Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
COUNSELING SERVICES INC
Employer identification number
01-0315038
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the 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)
(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.") ....
3,325,311
2,382,100
2,477,900
2,332,496
1,897,420
12,415,227
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
3,325,311
2,382,100
2,477,900
2,332,496
1,897,420
12,415,227
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
12,415,227
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
3,325,311
2,382,100
2,477,900
2,332,496
1,897,420
12,415,227
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
37,854
28,114
31,811
29,264
10,823
137,866
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12,553,093
12
Gross receipts from related activities, etc. (see instructions)
..................
12
19,294,037
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
98.900 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
98.450 %
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 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)
(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)
(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
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 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:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
COUNSELING SERVICES INC
Employer identification number
01-0315038
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
COUNSELING SERVICES, INC. (CSI) IS A COMPREHENSIVE ORGANIZATION COMMITTED TO OFFERING EASY ACCESS TO A FULL CONTINUUM OF HIGH-QUALITY, INTEGRATED AND AFFORDABLE COMMUNITY MENTAL HEALTH AND SUBSTANCE ABUSE RESOURCES AND SUPPORT FOR THE PEOPLE WE SERVE. CSI IS A CREATIVE ORGANIZATION THAT PROMOTES INNOVATION, EVALUATION AND ACCOUNTABILITY IN RESOURCE DEVELOPMENT AND DELIVERY. OUR MISSION IS TO IMPROVE QUALITY OF LIFE, ENHANCE RECOVERY AND REDUCE STIGMA. WE BELIEVE THESE EFFORTS, COMBINED WITH INCREASING PRIDE AND JOY, ARE KEY TO PROMOTING PERSONAL GROWTH, IMPROVED HEALTH AND LASTING SATISFACTION. CSI IS A COLLABORATIVE ORGANIZATION THAT WORKS IN PARTNERSHIP WITH THE INDIVIDUALS AND THE COMMUNITIES WE SERVE TO MAKE THOSE COMMUNITIES HEALTHIER PLACES TO LIVE. WE ARE PARTNERS AND LEADERS IN CREATING AN EXCEPTIONAL HEALTHCARE SYSTEM FOR OUR CONSTITUENTS. MORE THAN WORDS, OUR MISSION STATEMENT IS A COMMITMENT, AN OBLIGATION, A CALL TO SERVICE.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
(CONTINUED FROM PAGE 2) MANAGEMENT SERVICES. COMMUNITY INTEGRATION SERVICES INCLUDE SUPPORTIVE COUNSELING AND CASE MANAGEMENT SERVICES. COMMUNITY REHABILITATION SERVICES ARE OFFERED IN TWO LOCATIONS, NORTH BERWICK AND BIDDEFORD. AT THESE SITES INDIVIDUALS LIVE IN INDEPENDENT APARTMENTS WHICH ARE SUPERVISED 12 HOURS A DAY AND HAVE STAFF ON CALL 24/7. PROVIDING THESE LEVELS OF CARE ALONG WITH A CLINICAL TEAM APPROACH ALLOWS FOR AN EASY TRANSITION FROM ONE LEVEL OF CARE TO ANOTHER WITHOUT THE DISRUPTION, DUPLICATION AND COST OF CHANGING PROVIDERS. THESE SERVICES PROVIDE A SAFETY NET OF CARE AND CAN ASSIST IN DECREASING PSYCHIATRIC HOSPITALIZATION. LASTLY, CSI OFFERS OPPORTUNITIES FOR PEER INVOLVEMENT INCLUDING TWO SOCIAL CLUBS IN THE SANFORD/SPRINGVALE AND BIDDEFORD COMMUNITIES. THERE IS ALSO OPPORTUNITY FOR INDIVIDUALS TO PARTICIPATE IN LIFE ENRICHMENT AND PEER ACTIVITIES. THERE WERE 37,017 COMMUNITY INTEGRATION HOURS AND 5,231 DAYS OF COMMUNITY REHABILITATION SERVICE PROVIDED. CSI'S TWO ACT TEAMS EACH MAINTAIN AN AVERAGE CENSUS OF 65 CLIENTS RECEIVING SERVICES FROM THE MULTI-DISCIPLINARY TEAM.
