Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,378,768 | 785,700 | 1,199,826 | 461,096 | 514,058 | 5,339,448 |
| 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 | 2,378,768 | 785,700 | 1,199,826 | 461,096 | 514,058 | 5,339,448 |
| 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) .. | 691,940 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 4,647,508 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,378,768 | 785,700 | 1,199,826 | 461,096 | 514,058 | 5,339,448 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 383 | 10,712 | 80,900 | 91,995 | ||
| 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 VI.).. | 23,822 | 2,200 | 131 | 26,153 | ||
| 11 | Total support. Add lines 7 through 10 | 5,457,596 | |||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 on 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2019 AMOUNT: $ 3,450. 2020 AMOUNT: $ 2,200. 2021 AMOUNT: $ 131. BAD DEBT RECOVERY - 2019 AMOUNT: $ 20,372. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART I, LINE 1 | IN JANUARY, 2020, CGC FORMALIZED A NEW ALLIANCE WITH COMMUNITY HEALTH CENTERS INC. (CHCI), A NON-PROFIT BASED IN MIDDLETOWN, CT. CHCI HAS BECOME THE "SOLE MEMBER" OF CGC, WHICH ALLOWS CHILD GUIDANCE TO RETAIN ITS NAME AND ITS TAX ID AS A DISTINCT NON-PROFIT AND TO CONTINUE TO RAISE FUNDS FOR THE SAME PROGRAMS AND COMMUNITIES IT HAS SERVED FOR OVER 60 YEARS. THE CGC GOVERNING BOARD PRIOR TO THE ALLIANCE HAS BEEN CONVERTED TO AN ADVISORY BOARD POST-ALLIANCE IN ORDER TO SUPPORT THESE FUNDRAISING ACTIVITIES. AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC), CHCI DELIVERS INTEGRATED HEALTH CARE (MEDICAL, DENTAL AND BEHAVIORAL HEALTH) TO OVER 150,000 CHILDREN AND ADULTS STATEWIDE, BUT HAS CHOSEN TO STRATEGICALLY EXPAND ITS BEHAVIORAL HEALTH SERVICES TO CHILDREN. CHCI IS KEENLY FOCUSED ON PRESERVING THE SERVICES WE DELIVER IN THE SAME MANNER, TO THE SAME CLIENTS, AND WITH THE SAME PEOPLE. THIS ALLIANCE OPENS UP THE OPPORTUNITY FOR PROGRAM EXPANSION FOR BOTH ORGANIZATIONS. CHCI BENEFITS FROM CGC'S EXPERTISE IN TREATING THE MORE COMPLEX AND ACUTE MENTAL HEALTH ISSUES SEEN IN CHILDREN TODAY AND CHCI'S INTEGRATED HEALTHCARE SERVICES CREATE POSSIBILITIES FOR CGC TO IMPROVE ACCESS TO MEDICAL AND DENTAL CARE FOR ITS CLIENTS AND ENHANCE PROGRAMS. IN FY2020, CGC MOVED ITS SECOND STAMFORD OFFICE FROM AN OWNED DOWNTOWN LOCATION WITH LIMITED PARKING TO A LEASED, MORE CONVENIENT SPACE ON SHIPPAN AVENUE WITH AMPLE PARKING. BESIDES THE BENEFITS TO OUR MOBILE CRISIS UNIT AND THE EXPANSION OF OUR CFT CLINICAL HOURS, THIS NEWLY BUILT-OUT SPACE ALLOWED CGC TO UPDATE THE TECHNOLOGY AND CONFIGURATION OF OUR CHILD ADVOCACY CENTER TO BETTER SERVE THIS VULNERABLE POPULATION. CHILDREN REFERRED TO CGC STRUGGLE WITH A RANGE OF PSYCHIATRIC CONCERNS THAT INCLUDE