NORTHWEST BEHAVIORAL HEALTH SERVICES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
NORTHWEST BEHAVIORAL HEALTH SERVICES INC (EIN 59-3128476)
Tax period
2012-07-01 to 2013-06-30
Filed
2013-11-19
IRS object ID
201323239349300307
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-19T09:40:33-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLEIMAN & COMPANY PABusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line19471 BAYMEADOWS RD SUITE 308AddressLine1
CityJACKSONVILLECity
StateFLState
ZIP Code32256ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN593128476EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTHWEST BEHAVIORAL HEALTH SERVICEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone9047817797Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12392 EDGEWOOD AVENUEAddressLine1
CityJACKSONVILLECity
StateFLState
ZIP Code32254ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePATRICIA SAMPSONName
TitleEXECUTIVE DIRECTORTitle
Phone9047817797Phone
Date Signed2013-11-18DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS C PLEIMAN JRName
Phone9044485005Phone
Date Prepared2013-11-18DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts2614959GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Type Of Organization CorporationXTypeOfOrganizationCorporation
Activity Or Mission DescriptionMENTAL HEALTH AND SOCIAL REHABILITATION SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees64TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1625047ContributionsGrantsPriorYear
Contributions Grants Current Year1644274ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1106510ProgramServiceRevenuePriorYear
Program Service Revenue CY970685ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year2731557TotalRevenuePriorYear
Total Revenue Current Year2614959TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1740682SalariesEtcPriorYear
Salaries Etc Current Year1841142SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year954587OtherExpensePriorYear
Other Expenses Current Year940245OtherExpensesCurrentYear
Total Expenses Prior Year2695269TotalExpensesPriorYear
Total Expenses Current Year2781387TotalExpensesCurrentYear
Revenues Less Expenses Prior Year36288RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-166428RevenuesLessExpensesCY
Total Assets BOY999251TotalAssetsBOY
Total Assets EOY921948TotalAssetsEOY
Total Liabilities BOY280195TotalLiabilitiesBOY
Total Liabilities EOY386343TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY719056NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY535605NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMENTAL HEALTH AND SOCIAL REHABILITATION SERVICESMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense870352Expense
DescriptionMENTAL HEALTH CASE MANAGEMENT SERVICES PROVIDED TO TARGET ADULT POPULATION IN NORTHWEST QUADRANT OF DUVAL COUNTY.APPROXIMATELY 789 CLIENTS WERE SERVED DURING YEAR.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense742549Expense
DescriptionSOCIAL REHABILITATIVE SERVICES PROVIDED TO TARGETED POPULATION IN THE NORTHWEST QUADRANT OF DUVAL COUNTY. APPROXIMATELY 66 CLIENTS WERE SERVED DURING THE YEAR.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense816836Expense
DescriptionMENTAL HEALTH TREATMENT SERVICES PROVIDED TO THE CHILDREN POPULATION IN THE NORTHWEST QUADRANT OF DUVAL COUNTY.APPROXIMAELY 463 WERE SERVED DURING THE YEAR.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense51154Expense
DescriptionCOMMUNITY SERVICESDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp51154TotalOfOtherProgramServiceExp
Total Program Service Expense2480891TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredfalseScheduleORequired
Number Forms Transmitted With109631NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees64NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMELLEN BARNESNamePerson
Telephone Number9047817797TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12392 N EDGEWOOD AAddressLine1
CityJACKSONVILLECity
StateFLState
ZIP Code32254ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
PATRICIA SAMPSON
EXE. DIRECTO40.00XX8829800
STEWARD WASHINGTON
PRESIDENTX000
MAGDALENE HOPES
BOARD MEMBERX000
MIA R WILSON
VICE PRESIDEX000
CLIFTON COLEMAN
BOARD MEMBERX000
PADRICA MENDEZ
BOARD MEMBERX000
ANN BLACKSHEAR
BOARD MEMBERX000
CHARLES FRANZONI
BOARD MEMBERX000
REGINALD ESTELL JR
PARLIAMENTARX000
MARIE HEATH
SECRETARYX000
NINA HARLEY
VICE-PRESIDEX000
ODEAN THOMAS
TREASURERX000
FieldValueIRS element (for citing)
Total Reportable Comp From Org88298TotalReportableCompFromOrg
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Government Grants1593002GovernmentGrants
All Other Contributions51272AllOtherContributions
Total Contributions1644274TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID905557905557
OTHER6512865128
FieldValueIRS element (for citing)
Total Program Service Revenue970685TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2614959TotalRevenueColumn
Related Or Exempt Function Income970685RelatedOrExemptFunctionIncome

