2013-12-19T16:40:59-06:00 2013-06-30 610920132 RINEY HANCOCK CPAS PSC 2900 VEACH ROAD SUITE 2 OWENSBORO KY 42303 990 2012-07-01 610668290 GREEN RIVER REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD INC GREE 2706896500 CIGAR FACTORY COMPLEX 1100 WALNUT ST OWENSBORO KY 42301 MIKE MOUNTAIN 2706896500 2013-12-19 1 SCOTT L CLAY CPA P00114132 2709264540 2012 2016-03-07 17:11:31Z GAYLE DICESARE 1100 WALNUT STREET OWENSBORO KY 42301 35202097 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. 13 13 234 0 0 0 12004499 12157984 25434344 23022853 6107 11660 9600 9600 37454550 35202097 0 0 0 0 14770879 17758542 0 0 0 17600779 16414521 32371658 34173063 5082892 1029034 25704636 26773189 5042147 5048640 20662489 21724549 TO PROVIDE PLANNING, COORDINATION AND DIRECT DELIVERY OF MENTAL HEALTH, SUBSTANCE ABUSE AND MENTAL RETARDATION SERVICES AT VARIOUS LOCATIONS. 0 0 30820496 23032453 PLANNING, COORDINATION, AND DIRECT DELIVERY OF MENTAL HEALTH, SUBSTANCE ABUSE, AND MENTAL RETARDATION SERVICES, PRIMARILY ON AN OUT-PATIENT BASIS. 30820496 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 1 64 0 1 234 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 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 REBECCA EDMONDSON 0.50 X 0 0 0 NOEL QUINN 0.50 X 0 0 0 MARTHA HARDESTY 0.50 X 0 0 0 DR WES BOOKER 0.50 X 0 0 0 JUDGE RENONA BROWNING 0.50 X 0 0 0 JUDGE TOM CASTLEN 0.50 X 0 0 0 KENNY RILEY 0.50 X 0 0 0 GALENA FULKERSON 0.50 X 0 0 0 SHIRLEY MERCER 0.50 X 0 0 0 MYRA SPAULDING 0.50 X 0 0 0 PETRINA WEISS 0.50 X 0 0 0 KEITH WELLS 0.50 X 0 0 0 GAYLE DICESARE 40.00 X 0 252197 22872 MIKE MOUNTAIN 40.00 X 0 152264 12522 0 404461 35394 0 0 1 0 ARAMARK SERVICES INC 1112 FLORENCE ST EVANSVILLE IN 47710 FOOD PREP/JANITORIAL SERVICES 1169680 LIBERTY MUTUAL INSURANCE GROUP PO BOX 0569 CAROL STREAM IL 601320569 WORKERS COMPENSATION INSURANCE 587272 KENTUCKY HOSPITAL INSURANCE CO PO BOX 436629 LOUISVILLE KY 402536629 COMPANY LIABILITY INSURANCE 346378 UNIVERSITY PSYCHIATRIC FOUNDATION INC PO BOX 3367 LOUISVILLE KY 40201 PSYCHIATRIC SERVICES 298409 BCBSHEALTH CARE SERVICE CORP 25550 NETWORK PLACE CHICAGO IL 606731255 OOS EMPLOYEE HEALTH INS 241154 19 12154734 3250 12157984 PATIENT SERVICES 624100 20090846 20090846 MEDICARE/MEDICAID PAYMENTS 624100 1794322 1794322 MANAGEMENT SERVICES 624100 1110644 1110644 TENANT RENT 623000 27041 27041 23022853 11660 11660 9600 0 9600 9600 9600 35202097 23032453 0 11660 X 13847539 12462785 1384754 1259852 1133867 125985 1645083 1480575 164508 1006068 905461 100607 2501807 2251626 250181 147738 132964 14774 8560464 7704418 856046 39072 35165 3907 618933 557040 61893 256467 230820 25647 1042232 938009 104223 427605 384844 42761 39164 35247 3917 21786 19608 2178 328045 295240 32805 361640 325475 36165 SUPPLIES 1082626 974364 108262 BAD DEBTS 410019 410019 0 MEDICAID TAX ASSESSMENT 237385 237385 0 MISCELLANEOUS 130259 117233 13026 209279 188351 20928 34173063 30820496 3352567 0 9283825 8895820 156838 157034 67324 67770 4014670 4465773 506587 354259 14428400 10967374 3691217 3461026 166093 266137 507 461 7817575 9104909 25704636 26773189 3971896 4167350 707253 639852 362998 241438 5042147 5048640 X 20662489 21724549 20662489 21724549 25704636 26773189 1029034 33026 0 X X 0 1 X 1 1 1 X 13036744 12660031 10322972 12004499 12157984 60182230 19861239 19998723 20587228 25434344 23022853 108904387 32897983 32658754 30910200 37438843 35180837 169086617 0 0 0 169086617 157126 141816 62415 15707 21260 398324 157126 141816 62415 15707 21260 398324 33055109 32800570 30972615 37454550 35202097 169484941 0.99760 0.99640 0.00240 0.00360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 335913 335913 9350107 6753185 2596922 309173 242798 66375 3960986 3546073 414913 472221 425318 46903 3461026 RESERVE FOR REPLACEMENTS 