MID-ERIE MENTAL HEALTH SERVICES INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MID-ERIE MENTAL HEALTH SERVICES INC (EIN 16-1017709)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-05-11
IRS object ID
201131319349300613
Schema version
2010v3.2
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)
Timestamp2011-05-11T08:14:05-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LUMSDEN & MCCORMICK LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1403 MAIN ST SUITE 430AddressLine1
CityBUFFALOCity
StateNYState
ZIP Code14203ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN161017709EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MID ERIE MENTAL HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMIDENameControl
Phone7168957167Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11526 WALDEN AVENUE SUITE 400AddressLine1
CityCHEEKTOWAGACity
StateNYState
ZIP Code14225ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameELIZABETH L MAUROName
TitleEXECUTIVE DIRECTORTitle
Phone7168957167Phone
Date Signed2011-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone7168563300Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1MID ERIE COUNSELING AND TREATMENT SEBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonELIZABETH L MAURONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11526 WALDEN AVENUE SUITE 400AddressLine1
CityCHEEKTOWAGACity
StateNYState
ZIP Code14225ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6519926GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MID-ERIE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF MID-ERIE COUNSELING AND TREATMENT SERVICES IS TO COLLABORATE WITH CONSUMERS, FAMILIES AND COMMUNITIES TO PROMOTE WELLNESS AND RECOVERY THROUGH AN ARRAY OF MENTAL HEALTH AND CHEMICAL DEPENDENCY TREATMENT, EDUCATION AND SUPPORT SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees150TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1738029ContributionsGrantsPriorYear
Contributions Grants Current Year1849911ContributionsGrantsCurrentYear
Program Service Revenue Prior Year4605913ProgramServiceRevenuePriorYear
Program Service Revenue CY4640610ProgramServiceRevenueCY
Investment Income Prior Year305InvestmentIncomePriorYear
Investment Income Current Year1376InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year28029OtherRevenueCurrentYear
Total Revenue Prior Year6344247TotalRevenuePriorYear
Total Revenue Current Year6519926TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4131909SalariesEtcPriorYear
Salaries Etc Current Year4307046SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2172215OtherExpensePriorYear
Other Expenses Current Year2177395OtherExpensesCurrentYear
Total Expenses Prior Year6304124TotalExpensesPriorYear
Total Expenses Current Year6484441TotalExpensesCurrentYear
Revenues Less Expenses Prior Year40123RevenuesLessExpensesPriorYear
Revenues Less Expenses CY35485RevenuesLessExpensesCY
Total Assets BOY916243TotalAssetsBOY
Total Assets EOY1327303TotalAssetsEOY
Total Liabilities BOY1402123TotalLiabilitiesBOY
Total Liabilities EOY1782616TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-485880NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-455313NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF MID-ERIE COUNSELING AND TREATMENT SERVICES IS TO COLLABORATE WITH CONSUMERS, FAMILIES AND COMMUNITIES TO PROMOTE WELLNESS AND RECOVERY THROUGH AN ARRAY OF MENTAL HEALTH AND CHEMICAL DEPENDENCY TREATMENT, EDUCATION AND SUPPORT SERVICES.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1991028Expense
Revenue2075122Revenue
DescriptionADULT MENTAL HEALTH SERVICES - ADULT MENTAL HEALTH SERVICES ARE BASED ON THE PROMISE THAT INDIVIDUALS WHO SUFFER FROM SEVERE AND PERSISTENT MENTAL ILLNESS CAN, AND DO RECOVER THROUGH THE USE OF TREATMENT AND PSYCHIATRIC REHABILITATION INTERVENTIONS. INDIVIDUALS EXPERIENCING ACUTE MENTAL ILLNESS OR SITUATIONAL DIFFICULTIES UTILIZE SOLUTION-FOCUSED THERAPIES TO ACHIEVE PROBLEM RESOLUTION. ADULT MENTAL HEALTH PROGRAMMING FOCUSES ON THE FOLLOWING SERVICES: CLINIC TREATMENT, PERSONALIZED RECOVERY ORIENTED SERVICES (PROS), CASE MANAGEMENT, FORENSIC. (TOTAL 2010 VISITS - 17,332, PROS PARTICIPATION UNIT 29,210/85 AVERAGE CLIENTS PER MONTH)Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense913928Expense
Revenue814398Revenue
DescriptionCHEMICAL DEPENDENCY SERVICES - SERVICES ARE DESIGNED FOR ADULTS AND ADOLESCENTS WHOSE BASIC ATTACHMENTS (FAMILY, WORK, SCHOOL, ETC.) AND MANAGEMENT OF DAILY ACTIVITIES ARE IMPAIRED THROUGH THE ABUSIVE USE OF ALCOHOL AND/OR OTHER DRUGS. SERVICES INCLUDE: COUNSELING FOR INDIVIDUALS, FAMILIES AND GROUPS, CHEMICAL DEPENDENCY EDUCATION, AFTERCARE, MEDICAL EVALUATION, LINKING WITH OTHER SOCIAL AND COMMUNITY RESOURCES, AND SPECIALTY GROUPS. (TOTAL 2010 VISITS - 15,023)Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2561267Expense
Revenue1751090Revenue
DescriptionCHILD MENTAL HEALTH SERVICES - THE CHILD MENTAL HEALTH PROGRAM PROVIDES A COMPREHENSIVE ARRAY OF COMMUNITY BASED TREATMENT AND SUPPORT SERVICES TO FAMILIES WITH CHILDREN AND/OR ADOLESCENTS WHO HAVE SERIOUS EMOTIONAL AND BEHAVIORAL DISORDERS. THROUGH THEIR INVOLVEMENT IN SERVICES, CHILDREN AND ADOLESCENTS STRIVE TO REACH THEIR OPTIMAL POTENTIAL WHILE REMAINING IN THE SAFEST AVAILABLE ENVIRONMENT. SERVICES INCLUDE: CLINIC TREATMENT, ENHANCED TREATMENT CENTER, ENHANCEMENT STEP DOWN/DIVERSION, CHILD INTENSIVE CARE COORDINATION, SCHOOL-BASED MENTAL HEALTH PROGRAM, HOME AND COMMUNITY BASED SERVICES WAIVER PROGRAM/CARE COORDINATION, CASE MANAGEMENT, GRANDPARENT ADVOCACY PROJECT, AND FAMILY SUPPORT. (TOTAL 2010 VISITS - 7,650)Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense155842Expense
Grants155842Grants
DescriptionKINSHIP GRANTS PROVIDE LEGAL SERVICES FOR HELPING TO PLACE FOSTER CHILDREN WITH FAMILY MEMBERS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp155842TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt155842TotalOfOtherProgramServiceGrnt
