2013-04-12T12:53:04-05:00 2012-09-30 113518842 MARKS PANETH & SHRON LLP 685 THIRD AVENUE NEW YORK NY 10017 990 2011-10-01 800478843 CHILD MIND INSTITUTE INC CHIL 2123083118 445 PARK AVENUE NO 2ND FL NEW YORK NY 10022 DR HAROLD KOPLEWICZ MD PRESIDENT 2123083118 2013-04-12 1 ROBERT R LYONS CPA P00227472 2125038800 2011 2016-02-25 16:41:14Z DR HAROLD KOPLEWICZ MD 445 PARK AVENUE NO 2ND FL NEW YORK NY 10022 9849085 0 X WWW.CHILDMIND.ORG X 2009 NY WE ARE 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. 30 30 55 40 0 0 8975012 9573350 0 0 11131 14795 -26536 14859 8959607 9603004 690000 368066 0 0 2132516 3739872 130531 76046 1410683 3111197 3065507 6064244 7249491 2895363 2353513 9797368 13612923 386803 1858244 9410565 11754679 X 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. 0 0 1109904 PUBLIC EDUCATIONTHE 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! - THE CHILD MIND INSTITUTE'S SPEAK UP FOR KIDS IS A GLOBAL CAMPAIGN TO INCREASE PUBLIC AWARENESS OF THE SIGNS AND SYMPTOMS OF PSYCHIATRIC AND LEARNING DISORDERS IN CHILDREN, AND THE IMPORTANCE OF EARLY INTERVENTION THAT CAN TURN AROUND THEIR LIVES. EVERY MAY, DURING NATIONAL CHILDREN'S MENTAL HEALTH AWARENESS WEEK, THE CHILD MIND INSTITUTE WORKS WITH PARTNER ORGANIZATIONS WORLDWIDE TO SPONSOR EVENTS, INCLUDING FREE LECTURES BY PSYCHIATRISTS AND OTHER PROFESSIONALS, OPEN DAYS AT CLINICIANS' OFFICES AND NEUROSCIENCE LABS, EXHIBITIONS ABOUT CHILDREN'S MENTAL HEALTH, SOCIAL MEDIA ACTIVITIES, CLASSROOM WORKSHOPS, AND MORE. OVER THE LAST TWO YEARS. SPEAK UP FOR KIDS HAS HAD HUNDREDS OF THOUSANDS OF PARTICIPANTS "TURNING THE GLOBE GREEN," THE CAMPAIGN'S SIGNATURE COLOR, BY SPREADING THE WORD, GIVING A TALK, OR HOSTING A TALK IN THEIR LOCAL COMMUNITY OR THROUGH SOCIAL MEDIA TOOLS, SUCH AS FACEBOOK OR TWITTER.ADAM JEFFREY KATZ MEMORIAL LECTURE - DESIGNED TO RAISE AWARENESS AND EDUCATE THE PUBLIC ABOUT ADHD AND DYSLEXIA, THE KATZ FAMILY LAUNCHED THIS ANNUAL LECTURE IN 2003 AS A LIVING MEMORIAL TO ADAM KATZ, WHO STRUGGLED WITH BOTH DISORDERS. THE TWO-PART PROGRAM IS HELD EVERY MAY, DURING NATIONAL MENTAL HEALTH MONTH, AND FEATURES A LECTURE BY OR DISCUSSION WITH A LEADING EXPERT IN THE FIELD, AND A CANDID CONVERSATION WITH A CELEBRITY GUEST ABOUT LIVING WITH A MENTAL HEALTH DISORDER. PAST CELEBRITIES HAVE INCLUDED ACTOR ORLANDO BLOOM AND ACTRESS AND PRODUCER TRUDIE STYLER AND PRODUCER BRIAN GRAZER.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 - THE CHILD MIND INSTITUTE BELIEVES THE ARTS ARE CRITICAL TO CHILD DEVELOPMENT AND ACADEMIC SUCCESS BECAUSE THEY PROMOTE SELF-ESTEEM AND PROVIDE OPPORTUNITIES FOR SELF-EXPRESSION. THAT'S WHY THE CHILD MIND INSTITUTE INVITES PUBLIC AND INDEPENDENT SCHOOLS TO PARTICIPATE IN THE STUDENT ART PROJECT, OUR GALLERY PROGRAM DEDICATED TO DISPLAYING WORKS OF ART CREATED BY STUDENT ARTISTS. IN FOUR EXHIBITIONS A YEAR, STUDENT PIECES ARE DISPLAYED PROMINENTLY AT THE CHILD MIND INSTITUTE HEADQUARTERS, WHICH ACCOMMODATES 34 WORKS OF ART. EACH SHOW IS BASED ON A THEME CHOSEN BY AN ART TEACHER FROM THE SCHOOL. THE EXHIBITIONS LAUNCH WITH AN OPENING RECEPTION HOSTED BY THE CHILD MIND INSTITUTE 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. 