186197 DUE FROM GREEN RIVER INDEPENDENT LIVING II, INC. 71876 DUE FROM GREEN RIVER INDEPENDENT LIVING III, INC. 49465 DUE FROM HENDERSON GROUP HOME, INC. 146367 DUE FROM ACUMEN COUNSELING SERVICES, INC. 977143 TENANT SECURITY DEPOSITS 1940 RESIDUAL RECEIPTS RESERVE 3001 TAX AND INSURANCE ESCROW 1159 DUE FROM BEHAVIORAL HEALTH SERVICES, INC. 7414890 DUE FROM CIGAR FACTORY COMPLEX, INC. 252871 9104909 DUE TO RIVERVALLEY CONSULTING SERVICES, INC. 239498 TENANT SECURITY DEPOSITS 1940 241438 36788441 33026 9734551 9767577 27020864 8181233 8181233 35202097 37204081 11700537 11700537 25503544 8669519 8669519 34173063 PART XI, LINE 2D - OTHER ADJUSTMENTS: RELATED ENTITIES' REVENUE PER CONSOLIDATED FINANCIAL STATEMENTS 20,597,935. ELIMINATIONS PER CONSOLIDATED FINANCIAL STATEMENTS -10,401,672. OTHER ADJUSTMENTS 26,574. TAXES NETTED AGAINST REVENUE PER AUDITED STATEMENTS -78,267. BAD DEBT EXPENSE NETTED AGAINST REVENUE PER AUDITED STATEMENTS -410,019. PART XI, LINE 4B - OTHER ADJUSTMENTS: MICHELLE P. WAIVER REVENUES REPORTED NET OF EXPENSES PER AUDITED STATEMENTS 8,181,233. PART XII, LINE 2D - OTHER ADJUSTMENTS: RELATED ENTITIES' EXPENSES PER CONSOLIDATED FINANCIAL STATEMENTS 22,075,635. ELIMINATIONS PER CONSOLIDATED FINANCIAL STATEMENTS -10,401,672. OTHER ADJUSTMENTS 26,574. PART XII, LINE 4B - OTHER ADJUSTMENTS: MICHELLE P. WAIVER REVENUES REPORTED NET OF EXPENSES PER AUDITED STATEMENTS 8,181,233. TAXES NETTED AGAINST REVENUE PER AUDITED STATEMENTS 78,267. BAD DEBT EXPENSE NETTED AGAINST REVENUE PER AUDITED STATEMENTS 410,019. 0 0 28149523 24292287 3857236 0.11290 28149523 24292287 3857236 0.11290 655186 0 655186 0.01920 89022 0 89022 0.00260 15000 0 15000 0.00040 759208 759208 0.02220 28908731 24292287 4616444 0.13510 0 370018 0 0 0 0 1 1 RIVERVALLEY BEHAVIORAL HEALTH HOSPITAL

1000 INDUSTRIAL DRIVE OWENSBORO KY 42301

X CHILDREN'S PSYCHIATRIC HOSPITAL RIVERVALLEY BEHAVIORAL HEALTH HOSPITAL 1 0 0 0 0 0 0 0 1 X 1 X X X 1 X 0 0 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 20D: 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 252197 0 0 0 0 0 0 0 22872 0 275069 0 0 MIKE MOUNTAIN 0 152264 0 0 0 0 0 0 0 12522 0 164786 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. OTHER FEES FORM 990, PART IX, LINE 11G PROGRAM CONTRACT SERVICES : PROGRAM SERVICE EXPENSES 7,704,418. MANAGEMENT AND GENERAL EXPENSES 856,046. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,560,464. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ACUMEN COUNSELING SERVICES INC 1100 WALNUT STREET OWENSBORO KY 42301 611248638 COUNSELING SERVICES TO CHARITABLE ACTIVITIES OF RELATED ORGANIZATIONS KY 501(C)(3) 11C GREEN RIVER REGIONAL MHMR BOARD 1 BEHAVIORAL HEALTHCARE SERVICES INC 1100 WALNUT STREET OWENSBORO KY 42301 311563579 OFFERS RESIDENTIAL SERVICES TO MENTALLY RETARDED INDIVIDUALS KY 501(C)(3) 9 GREEN RIVER REGIONAL MHMR BOARD 1 CIGAR FACTORY COMPLEX INCORPORATED 1100 WALNUT STREET OWENSBORO KY 42301 611303939 OWNS AND MANAGES PROPERTY FOR OTHER CHARITABLE ORGANIZATIONS KY 501(C)(2) GREEN RIVER REGIONAL MHMR BOARD 1 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 GREEN RIVER REGIONAL MHMR BOARD 1 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 GREEN RIVER REGIONAL MHMR BOARD 1 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 GREEN RIVER REGIONAL MHMR BOARD 1 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 GREEN RIVER REGIONAL MHMR BOARD 1 EFFEXAS INC 1100 WALNUT STREET OWENSBORO KY 42301 271506915 SOFTWARE DEVELOPMENT KY BEHAVIORAL HEALTHCARE SERVICES INC C 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 CIGAR FACTORY COMPLEX INCORPORATED K 522000 FMV - CASH TRANSACTIONS ACUMEN COUNSELING SERVICES INC M 6086472 FMV - CASH TRANSACTIONS RIVERVALLEY CONSULTING SERVICES INC M 1685438 FMV - CASH TRANSACTIONS