DEPRESSION, ANXIETY, DEVELOPMENTAL DELAYS, TRAUMA, AGGRESSION TOWARD OTHERS, AND SUICIDAL AND SELF-INJURIOUS BEHAVIOR. WITH SIX OFFICE LOCATIONS SERVING STAMFORD, GREENWICH, DARIEN, AND NEW CANAAN, CGC PROVIDES COMPREHENSIVE SERVICES IN-OFFICE, IN-HOME, IN THE COMMUNITY, AS WELL AS 365 DAYS PER YEAR MOBILE CRISIS INTERVENTION SERVICES. CGC SERVICES ARE AVAILABLE TO ALL CHILDREN AND FAMILIES SEEKING TREATMENT, REGARDLESS OF THEIR ABILITY TO PAY. CGC SUBSIDIZES CARE FOR ITS CLIENTS AND HAS A SLIDING FEE SCALE TO ENSURE THAT EVEN FAMILIES WITH HIGH DEDUCTIBLE PRIVATE INSURANCE PLANS ARE ABLE TO ACCESS NEEDED MENTAL HEALTH SERVICES FOR THEIR CHILDREN. THE AGENCY'S SERVICES TO CHILDREN DECREASE THE LIKELIHOOD OF NEGATIVE OUTCOMES LATER IN LIFE, SUCH AS ADULT MENTAL ILLNESS, UNEMPLOYMENT, POVERTY, AND DIFFICULTY SUSTAINING STABLE RELATIONSHIPS. |
| FORM 990, PART VI, SECTION A, LINE 6 | COMMUNITY HEALTH CENTER, INCORPORATED SHALL BE THE SOLE MEMBER OF THE ORGANIZATION AND IS HEREAFTER REFFERED TO AS THE "MEMBER" AS OF JANUARY 5, 2020. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO APPOINT, REMOVE, OR REPLACE THOSE INDIVIDUALS SERVING ON THE CORPORATION'S BOARD OF DIRECTORS (THE "BOARD"). IN ADDITION, THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO DETERMINE THE NUMBER OF DIRECTORS TO SERVE IN A PARTICULAR YEAR UNDER ARTICLE 3 OF THE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION'S BOARD CANNOT MAKE DECISIONS ON THE FOLLOWING MATTERS WITHOUT THE CONSENT OR APPROVAL OF THE SOLE MEMBER: 1. THE AMENDMENT OF THE CERTIFICATE OF INCORPORATION 2. THE AMENDMENT OF THE BYLAWS 3. THE APPROVAL OF A PLAN OF MERGER OR A SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ASSETS, OTHER THAN A DISPOSITION DESCRIBED IN SECTION 33-1165 OF THE ACT, IF THE DISPOSITION WOULD LEAVE THE CORPORATION WITHOUT A SIGNIFICANT CONTINUING ACTIVITY; OR 4. THE APPROVAL OF A PROPOSAL TO DISSOLVE THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY THE ORGANIZATION'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS. PRIOR TO FILING, IT IS REVIEWED AND APPROVED BY THE PRESIDENT/CEO, CHIEF FINANCIAL OFFICER AND CONTROLLER OF THE SOLE MEMBER. A COPY IS THEN PROVIDED ELECTRONICALLY TO THE GOVERNING BOARD AND ADVISORY BOARD FOR QUESTIONS AND COMMENTS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS, OFFICERS, THE CHIEF FINANCIAL OFFICER, AND THE PRESIDENT/CEO ARE COVERED BY THE CENTER'S POLICY AND ARE REQUIRED ANNUALLY TO SIGN A STATEMENT INDICATING THAT THEY ARE FAMILIAR WITH THE CENTER'S POLICY AND THAT THEY EITHER HAVE NO CONFLICTS OR LIST WHATEVER CONFLICTS THEY MAY HAVE. ANY PERSON COVERED BY THE POLICY WITH A CONFLICT OF INTEREST WITH RESPECT TO A TRANSACTION IS REQUIRED TO DISCLOSE THE NATURE OF SUCH INTEREST AND ALL MATERIAL FACTS RELATING THERETO PRIOR TO THE BOARD'S