1947262 SCIENCE AND INNOVATIONTHE CHILD MIND INSTITUTE HAS A SCIENCE AND INNOVATION MISSION THAT UNDERSCORES THE TRANSFORMATIVE POWER OF COLLABORATIVE RESEARCH IN THE FIELD OF CHILD MENTAL HEALTH.CENTER FOR THE DEVELOPING BRAIN - THE CHILD MIND INSTITUTE'S CENTER FOR THE DEVELOPING BRAIN LEADS AN INNOVATIVE NEUROSCIENCE INITIATIVE TO EXAMINE AND UNDERSTAND THE DEVELOPING BRAIN AND ACCELERATES THE PACE OF DISCOVERY IN THE FIELD. FOCUSED ON PROMOTING "OPEN SCIENCE" IN THE NEUROIMAGING FIELD, THE CENTER SPEARHEADS LARGE-SCALE DEMONSTRATIONS OF THE FEASIBILITY AND VALUE OF PROSPECTIVE DATA-SHARING: DISTRIBUTING THOUSANDS OF IMAGING DATASETS TO MULTIDISCIPLINARY SCIENTISTS WORLDWIDE FOR STUDY. THIS INITIATIVE IS KNOWN AS THE INTERNATIONAL DATA-SHARING INITIATIVE (INDI) AND IS A GAME-CHANGER IN THE SCIENTIFIC COMMUNITY OF CHILD PSYCHIATRY AND LEARNING DISORDERS; A FEW YEARS AGO SCIENTISTS VIEWED A MERE FEW DOZEN DATASETS AS A MAJOR RESOURCE. 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 HEALTHY BRAIN NETWORK AIMS TO ACQUIRE A FULL PICTURE OF HOW THE BRAIN MATURES AND FUNCTIONS AS A CHILD GROWS INTO ADOLESCENCE AND ADULTHOOD. BY COLLECTING NEUROIMAGING AND DNA DATA ON AN UNPRECEDENTED SCALE, CHILD MIND INSTITUTE SCIENTISTS WILL WORK TO CREATE A LANDMARK DATABASE, THE CHILD MIND INSTITUTE BIOBANK, THAT WILL ENABLE THE CREATION OF BRAIN "GROWTH CHARTS." THESE WILL BE THE WORLD'S FIRST COMPREHENSIVE MAPS OF HUMAN BRAIN FUNCTION OVER THE COURSE OF DEVELOPMENT, MIMICKING THE CHARTS PEDIATRICIANS USE TO TRACK CHILDREN'S HEIGHT AND WEIGHT. GIVING CLINICIANS THESE MAPS WILL IMPROVE THE EARLY IDENTIFICATION, ACCURATE DIAGNOSIS, AND APPROPRIATE TREATMENT OF 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.TEACHER CHILD INTERACTION TRAINING (NEW PROGRAM ADDED IN OCTOBER 2011) - IN PARTNERSHIP WITH THE DEPARTMENT OF EDUCATION AND SPONSORED BY THE NEW YORK CITY COUNCIL, TEACHER-CHILD INTERACTION TRAINING (TCIT) WAS IMPLEMENTED TO PROVIDE TEACHERS WITH CLASSROOM MANAGEMENT SKILLS TO BETTER MANAGE DISRUPTIVE BEHAVIOR BY THE STUDENTS. THIS PILOT PROGRAM WAS CONDUCTED IN FIVE GENERAL EDUCATION KINDERGARTEN AND FIRST GRADE CLASSES IN NEW YORK CITY PUBLIC SCHOOLS. THE TRAINING FOCUSED ON TWO SETS OF SKILLS: CHILD-DIRECTED INTERACTION (CDI), WHICH PROVIDES TEACHERS WITH SKILLS THAT REINFORCE STUDENTS' POSITIVE CLASSROOM BEHAVIORS AND PREVENT NEGATIVE CLASSROOM BEHAVIOR, AND TEACHER-DIRECTED INTERACTION (TDI), WHICH PROVIDES TEACHERS WITH EFFECTIVE METHODS OF INTERVENING AND SETTING LIMITS WHEN DISRUPTIVE BEHAVIOR OCCURS. 973948 ACCESS TO CLINICAL CARETHE 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 THE 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 90% 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 FOUNDATION HAS RAISED A CUMULATIVE TOTAL OF $520,500 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 $1,041,000. THIS PAST YEAR ALONE, THE CLINICIANS PROVIDED CLINICAL CARE WORTH APPROXIMATELY $524,000 IN FINANCIAL AID. 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 AGREEGATE), 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, 2012, NO AMOUNTS WERE PAID AS GRANTS. AGGREGATE GRANTS PAID TO DATE ARE $690,000. CMI'S FINANCE COMMITTEE MONITORS GRANTS MADE TO THE PRACTICE. 