2014-02-14T11:51:25-07:00 2013-06-30 APC Accounting & Tax Service 455 First Street Jesup IA 50648 990 2012-07-01 420763978 Mental Health Center of North Iowa Inc MENT 6414242075 235 S Eisenhower Avenue Mason City IA 50401 Andrew Eastwood 6414242075 2014-02-14 1 Pamela Bergmann P00891984 3192400518 2014-01-31 X 2012 2015-11-30 17:44:51Z Andrew Eastwood 235 S Eisenhower Avenue Mason City IA 50401 2589571 0 X www.mhconi.org X 1955 IA Provides diagnosis and treatment of general psychiatric and psychological disorders in a six county area. 8 8 42 0 0 0 51951 70662 2282359 2508769 10304 7522 5889 2618 2350503 2589571 0 0 0 0 1575140 1935997 0 0 0 1016319 662872 2591459 2598869 -240956 -9298 2025189 2020517 260797 257854 1764392 1762663 Provides diagnosis and treatment of general psychiatric and psychological disorders in a six county area. 0 0 1862022 0 2518909 Provided 5810 units of Psychiatric/Psychological Services 12801 units of Individual and Group Therapy Services and 1827 units of Diagnostic Services to patients in a six county area. 0 0 0 1862022 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 13 0 1 42 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Andrew Eastwood 6414242075 235 S Eisenhower Avenue Mason City IA 50401 Douglas Krull 0 0 X 0 0 0 Patricia Petersen 0 0 X 0 0 0 Ron Noah 0 0 X 0 0 0 James Hill 0 0 X 0 0 0 Penney Morse 0 0 X 0 0 0 Terri Tesch 0 0 X 0 0 0 Scott Helgeson 0 0 X 0 0 0 Andrew Hill 0 0 X 0 0 0 Andrew Eastwood 40 0 X 81553 0 14000 Abbie White 40 0 X 108056 0 13000 189609 0 27000 1 0 0 0 FasPsych LLC 3260 N Hayden Road Suite 105 Scottsdale AZ 85251 Psychiatric Services 165393 1 0 0 0 0 70473 189 0 70662 Patient Fees 624100 2229395 2229395 0 0 County Patient Fees Paid 624100 279374 279374 0 0 0 0 0 0 2508769 7522 7522 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2618 2618 0 0 2618 2589571 2518909 0 0 X 0 0 0 0 0 0 0 0 95553 0 95553 0 0 0 0 0 1492949 1140060 352889 0 69207 54689 14518 0 166225 105309 60916 0 112063 85788 26275 0 0 0 0 0 11385 0 11385 0 20621 0 20621 31617 20546 11071 0 37582 2358 35224 0 29699 29699 0 0 15425 10669 4756 0 3734 0 3734 0 59156 45567 13589 0 23417 15598 7819 0 Psychiatric Services 186453 186453 0 0 Repairs and Maintenance 44481 38393 6088 0 Continued Education 38878 38136 742 0 Program Supplies 23163 23163 0 0 137261 65594 71667 0 2598869 1862022 736847 0 372859 57914 445674 360196 21931 56618 916713 1316089 38801 37046 1522027 1329373 229211 192654 2025189 2020517 260797 257854 260797 257854 X 1748561 1746770 14565 14625 1266 1268 1764392 1762663 2025189 2020517 -9298 7569 0 0 0 0 X 0 1 X 1 0 X 219526 134958 152289 51951 70662 629386 575273 445566 415778 377227 379374 2193218 0 0 0 0 0 0 794799 580524 568067 429178 450036 2822604 0 2822604 48643 29790 19611 13267 15029 126340 0 0 0 0 0 0 11741 9459 13733 6173 2618 43724 2992668 0 0.94317 0.9379 X Part II Section B Line 10 Miscellaneous Income RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 2000 2000 0 818179 691134 127045 0 0 0 0 0 666687 608171 58516 0 35161 30068 5093 192654 2597140 7569 0 0 0 7569 2589571 0 0 0 2589571 2598869 0 0 0 0 0 2598869 0 0 0 2598869 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b Board Members and the Executive Director are given a copy of the 990 to review prior to filing. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Centers Conflict of Interest policy requires each employee, student, independent contractor, volunteer and Board Member to advise the Executive Director immediately of any conflict of interest. Written disclosures are obtained and reviewed annually by the Executive Director. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Compensation for the Executive Director and Key Employees is determined using comparative data and is substantiated in the personnel files. The Board of Directors reviews and approves compensation. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Governing Documents, Conflict of Interest policy and Financial Statements are made available upon request to the public at the facility's central location, 235 S Eisenhower Avenue, Mason City, IA 50401. Financial Statements are also available at the Iowa State Auditors website at http://auditor.iowa.gov/reports/index.html F990_P09_S00_L24a Form 990, Part IX, Line 24a - 24e Line 24e Telephone and Utilities 55957 Provision for Doubtful Accounts 54951 Staff Recruiting 12802 CHMC Association Dues 2273 Miscellaneous 11278