NORTHWEST BEHAVIORAL HEALTH SERVICES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NORTHWEST BEHAVIORAL HEALTH SERVICES INC (EIN 59-3128476)
Tax period
2011-07-01 to 2012-06-30
Filed
2012-12-17
IRS object ID
201243529349300004
Schema version
2011v1.2
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)
Timestamp2012-12-17T08:24:37-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

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 Date2011-07-01TaxPeriodBeginDate

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 Signed2012-12-10DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS C PLEIMAN JRName
Phone9044485005Phone
Date Prepared2012-12-07DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts2731557GrossReceipts
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 Members12NbrIndependentVotingMembers
Total Nbr Employees63TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1632690ContributionsGrantsPriorYear
Contributions Grants Current Year1625047ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1068715ProgramServiceRevenuePriorYear
Program Service Revenue CY1106510ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year2701405TotalRevenuePriorYear
Total Revenue Current Year2731557TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year1802048SalariesEtcPriorYear
Salaries Etc Current Year1740682SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year952867OtherExpensePriorYear
Other Expenses Current Year954587OtherExpensesCurrentYear
Total Expenses Prior Year2754915TotalExpensesPriorYear
Total Expenses Current Year2695269TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-53510RevenuesLessExpensesPriorYear
Revenues Less Expenses CY36288RevenuesLessExpensesCY
Total Assets BOY1000526TotalAssetsBOY
Total Assets EOY999251TotalAssetsEOY
Total Liabilities BOY317757TotalLiabilitiesBOY
Total Liabilities EOY280195TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY682769NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY719056NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMENTAL HEALTH AND SOCIAL REHABILITATION SERVICESMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense927393Expense
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)
Expense717381Expense
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)
Expense719775Expense
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)
Expense55950Expense
DescriptionCOMMUNITY SERVICESDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp55950TotalOfOtherProgramServiceExp
Total Program Service Expense2420499TotalProgramServiceExpense
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 LiabilitiesfalseReportOtherLiabilities
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
Transaction Related EntityfalseTransactionRelatedEntity
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 Employees63NumberOfEmployees
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 Members12NumberIndependentVotingMembers
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
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per WeekAverageHoursPerWeekOfficerOfficer
STEWARD WASHINGTON
BOARD MEMBERX000
RAYMOND CAMPBELL
BOARD MEMBERX000
CLIFTON COLEMAN
BOARD MEMBERX000
PADRICA MENDEZ
BOARD MEMBERX000
HOWARD SAVAGE II
BOARD MEMBERX000
ANN BLACKSHEAR
BOARD MEMBERX000
OREATHA COLVIN
BOARD MEMBERX000
PATRICIA SAMPSON
EXE. DIRECTO00045.00X
MAGDALENE HOPES
PRESIDENT000X
REGINALD ESTELL JR
PARLIAMENTAR000X
MARIE HEATH
SECRETARY000X
NINA HARLEY
VICE-PRESIDE000X
ODEAN THOMAS
TREASURER000X
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Government Grants1575016GovernmentGrants
All Other Contributions50031AllOtherContributions
Total Contributions1625047TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID10681631068163
OTHER3834738347
FieldValueIRS element (for citing)
Total Program Service Revenue1106510TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2731557TotalRevenueColumn
Related Or Exempt Function Income1106510RelatedOrExemptFunctionIncome

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1364441Total
Program Services1248462ProgramServices
Management And General115979ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total259610Total
Program Services236202ProgramServices
Management And General23408ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total116631Total
Program Services107771ProgramServices
Management And General8860ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total86Total
Program Services86ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total30683Total
Management And General30683ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total809Total
Program Services809ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total163290Total
Program Services131873ProgramServices
Management And General31417ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total53615Total
Program Services50700ProgramServices
Management And General2915ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total15603Total
Program Services14012ProgramServices
Management And General1591ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total18489Total
Program Services14781ProgramServices
Management And General3708ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CONSULTANTS AND SUBCONTRA25965224750512147
CLIENT SERVICES148303148303
PSYCHIATRIST114900114900
TELEPHONE35393284616932

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total113764Total
Program Services76634ProgramServices
Management And General37130ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2695269Total
Program Services2420499ProgramServices
Management And General274770ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1798BOY
EOY1617EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY248625BOY
EOY281448EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY79983BOY
EOY89681EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY90642BOY
EOY62767EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis765633LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec205357LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY575878BOY
EOY560276EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3600BOY
EOY3462EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1000526BOY
EOY999251EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY295843BOY
EOY280195EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY21914BOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY317757BOY
EOY280195EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY682769BOY
EOY719056EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY682769BOY
EOY719056EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1000526BOY
EOY999251EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses36288ReconcilationRevenueExpenses
Reconcilation Other Changes-1ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1776008CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1519530CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1515305CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1632690CurrentTaxYearMinus1Year
Current Tax Year1625047CurrentTaxYear
Total8068580Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1776008CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1519530CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1515305CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1632690CurrentTaxYearMinus1Year
Current Tax Year1625047CurrentTaxYear
Total8068580Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total3134166AmountsSubstContributorsTotal
Public Support Total1704934414PublicSupportTotal170
Total Support8068580TotalSupport
Gross Receipts From Admissions Etc1106510GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.61160PublicSupportPertcentage170
Public Support Pertcent Prior Year0.41550PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis765633OtherCostOrOtherBasis
Book Value765633BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings765633TotalOfBookValueLandBuildings
Total Revenue2731557TotalRevenue
Total Expenses2695269TotalExpenses
Excess Or Deficit For Year36288ExcessOrDeficitForYear
Excess Or Deficit Per FS36288ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2731557TotRevenueEtcAuditedFinclStmt
Revenue Subtotal2731557RevenueSubtotal
Total Revenue Per Form9902731557TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2695269TotExpensesEtcAuditedFinclStmt
Expenses Subtotal2695269ExpensesSubtotal
Total Expenses Per Form9902695269TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 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.

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