4031114 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 37 0 1 55 1 0 0 0 0 0 1 1 0 0 0 0 X 30 30 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY GA NH AL WI NC OR AZ CT MA PA X DAVID RIVERA 2123083118 445 PARK AVENUE NEW YORK NY 10022 X PHYLLIS GREEN 0.50 X 0 0 0 RANDOLPH COWEN 0.50 X 0 0 0 MEGAN DOWLEY 0.50 X 0 0 0 MARK DOWLEY 0.50 X 0 0 0 AUTHUR G ALTSCHUL JR 0.50 X 0 0 0 MARGARET GRIEVE 13.50 X 0 0 0 ELIZABETH FASCITELLI 0.50 X X 0 0 0 MICHAEL FASCITELLI 0.50 X 0 0 0 GIDEON M GIL 0.50 X 0 0 0 DEBRA PERELMAN 2.50 X X 0 0 0 GEORGE HALL 0.50 X 0 0 0 JANE ROSENTHAL 0.50 X 0 0 0 CRAIG HATKOFF 0.50 X 0 0 0 JOSEPH HEALEY 0.50 X 0 0 0 ELLEN KATZ 0.50 X 0 0 0 HOWARD KATZ 0.50 X 0 0 0 CHRISTINE MACK 0.50 X 0 0 0 RICHARD MACK 0.50 X 0 0 0 STEVEN MARCUS 0.50 X 0 0 0 ANNE WELSH MCNULTY 0.50 X X 0 0 0 JULIE MINSKOFF 0.50 X 0 0 0 MARCIA MISHAAN 0.50 X 0 0 0 RICHARD MISHAAN 0.50 X 0 0 0 DANIEL NEIDICH 0.50 X 0 0 0 JORDAN SCHAPS 0.50 X 0 0 0 LINDA SCHAPS 0.50 X 0 0 0 CLAUDE WASSERSTEIN 0.50 X 0 0 0 PREETHI KRISHNA 0.50 X 0 0 0 RAM SUNDARAM 0.50 X 0 0 0 BROOKE GARBER NEIDICH 3.00 X X 0 0 0 DR HAROLD KOPLEWICZ MD 40.00 X 600101 0 256907 SHERINE KHALIL 40.00 X 280745 0 22528 REBECCA BENGHIAT 40.00 X 77457 0 22927 DAVID RIVERA 40.00 X 0 0 0 LISA GIOIA-HERNANDEZ 40.00 X 134379 0 16255 DAWN THOMSEN 40.00 X 111665 0 27085 ILEAN HELLAND 40.00 X 105142 0 30060 MICHAEL MILHAM 40.00 X 125413 0 12036 1434902 0 387798 6 0 1 0 MCGOVERN AND COMPANY 286 MADISON AVE 22ND FL NEW YORK NY 10017 CONSTRUCTION 1308148 MADISON TECHNOLOGY 825 THIRD AVENUE 2ND FL NEW YORK NY 10022 OUTSOURCED IT SUPPORT 314343 RED INTERACTIVE AGENCY LLC 3420 OCEAN PK BLVD STE 3080 SANTA MONICA CA 90405 WEBSITE DEVELOPMENT 290418 42ND STREET LESSEE 110 EAST 42ND STREET NEW YORK NY 10017 EVENT VENUE 170170 4 4715001 4858349 423286 9573350 14795 14795 246081 4715001 246081 0 MISCELLANEOUS REVENUE 900099 14859 14859 14859 9603004 0 0 29654 105590 105590 262476 262476 1290633 293138 551764 445731 2025752 1576755 275270 173727 423487 290511 86862 46114 107593 107593 104704 104704 76046 76046 824612 298188 176138 350286 7742 4412 3330 64466 35209 17106 12151 84952 56880 6157 21915 806874 507973 176395 122506 132565 61532 50191 20842 7542 4370 1983 1189 508027 336568 119600 51859 58909 36817 16388 5704 COMPUTERS & EQUIPMENT 185154 87469 75659 22026 PRINTING 49465 13093 3024 33348 BANK FEES 47175 22120 16863 8192 TELEPHONE 26183 10616 13444 2123 49544 27397 5223 16924 7249491 4031114 1807694 1410683 5190112 777697 81082 5871763 1357393 2821575 184589 214562 3510462 809234 2448409 2701228 327901 535783 898197 9797368 13612923 363645 1015269 23158 842975 386803 1858244 X 7514954 8574646 1895611 3180033 9410565 11754679 9797368 13612923 X 2353513 -9399 X X 0 1 1 X 0 X 8570923 8975012 9573350 27119285 8570923 8975012 9573350 27119285 7216712 19902573 2513 11131 14795 28439 16971 14859 31830 27179554 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 35098 0 0 35098 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PREVENT THE $29 MILLION FUNDING REDUCTION IN PRESIDENT OBAMA'S 2013 BUDGET FOR THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA). EXPLORE