERVICES FORM 990, PART I, LINE 1 OUR ORGANIZATION IS COMMITTED TO FINDING MORE EFFECTIVE TREATMENTS FOR CHILDHOOD PSYCHIATRIC AND LEARNING DISORDERS, BUILDING THE SCIENCE OF HEALTHY BRAIN DEVELOPMENT, AND EMPOWERING CHILDREN AND THEIR FAMILIES WITH HELP, HOPE AND ANSWERS. FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES CLINICAL CARE: IN JULY 2010, THE CHILD MIND MEDICAL PRACTICE, PLLC ("PRACTICE") AND THE CHILD MIND INSTITUTE, INC. ("CMI") ENTERED INTO A RESTRICTED GRANT AGREEMENT WHEREBY CMI WOULD MAKE ONE OR MORE INITIAL GRANTS NOT TO EXCEED $750,000 IN AGGREGATE (SUBSEQUENTLY INCREASED BY CMI BOARD TO $1,750,000 IN AGGREGATE), TO THE PRACTICE IN ORDER TO ENABLE THE PRACTICE TO COVER ITS START UP COSTS AND BEGIN TREATING PATIENTS. DURING THE YEAR ENDED SEPTEMBER 30, 2013, NO AMOUNTS WERE PAID AS GRANTS. AGGREGATE GRANTS PAID TO DATE ARE $690,000. CMI'S FINANCE COMMITTEE MONITORS GRANTS MADE TO THE PRACTICE. SEE SCHEDULE L FOR ADDITIONAL INFORMATION REGARDING THE PRACTICE.
FAMILY RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 PHYLLIS GREEN AND RANDOLPH COWEN ARE HUSBAND AND WIFE MEGAN AND MARK DOWLEY ARE HUSBAND AND WIFE ELIZABETH AND MICHAEL FASCITELLI ARE HUSBAND AND WIFE DEBRA G. PERELMAN AND GIDEON M. GIL ARE HUSBAND AND WIFE AMY AND JOHN PHELAN ARE HUSBAND AND WIFE JANE ROSENTHAL AND CRAIG HATKOFF ARE HUSBAND AND WIFE ELLEN AND HOWARD KATZ ARE HUSBAND AND WIFE CHRISTINE AND RICHARD MACK ARE HUSBAND AND WIFE BROOKE GARBER NEIDICH AND DANIEL NEIDICH ARE HUSBAND AND WIFE JORDAN SCHAPS IS THE SON OF LINDA SCHAPS PREETHI KRISHNA AND RAM SUNDARAM ARE HUSBAND AND WIFE
FORM 990 FORM 990, PART VI, SECTION B, LINE 11 CMI'S FORM 990 IS PREPARED BY ITS INDEPENDENT ACCOUNTING FIRM, WITH THE ASSISTANCE OF CMI STAFF. THE DRAFT FORM 990 IS THEN REVIEWED BY CMI'S Executive Vice President/COO AND BY EXTERNAL INDEPENDENT LEGAL COUNSEL. THE DRAFT FORM 990 IS REVIEWED IN DETAIL BY THE FINANCE COMMITTEE OF CMI'S BOARD OF DIRECTORS, WHICH WAS DELEGATED THIS RESPONSIBILITY BY THE FULL BOARD OF DIRECTORS. THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND DISCUSSES THE CONTENTS THEREOF AT A MEETING WITH CMI'S INDEPENDENT AUDITORS. THE DRAFT FORM 990 IS THEN PRESENTED AND DISCUSSED BY THE CHAIR OF THE FINANCE COMMITTEE AT THE ANNUAL MEETING OF THE FULL BOARD. PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE, A COPY OF THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE ENTIRE BOARD FOR REVIEW AND COMMENT.
CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C CMI'S CONFLICT OF INTEREST POLICY REQUIRES DIRECTORS HAVING A POTENTIAL CONFLICT TO REPORT TO THE BOARD AND RECUSE THEMSELVES FROM A DISCUSSION AND A VOTE ON A CONFLICTED MATTER. CMI OBTAINS A SIGNED CONFLICT OF INTEREST DISCLOSURE FORM FROM EACH OF THE BOARD MEMBERS AND MANAGEMENT ON AN ANNUAL BASIS.
COMPENSATION POLICY FORM 990, PART VI, SECTION B, LINE 15 ALL EXECUTIVE LEVEL COMPENSATION IS REVIEWED BY AN OUTSIDE INDEPENDENT CONSULTANT, QUALIFIED TO REVIEW sIMILAR POSITIONS IN SIMILAR NON-PROFIT HEALTHCARE ENTITIES. THE REVIEW INCLUDES EACH INDIVIDUAL'S CV, YEARS OF EXPERIENCE, JOB DESCRIPTION AND GOALS FOR CURRENT POSITION, COMPARISON TO THE MARKET, AND SPECIAL CONSIDERATIONS SUCH AS RELOCATION, PAST PERFORMANCES AND ACCOMPLISHMENTS, AND NICHE EXPERTISE / KNOWLEDGE OF REQUIRED AREAS. NON-INTERESTED MEMBERS OF THE COMPENSATION COMMITTEE OF THE CMI BOARD OF DIRECTORS REVIEW THE COMPENSATION CONSULTANT'S REPORT AND MAKE A DETERMINATION ABOUT COMPENSATION BASED ON ALL RELEVANT FACTORS. THE COMPENSATION COMMITTEE'S DELIBERATIONS AND DECISIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE MINUTES AND RETAINED IN CHILD MIND INSTITUTE RECORDS.
AVAILABILITY OF ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE FORM 990 IS AVAILABLE UPON REQUEST. CMI PUBLISHES A SUMMARY OF ITS AUDITED FINANCIAL STATEMENTS IN THE ANNUAL REPORT WHICH IS AVAILABLE ON ITS WEBSITE.
REPORTABLE COMPENSATION FORM 990, PART VII, SECTION A, COLUMN D COMPENSATION OF THE PRESIDENT AND OTHER KEY EXECUTIVES IS SUBJECT TO THE CHILD MIND INSTITUTE'S WRITTEN COMPENSATION POLICY WHICH INCLUDES REVIEW BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION, BY THE BOARD'S COMPENSATION COMMITTEE.
PRIOR PERIOD ADJUSTMENTS FORM 990, PART X, LINES 25 AND 33 RESTATEMENT OF NET ASSETS: UNRESTRICTED NET ASSETS AT THE BEGINNING OF THE YEAR HAVE BEEN DECREASED BY $786,723 TO REFLECT INCREASES IN THE FOLLOWING LIABILITY BALANCES: DUE TO CHILD MIND MEDICAL PRACTICE - SUB-CONTRACTED SERVICES: $200,411 DEFERRED RENT LIABILITY: $586,312
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version: