2013-01-09T15:34:30-06:00 2012-06-30 610920132 RINEY HANCOCK CPAS PSC 2900 VEACH ROAD SUITE 2 OWENSBORO KY 42303 990 2011-07-01 610668290 GREEN RIVER REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD INC GREE 2706896500 CIGAR FACTORY COMPLEX 1100 WALNUT ST OWENSBORO KY 42301 MIKE MOUNTAIN 2706896500 2013-01-09 1 SCOTT L CLAY CPA P00114132 2709264540 2011 2016-02-25 16:41:14Z GAYLE DICESARE 1100 WALNUT STREET OWENSBORO KY 42301 37454550 0 X WWW.RVBH.COM X 1966 KY PLANNING, COORDINATION AND DIRECT DELIVERY OF MENTAL HEALTH, SUBSTANCE ABUSE AND MENTAL RETARDATION SERVICES AT VARIOUS LOCATIONS. 18 18 240 0 0 0 10322972 12004499 20587228 25434344 53615 6107 8800 9600 30972615 37454550 0 0 0 0 8411935 14770879 0 0 0 18645487 17600779 27057422 32371658 3915193 5082892 21230503 25704636 5646948 5042147 15583555 20662489 TO PROVIDE PLANNING, COORDINATION AND DIRECT DELIVERY OF MENTAL HEALTH, SUBSTANCE ABUSE AND MENTAL RETARDATION SERVICES AT VARIOUS LOCATIONS. 0 0 29177569 25434344 PLANNING, COORDINATION, AND DIRECT DELIVERY OF MENTAL HEALTH, SUBSTANCE ABUSE, AND MENTAL RETARDATION SERVICES, PRIMARILY ON AN OUT-PATIENT BASIS. 29177569 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 57 0 1 240 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X MIKE MOUNTAIN 2706896500 CIGAR FACTORY COMPLEX 1100 WALNUT OWENSBORO KY 42301 RICK COX 0.50 X 0 0 0 GALENA FULKERSON 0.50 X 0 0 0 NOEL QUINN 0.50 X 0 0 0 PATTI ALLEN 0.50 X 0 0 0 DR WES BOOKER 0.50 X 0 0 0 JUDGE RENONA BROWNING 0.50 X 0 0 0 DONNA BUMPUS 0.50 X 0 0 0 JUDGE TOM CASTLEN 0.50 X 0 0 0 KELLY EDMONDSON 0.50 X 0 0 0 REBECCA EDMONDSON 0.50 X 0 0 0 KRISTI HIGDON 0.50 X 0 0 0 BETH MITCHELL 0.50 X 0 0 0 SHIRLEY MERCER 0.50 X 0 0 0 MYRA SPAULDING 0.50 X 0 0 0 STEVE STEINER 0.50 X 0 0 0 PETRINA WEISS 0.50 X 0 0 0 KEITH WELLS 0.50 X 0 0 0 JUDY WOOD 0.50 X 0 0 0 GAYLE DICESARE 40.00 X 0 278205 32835 MIKE MOUNTAIN 40.00 X 0 194036 21545 JAMES STEIN 40.00 X 0 94232 10922 0 566473 65302 0 0 1 0 ARAMARK SERVICES INC 1112 FLORENCE ST EVANSVILLE IN 47710 FOOD PREP/CLEANING SERVICES 1297711 LIBERTY MUTUAL INSURANCE GROUP PO BOX 0569 CAROL STREAM IL 601320569 WORKERS COMPENSATION INSURANCE 638259 DANHAUER DRUGS 330 FREDERICA ST OWENSBORO KY 42301 PHARMACY 407624 KENTUCKY HOSPITAL INSURANCE CO PO BOX 436629 LOUISVILLE KY 402536629 COMPANY LIABILITY INSURANCE 369604 UNIVERSITY PSYCHIATRIC FOUNDATION INC PO BOX 3367 LOUISVILLE KY 40201 PSYCHIATRIC SERVICES 291281 19 12001671 2828 12004499 PATIENT SERVICES 624100 18372410 18372410 MEDICARE/MEDICAID PAYM 624100 5922480 5922480 MANAGEMENT SERVICES 624100 1113112 1113112 TENANT RENT 623000 26342 26342 25434344 6107 6107 9600 0 9600 9600 9600 37454550 25434344 0 15707 11513317 10361985 1151332 1025109 922598 102511 1433299 1289969 143330 799154 719238 79916 2069891 1862901 206990 310562 279505 31057 10059453 9053507 1005946 148279 133450 14829 652833 587550 65283 257967 232170 25797 1059599 953639 105960 395745 356170 39575 46541 41887 4654 23915 21524 2391 348614 313752 34862 298495 268645 29850 SUPPLIES 1154416 1038974 115442 BAD DEBTS 300000 300000 MISCELLANEOUS 131791 118612 13179 MEDICAID TAX ASSESSMENT 130821 130821 211857 190672 21185 32371658 29177569 3194089 0 8351999 9283825 156408 156838 69280 67324 3614406 4014670 595882 506587 14348060 10656843 4048472 3691217 93667 166093 554 507 4299835 7817575 21230503 25704636 4432093 3971896 774499 707253 440356 362998 5646948 5042147 X 15583555 20662489 15583555 20662489 21230503 25704636 X 5082892 -3958 X X 0 1 1 X 1 1 X 12375952 13036744 12660031 10322972 12004499 60400198 18917653 19861239 19998723 20587228 25434344 104799187 31293605 32897983 32658754 30910200 37438843 165199385 0 0 0 165199385 218460 157126 141816 62415 15707 595524 218460 157126 141816 62415 15707 595524 31512065 33055109 32800570 30972615 37454550 165794909 0.99640 0.99470 0.00360 0.00530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 335913 335913 9319080 6556457 2762623 309173 230013 79160 3844532 3401145 443387 539362 469228 70134 3691217 RESERVE FOR REPLACEMENTS 176255 DUE FROM GREEN RIVER INDEPENDENT LIVING II, INC. 39784 DUE FROM GREEN RIVER INDEPENDENT LIVING III, INC. 51062 DUE FROM HENDERSON GROUP HOME, INC. 231795 DUE FROM ACUMEN COUNSELING SERVICES, INC. 715188 TENANT SECURITY DEPOSITS 2135 RESIDUAL RECEIPTS RESERVE 3593 TAX AND INSURANCE ESCROW 1074 DUE FROM BEHAVIORAL HEALTH SERVICES, INC. 6543043 DUE FROM CIGAR FACTORY COMPLEX, INC. 53646 7817575 DUE TO RIVERVALLEY CONSULTING SERVICES, INC. 360863 TENANT SECURITY DEPOSITS 2135 362998 37454550 32371658 5082892 -3958 -3958 5078934 42752952 -3958 11122872 11118914 31634038 5820512 5820512 37454550 39612068 13060922 13060922 26551146 5820512 5820512 32371658 PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED ENTITIES' REVENUE PER CONSOLIDATED FINANCIAL STATEMENTS 22,499,611. ELIMINATIONS PER CONSOLIDATED FINANCIAL STATEMENTS -11,403,237. OTHER ADJUSTMENTS 26,498. PART XII, LINE 4B - OTHER ADJUSTMENTS: MICHELLE P. WAIVER REVENUES REPORTED NET OF EXPENSES ON AUDIT REPORT 5,820,512. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RELATED ENTITIES' EXPENSES PER CONSOLIDATED FINANCIAL STATEMENTS 24,437,661. ELIMINATIONS PER CONSOLIDATED FINANCIAL STATEMENTS -11,403,237. OTHER ADJUSTMENTS 26,498. PART XIII, LINE 4B - OTHER ADJUSTMENTS: MICHELLE P. WAIVER REVENUES REPORTED NET OF EXPENSES ON AUDIT REPORT 5,820,512. 0 0 28534134 23105873 5428261 0.16930 28534134 23105873 5428261 0.16930 179039 0 179039 0.00560 72239 0 72239 0.00230 15000 0 15000 0.00050 266278 266278 0.00840 28800412 23105873 5694539 0.17770 0 300000 0 0 0 0 1 1 RIVERVALLEY BEHAVIORAL HEALTH HOSPITAL

1000 INDUSTRIAL DRIVE OWENSBORO KY 42301

CHILDREN'S PSYCHIATRIC HOSPITAL RIVERVALLEY BEHAVIORAL HEALTH HOSPITAL 1 0 0 0 0 0 0 0 1 X 1 X X X X 1 X 0 0 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 300000. PART III, LINE 4: THE AGENCY DOES NOT DESCRIBE BAD DEBT EXPENSE IN THEIR FINANCIAL STATEMENTS. THE COSTING METHODOLOGY USED TO REPORT THE AMOUNTS ON LINES 2 AND 3 WAS THE RATIO DETERMINED FROM WORKSHEET 2. NO BAD DEBT EXPENSES WERE INCLUDED IN THE AMOUNTS LISTED AS COMMUNITY BENEFIT. RIVERVALLEY BEHAVIORAL HEALTH HOSPITAL PART V, SECTION B, LINE 19D: THE HOSPITAL USED THE MEDICAID RATE FOR INDIVIDUALS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. X 0 0 0 0 0 0 0 0 0 GAYLE DICESARE 0 278205 0 0 0 0 0 0 0 32835 0 311040 0 0 MIKE MOUNTAIN 0 194036 0 0 0 0 0 0 0 21545 0 215581 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE CEO AND CONTROLLER AND THEN BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE BOARD, CFO, PURCHASING MANAGER, AND HUMAN RESOURCES DEPARTMENT AND INCLUDES REVIEWS OF VENDOR CONTRACTS AND EMPLOYMENT APPLICATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWS AND APPROVES THE CEO'S COMPENSATION. THE HUMAN RESOURCES DEPARTMENT FORWARDS PROPOSED COMPENSATION ARRANGEMENTS FOR OTHER KEY PERSONNEL TO THE CEO FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023 AND FORM 990 ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND FORM 990 IS ALSO AVAILABLE ON PUBLIC WEBSITES SUCH AS GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,958. FORM 990, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. ACUMEN COUNSELING SERVICES INC 1100 WALNUT STREET OWENSBORO KY 42301 611248638 COUNSELING SERVICES TO CHARITABLE ACTIVITIES OF RELATED ORGANIZATIONS KY 501(C)(3) 11C 0 BEHAVIORAL HEALTHCARE SERVICES INC 1100 WALNUT STREET OWENSBORO KY 42301 311563579 OFFERS RESIDENTIAL SERVICES TO MENTALLY RETARDED INDIVIDUALS KY 501(C)(3) 9 0 CIGAR FACTORY COMPLEX INCORPORATED 1100 WALNUT STREET OWENSBORO KY 42301 611303939 OWNS AND MANAGES PROPERTY FOR OTHER CHARITABLE ORGANIZATIONS KY 501(C)(2) 0 GREEN RIVER INDEPENDENT LIVING - II INC 1100 WALNUT STREET OWENSBORO KY 42301 611027454 PROVIDE HOUSING FOR ELDERLY AND/OR HANDICAPPED PERSONS KY 501(C)(3) 9 0 GREEN RIVER INDEPENDENT LIVING - III INC 1100 WALNUT STREET OWENSBORO KY 42301 611153453 PROVIDE HOUSING FOR ELDERLY AND/OR HANDICAPPED PERSONS KY 501(C)(3) 9 0 HENDERSON GROUP HOME INC 1100 WALNUT STREET OWENSBORO KY 42301 611171902 PROVIDE HOUSING & PERSONAL CARE FOR PHYSICALLY AND/OR MENTALLY HANDICAPPED KY 501(C)(3) 9 0 RIVERVALLEY CONSULTING SERVICES INC 1100 WALNUT STREET OWENSBORO KY 42301 611354311 TO OFFER CONSULTING SERVICES TO RELATED NON-PROFIT ENTITIES KY 501(C)(3) 11B 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 CIGAR FACTORY COMPLEX INCORPORATED J 522000 FMV - CASH TRANSACTIONS ACUMEN COUNSELING SERVICES INC L 7517751 FMV - CASH TRANSACTIONS RIVERVALLEY CONSULTING SERVICES INC L 1363790 FMV - CASH TRANSACTIONS