OPPORTUNITIES WITH SAMHSA TO CREATE A WORKFORCE DEVELOPMENT PROGRAM FOR CHILD AND ADOLESCENT PSYCHIATRY THAT WOULD HELP ADDRESS THE CRITICAL SHORTAGE OF QUALIFIED MENTAL HEALTH PROFESSIONALS. EXPLORE GENERATING GRANT FROM THE MILITARY TO SUPPORT VETERANS AND THEIR FAMILIES. GRASS ROOTS LOBBYING- $415 DIRECT LOBBYING- $34,683 1762812 173048 1589764 1009452 232306 777146 738198 403880 334318 2701228 SECURITY DEPOSITS 119049 DUE FROM CHILD MIND MEDICAL PRACTICE, PLLC 779148 898197 DEFERRED RENT LIABILITY 733675 DEFERRED COMPENSATION LIABILITY 109300 842975 9603004 7249491 2353513 -9399 -9399 2344114 9619238 16234 16234 9603004 0 9603004 7275124 16234 9399 25633 7249491 0 7249491 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: CHILD MIND INSTITUTE HAS NO UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2012 AND 2011 IN ACCORDANCE WITH ACCOUNTING STANDARDS CODIFICATION ("ASC") TOPIC 740, INCOME TAXES, WHICH PROVIDES STANDARDS FOR ESTABLISHING AND CLASSIFYING ANY TAX PROVISION FOR UNCERTAIN TAX POSITIONS. X X X X X X X 1 EVENT ASSOCIATESINC 162 WEST 56TH ST NY NY 10019 FUNDRAISING FOR GALA 0 4961082 76046 4885036 4961082 76046 4885036 NY GA NH AL WI NC OR AZ CT MA PA GALA EVENT 4961082 4715001 246081 246081 4961082 4715001 246081 246081 246081 0 EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) THE $76,046 INDICATED REPRESENTS THE AMOUNT PAID TO THE PROFESSIONAL FUNDRAISING COMPANY, EVENT ASSOCIATES, TOWARDS THE PLANNING OF THE DECEMBER 2011 ANNUAL BENEFIT DINNER. OF THAT AMOUNT, $43,000 WAS PRE-PAID TO EVENT ASSOCIATES IN THE PREVIOUS FISCAL YEAR 2011, TOWARD THE PLANNING OF DECEMBER 2011 ANNUAL BENEFIT DINNER. THE TOTAL AMOUNT PAID TO EVENT ASSOCIATES FOR THE PLANNING OF THE DECEMBER 2011 ANNUAL DINNER WAS $76,046, WHICH INCLUDED THE $65,000 CONTRACT, PLUS $11,046 IN REIMBURSABLE EXPENSES (I.E. POSTAGE, PRINTING, ETC.). FURTHER, A NEW CONTRACT WITH EVENT ASSOCIATES TO PLAN THE DECEMBER 2012 ANNUAL BENEFIT DINNER WAS EXECUTED, AND $32,000 WAS PRE-PAID TOWARDS THAT CONTRACT IN FISCAL YEAR 2012. 1 RESEARCH FOUNDATION FOR MENTAL HYGIENE 150 BROADWAY SUITE 301 MENANDS NY 12204 141410842 501(C)(6) 80590 FMV SEE PART IV NATIONAL FEDERATION OF FAMILIES 9605 MEDICAL CENTER DRIVE SUITE 280 280 ROCKVILLE MD 20850 521671408 501(C)(3) 25000 FMV SEE PART IV 1 1 SEE PART IV 159 262476 0 FMV N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CMI RECEIVES EXPENSE REPORTS ON A QUARTERLY BASIS FROM GRANTEES 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 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 II, LINE 1A THE CHILD MIND INSTITUTE CONTRIBUTED $25,000 TO THE NATIONAL FEDERATION OF FAMILIES FOR CHILDREN'S MENTAL HEALTH AS A CONTRIBUTION TO NATIONAL CHILDREN'S MENTAL HEALTH AWARENESS DAY. SCHEDULE I, PART III, LINE 1A THE CHILD MIND INSTITUTE PROVIDES A FINANCIAL AID PROGRAM THAT OFFERS ELIGIBLE FAMILIES A FEE DISCOUNT FOR CHILD MENTAL HEALTH CARE, INCLUDING THOSE ASSOCIATED WITH LEARNING DISABILITIES. 