CONSIDERATION. CONSIDERATION AND ACTION ON THE TRANSACTION IS BY A MAJORITY OF THE BOARD OF DIRECTORS WHO DO NOT HAVE A CONFLICTING INTEREST WITH RESPECT TO THE TRANSACTION. NO TRANSACTION INVOLVING A CONFLICTING INTEREST SHALL BE APPROVED EXCEPT AS PERMITTED BY SECTION 33-1129 OR 33-1130 OF THE CONNECTICUT GENERAL STATUTES AND AS FOLLOWS: (A) APPROVAL SHALL BE BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THOSE MEMBERS OF THE BOARD OF DIRECTORS WHO ARE PRESENT AT A DULY CONSTITUTED MEETING OF THE BOARD AND WHO DO NOT HAVE A CONFLICTING INTEREST WITH RESPECT TO THE TRANSACTION; (B) NO PERSON (INCLUDING A DIRECTOR) WITH A CONFLICTING INTEREST WITH RESPECT TO A TRANSACTION SHALL VOTE ON THE TRANSACTION OR REMAIN PRESENT DURING DEBATE OR VOTING ON THE TRANSACTION, BUT MAY OTHERWISE BE PRESENT TO ANSWER QUESTIONS; (C) THE BOARD SHALL DETERMINE, WITH APPROPRIATE DUE DILIGENCE, WHETHER THE CORPORATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST; (D) IN CONSIDERING WHETHER TO APPROVE THE TRANSACTION INVOLVING A CONFLICT OF INTEREST, THE BOARD SHALL DETERMINE WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE;(E) THE BOARD SHALL NOT APPROVE ANY "EXCESS BENEFIT TRANSACTION" FOR WHICH ANY EXCISE TAX MAY BE IMPOSED UNDER SECTION 4958 OF THE INTERNAL REVENUE CODE AND THE RULES AND REGULATIONS THEREUNDER; AND (F) THE SECRETARY SHALL DOCUMENT THE BASIS FOR THE BOARD OF DIRECTORS' DETERMINATION, INCLUDING A RECORD OF THE DISCUSSION PRECEDING THE VOTE AND ANY DOCUMENTARY OR OTHER DATA REVIEWED BY THE DIRECTORS, IN THE MINUTES OF THE MEETING OR OTHERWISE, BUT IN ALL EVENTS PRIOR TO THE NEXT MEETING OF THE BOARD OR COMMITTEE, AND SUCH MINUTES OR OTHER RECORD SHALL BE APPROVED AS ACCURATE AND COMPLETE AT SUCH NEXT MEETING. |
| FORM 990, PART VI, SECTION B, LINE 15A | CGC'S CEO IS PAID BY A RELATED ORGANIZATION, MOSES-WEITZMAN HEALTH SYSTEM, INC. THE COMPENSATION FOR CGC'S CEO WAS SET BY THE CHAIRMAN OF CGC'S GOVERNING BOARD, WHO IS ALSO THE CEO OF MOSES-WEITZMAN HEALTH SYSTEM, INC. THIS WAS DONE EVERY YEAR AFTER THE CLOSE OF THE FISCAL YEAR IN ORDER TO REFLECT THE CGC CEO'S PERFORMANCE AS MEASURED AGAINST HER GOALS FOR THE FISCAL YEAR. THE PROCESS AND APPROVAL WAS DOCUMENTED IN THE CGC CEO'S PERSONNEL FILE. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST, THE ORGANIZATION WILL PROVIDE THE GENERAL PUBLIC WITH A COPY OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990, FORM 1023 AND FINANCIAL STATEMENTS. |
| FORM 990, PART XII, LINE 2C: | CHILD GUIDANCE CENTER OF SOUTHERN CONNECTICUT, INC. HAD THE GOVERNING BOARD ASSUME RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF ITS INDEPENDENT AUDITOR. THE POLICY FOR SELECTION AND OVERSIGHT OF THE INDEPENDENT AUDITORS HAS NOT CHANGED SINCE LAST YEAR. |
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