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1449331Total
Program Services1326589ProgramServices
Management And General122742ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total261475Total
Program Services242469ProgramServices
Management And General19006ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total130336Total
Program Services119690ProgramServices
Management And General10646ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total124Total
Program Services124ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total29845Total
Management And General29845ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total400Total
Program Services250ProgramServices
Management And General150ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total154769Total
Program Services122159ProgramServices
Management And General32610ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total29483Total
Program Services28424ProgramServices
Management And General1059ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total19239Total
Program Services15370ProgramServices
Management And General3869ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CONSULTANTS AND SUBCONTRA26219124655115640
CLIENT SERVICES119878119878
PSYCHIATRIST110850110850
OTHER40235816932066

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total173231Total
Program Services140368ProgramServices
Management And General32863ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2781387Total
Program Services2480891ProgramServices
Management And General300496ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1617BOY
EOY1065EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY281448BOY
EOY259278EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY89681BOY
EOY52121EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY62767BOY
EOY62767EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis765633LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec222378LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY560276BOY
EOY543255EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3462BOY
EOY3462EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY999251BOY
EOY921948EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY280195BOY
EOY370343EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY16000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY280195BOY
EOY386343EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY719056BOY
EOY535605EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY719056BOY
EOY535605EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY999251BOY
EOY921948EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-166428ReconcilationRevenueExpenses
Reconcilation Other Changes-17023ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1519530CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1515305CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1632690CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1625047CurrentTaxYearMinus1Year
Current Tax Year1644274CurrentTaxYear
Total7936846Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1519530CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1515305CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1632690CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1625047CurrentTaxYearMinus1Year
Current Tax Year1644274CurrentTaxYear
Total7936846Total
FieldValueIRS element (for citing)
Public Support Total1707936846PublicSupportTotal170
Total Support7936846TotalSupport
Gross Receipts From Admissions Etc970685GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1701.00000PublicSupportPertcentage170
Public Support Pertcent Prior Year0.61160PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO NORTHWEST HOUSING INITIATIVEDescription
Amount$16,000Amount
FieldValueIRS element (for citing)
Total Of Amounts16000TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt2614959TotRevenueEtcAuditedFinclStmt
Revenue Subtotal2614959RevenueSubtotal
Total Revenue Per Form9902614959TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2798407TotExpensesEtcAuditedFinclStmt
Other Expenses Included17020OtherExpensesIncluded
Expenses Not Rptd F99017020ExpensesNotRptdF990
Expenses Subtotal2781387ExpensesSubtotal
Total Expenses Per Form9902781387TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierEXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHERIdentifier
Return ReferenceSCHEDULE D, PAGE 4, PART XII, LINE 2DReturnReference
ExplanationBOOK / TAX DEPRECIATION DIFFERENCE 17,020Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ALL OTHER ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4DCOMMUNITY SERVICES
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BNO REVIEW WAS OR WILL BE CONDUCTED.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19DOCUMENTS ARE AVAILABLE AT NORTHWEST BEHAVIORAL SERVICES, INC. OFFICES AT 2392 EDGEWOOD AVENUE, JACKSONVILLE, FL DURING NORMAL BUSINESS HOURS.
RECONCILIATION OF CHANGES - OTHERFORM 990, PART XI, LINE 9BOOK / TAX DEPRECIATION DIFFERENCE -17,020
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 9DEPRECIATION 0 CHANGES IN TEMPORARILY RESTRICTED NET ASSETS 0 ROUNDING 3

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