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. IN FY 2012 A TOTAL OF 159 PATIENTS RECEIVED $262,476 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 $524,000 OF SUPPORT TOWARDS CLINICAL SERVICES. X X X X X 0 1 0 0 0 0 0 0 0 DR HAROLD KOPLEWICZ MD 420101 0 180000 0 0 0 119300 0 137607 0 857008 0 0 0 SHERINE KHALIL 280745 0 0 0 0 0 8143 0 14385 0 303273 0 0 0 LISA GIOIA-HERNANDEZ 134379 0 0 0 0 0 6750 0 9505 0 150634 0 0 0 SUPPLEMENTAL INFORMATION PART III 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. CMMP PLLC SEE PART V 779148 SEE PART V 0 SCH 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 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, THEREFORE IS NOT 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 THE OTHER MEMBER'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 INTEREST'S. 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 ARE IN THE PROCESS OF BEING AMENDED TO PROVIDE THAT THE PRACTICE IS TO BE OPERATED SOLELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL 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 AMENDED ARTICLES OF ORGANIZATION OF THE PRACTICE WILL 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. THE PRACTICE DOES NOT FALL UNDER THE DEFINITION OF A "RELATED ORGANIZATION" 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 METHODOLOGY FOR DETERMINING THE FAIR VALUE OF SUCH SERVICES IS INDEPENDENTLY MONITORED PERIODICALLY BY CMI'S INDEPENDENT AUDITORS. 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 $779,148, AS REFLECTED IN PART X OF THIS FORM 990. (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 THE TERMS AND CONDITIONS THEREOF, 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. X 13 423286 FMV 0 0 0 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 LORI AND GEORGE HALL 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 MARCIA AND RICHARD MISHAAN ARE HUSBAND AND WIFE BROOKE GARBER NEIDICH AND DANIEL NEIDICH ARE HUSBAND AND WIFE JORDAN SCHAPS IS THE SON OF LINDA SCHAPS LINDA SCHAPS IS THE MOTHER OF JORDAN SCHAPS PREETHI KRISHNA AND RAM SUNDARAM ARE HUSBAND AND WIFE 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 CHIEF OPERATING OFFICER AND BY EXTERNAL INDEPENDENT LEGAL COUNSEL. THE DRAFT FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE OF CMI'S BOARD OF DIRECTORS, WHICH WAS DELEGATED RESPONSIBILITY BY THE FULL BOARD OF DIRECTORS TO REVIEW THE FORM 990 IN DETAIL. 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. 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 ANNUALLY A SIGNED CONFLICT OF INTEREST DISCLOSURE FORM FROM EACH OF THE BOARD MEMBERS AND MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 ALL EXECUTIVE LEVEL COMPENSATION IS REVIEWED BY A CONTRACTED 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 THE DOCUMENTATION RELIED ON BY THE COMMITTEE IS RETAINED IN CHILD MIND INSTITUTE RECORDS. FORM 990, PART VI, SECTION C, LINE 19 A SUMMARY OF AUDITED FINANCIAL STATEMENTS IS AVAILABLE IN THE CHILD MIND INSTITUTE'S ONLINE ANNUAL REPORT. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -9,399. FORM 990, PART XII, LINE 2C: THE CHILD MIND INSTITUTE INITIALLY RETAINED MARKS PANETH & SHRON THROUGH A COMPETITIVE PROCESS. SUBSEQUENTLY, IN 2011 THE BOARD, UPON THE RECOMMENDATION OF THE FINANCE COMMITTEE, DETERMINED TO CONTINUE TO RETAIN THEIR SERVICES AS THE INDEPENDENT AUDITOR FOR THE CHILD MIND INSTITUTE.