THIRD ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
(CONTINUED FROM PAGE 2) HOSPITALIZATION. THERE WERE 44,521 HOURS OF SERVICE PROVIDED.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
OTHER PSYCHIATRIC SERVICES-AN INTEGRAL PART OF CSI'S COMPREHENSIVE SERVICES INCLUDES THE AGENCY'S PSYCHIATRIC PROGRAM. PSYCHIATRISTS, NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS WORK IN PARTNERSHIP WITH THE CLIENT, THEIR FAMILY/SUPPORT SYSTEM, CLINICIAN AND TREATMENT TEAM. CSI PSYCHIATRIC STAFF PROVIDE PSYCHIATRIC EVALUATION AND MEDICATION MANAGEMENT AND ALSO PROVIDE CONSULTATION TO PRIMARY CARE PROVIDERS. CSI EMPLOYS A TEAM OF 15-20 PSYCHIATRIC STAFF WHO ARE LICENSED TO WORK WITH CHILDREN, ADOLESCENTS AND ADULTS. THERE WERE 12,895 HOURS OF SERVICE PROVIDED. ADULT OUTPATIENT SERVICES- ADULT SERVICES ARE DESIGNED TO RECOGNIZE CLIENTS' STRENGTHS, OPPORTUNITIES FOR GROWTH, AND TO FOCUS ON THEIR DIVERSITY BY OFFERING CLIENT FOCUSED TREATMENT PLANS WHILE PROVIDING OUTPATIENT PSYCHOTHERAPY SERVICES. THE GOAL IS TO IMPROVE THEIR QUALITY OF LIFE AND HELP THEM DEVELOP TO THEIR FULLEST POTENTIAL. CSI OFFERS A VARIETY OF COMPLEMENTARY THERAPIES INCLUDING MASSAGE, REIKI, AND ACUPUNCTURE, AS AN ADJUNCT TO TRADITIONAL MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES. THERE WERE 29,134 HOURS OF SERVICE PROVIDED. RESIDENTIAL SERVICES - CSI OPERATES INDEPENDENT AND SUPERVISED HOUSING. GROUP HOMES ARE LOCATED IN YORK AND BIDDEFORD AND TRANSITIONAL RESIDENTIAL HOUSING FACILITIES ARE OPERATED IN BIDDEFORD AND SANFORD. THERE WERE 8,808 DAYS OF SERVICE PROVIDED. SUBSTANCE ABUSE SERVICES- CSI PROVIDES SUBSTANCE ABUSE SERVICES FOR CHILDREN, ADOLESCENTS, ADULTS AND AFFECTED OTHERS INCLUDING EVALUATIONS, INDIVIDUAL COUNSELING, GROUP COUNSELING, DRIVER EDUCATION AND DRUG COURT. ALL SERVICES ARE TAILORED TO MEET THE NEEDS IDENTIFIED IN THE EVALUATION. THERE WERE 4,648 HOURS OF SERVICE PROVIDED.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS
FORM 990, PAGE 6, PART VI, LINE 4
ON APRIL 1, 2014, MAINE MENTAL HEALTH PARTNERS (26-3426990) AND ITS MEMBERS, SPRING HARBOR HOSPITAL (01-0524834), COMMUNITY COUNSELING CENTER (01-0288362), COUNSELING SERVICES INC. (01-0315038) AND SPRING HARBOR COMMUNITY SERVICES (01-0524835) MERGED INTO A SINGLE, UNIFIED ORGANIZATION UNDER THE TAX IDENTIFICATION NUMBER OF SPRING HARBOR HOSPITAL. THE NEW, MERGED ORGANIZATION WAS RENAMED MAINE BEHAVIORAL HEALTHCARE.
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PAGE 6, PART VI, LINE 6
MAINE MENTAL HEALTH PARTNERS (MMHP) IS THE SOLE MEMBER OF COUNSELING SERVICES, INC. MAINEHEALTH (EIN01-0431680), AS THE SOLE MEMBER OF MMHP, HAS THE RIGHT TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY OF MMHP AND ITS SUBSIDIARIES.
ELECTION OF MEMBERS AND THEIR RIGHTS
FORM 990, PAGE 6, PART VI, LINE 7A
THE SOLE MEMBER, MAINE MENTAL HEALTH PARTNERS, MAY ELECT THE BOARD OF DIRECTORS FROM A SLATE OF NOMINEES SUBMITTED BY THE CORPORATION. THE OFFICERS ARE ELECTED BY THE BOARD OF TRUSTEES, EXCEPT THAT THE CFO, COO, CHIEF MEDICAL OFFICER AND CHIEF CLINICAL & NURSING OFFICER ARE APPOINTED BY THE BOARD OF TRUSTEES BASED UPON A RECOMMENDATION OF THE CEO.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PAGE 6, PART VI, LINE 7B
DECISIONS OF THE GOVERNING BODY SUCH AS BUDGETS, BUSINESS STRATEGIES, SIGNIFICANT FINANCIAL COMMITMENTS, AMENDMENTS TO THE ARTICLES OF INCORPORATION, AND ELECTION OF THE PRESIDENT/CEO AMONG OTHER DECISIONS, ARE SUBJECT TO APPROVAL OF THE SOLE MEMBER.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE FORM 990 WAS REVIEWED BY THE BOARD OF THE NEWLY FORMED ORGANIZATION, MAINE BEHAVIORAL HEALTHCARE. (DETAILS AT BEGINNING OF SCHEDULE O). A DETAILED REVIEW OF THE FORM 990 IS PERFORMED BY THE CONTROLLER & CFO, PRIOR TO THE CFO SIGNING AND FILING THE RETURN.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
CONFLICT OF INTEREST STATEMENTS ARE OBTAINED ANNUALLY. THE ORGANIZATION REVIEWS THE RESPONSES TO THESE DOCUMENTS AND ADDRESSES ANY ISSUES IMMEDIATELY.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
COUNSELING SERVICES, INC. BOARD OF DIRECTORS ARE RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. FOR THOSE KEY ADMINISTRATIVE EMPLOYEES THAT ARE SHARED WITH MMHP, COMPENSATION IS EVALUATED BY THE MMHP GOVERNANCE COMMITTEE AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION COUNSULTING FIRM, AND INDUSTRY SURVEY.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
THE MEMBER IS RESPONSIBLE FOR AN ANNUAL EVALUATION OF THE PRESIDENT/CEO AND THE OTHER KEY ADMINISTRATIVE EMPLOYEES OF THE ORGANIZATION. COMPENSATION IS EVALUATED BY THE COMPENSATION COMMITTEE APPOINTED BY THE MEMBER, AND THE ORGANIZATION'S BOARD OF TRUSTEES MUST APPROVE OF THE COMPENSATION. IN ADDITION, THE ORGANIZATION UTILIZES THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTING FIRM, AND INDUSTRY SURVEY.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION ARE MADE AVAILABLE UPON REQUEST.
RECONCILIATION OF CHANGES - OTHER
FORM 990, PART XI, LINE 9
INCOME ON PERMANENTLY RESTRICTED NET ASSETS 7 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 5,894 GAIN ON INTEREST RATE SWAP 158,627
ADDITIONAL INFORMATION
FORM 990, PART XII
THE ORGANIZATION DID NOT HAVE A SEPARATE A-133 AUDIT. IT WAS PART OF THE CONSOLIDATED A-133 AUDIT OF ITS PARENT COMPANY, MAINE MENTAL HEALTH PARTNERS (EIN 26-3426990).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.