Total Program Service Expense5622065TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109616NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees150NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNYStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PATRICK MCINERNEYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7168957167TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11520 WALDEN AVENUEAddressLine1
CityCHEEKTOWAGACity
StateNYState
ZIP Code14225ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
BRIAN MURPHY
PRESIDENT2.00XX000
PAMELA GERMAIN
VICE PRESIDENT2.00XX000
TAK NOBUMOTO
TREASURER (FORMER)2.00XX000
SANDRA SCHOFIELD
SECRETARY2.00XX000
JOHN GILEWICZ
DIRECTOR2.00X000
JOHN BOS
DIRECTOR2.00X000
DR VICTORIA BROOKS
DIRECTOR2.00X000
BARBARA CHMIELEWSKI
DIRECTOR2.00X000
STEVEN RUBINSTEIN
DIRECTOR2.00X000
JOCELYN BOS
DIRECTOR2.00X000
ELIZABETH MAURO
EXECUTIVE DIRECTOR40.00X106239022665
PATRICK MCINERNEY
CFO40.00X105858016144
FieldValueIRS element (for citing)
Total Reportable Comp From Org212097TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation38809TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
UNIVERSITY PSYCHIATRIC PRACTICE
ECMC - 462 GRIDER STREET 11TH FLOOBUFFALONY14215CONSULTANT155138
DR ARVIND SAMANT
83 CRESTWOODWILLIAMSVILLENY14221CONSULTANT102339
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants1781361GovernmentGrants
All Other Contributions68550AllOtherContributions
Total Contributions1849911TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICAID62410038074093807409
THIRD PARTY INSURANCE624100563347563347
PATIENT FEES624100205819205819
MEDICARE6241006403564035
FieldValueIRS element (for citing)
Total Program Service Revenue4640610TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1376TotalRevenueColumn
Exclusion$1,376ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column28029TotalRevenueColumn
Exclusion$28,029ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue28029TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6519926TotalRevenueColumn
Related Or Exempt Function Income4640610RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$29,405ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total250906Total
Management And General250906ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3373074Total
Program Services3089798ProgramServices
Management And General283276ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total93573Total
Program Services86327ProgramServices
Management And General7246ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total345563Total
Program Services315917ProgramServices
Management And General29646ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total243930Total
Program Services223772ProgramServices
Management And General20158ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total119384Total
Program Services67541ProgramServices
Management And General51843ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total111170Total
Program Services74652ProgramServices
Management And General36518ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total168882Total
Program Services131470ProgramServices
Management And General37412ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total400935Total
Program Services312931ProgramServices
Management And General88004ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total81325Total
Program Services68997ProgramServices
Management And General12328ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total18287Total
Program Services10680ProgramServices
Management And General7607ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total916Total
Program Services441ProgramServices
Management And General475ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total44519Total
Program Services21268ProgramServices
Management And General23251ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total26816Total
Program Services24946ProgramServices
Management And General1870ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
TENANT DEPOSIT/WRAP EXP6055156055150
CONSULTANTS4274814274810
BUILDING MAINTENANCE AN956638543710226
MISCELLANEOUS40786391911595
PROGRAM SUPPLIES357163570115

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6484441Total
Program Services5622065ProgramServices
Management And General862376ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY284311BOY
EOY593595EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY21353BOY
EOY24610EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY487541BOY
EOY447008EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY17360BOY
EOY30212EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis952403LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec728154LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY98049BOY
EOY224249EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7629BOY
EOY7629EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY916243BOY
EOY1327303EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY458029BOY
EOY594484EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY16744BOY
EOY185700EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY927350BOY
EOY1002432EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1402123BOY
EOY1782616EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-485880BOY
EOY-455313EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-485880BOY
EOY-455313EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY916243BOY
EOY1327303EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses35485ReconcilationRevenueExpenses
Reconcilation Other Changes-4918ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1398923CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1780588CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1712944CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1738029CurrentTaxYearMinus1Year
Current Tax Year1849911CurrentTaxYear
Total8480395Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1398923CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1780588CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1712944CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1738029CurrentTaxYearMinus1Year
Current Tax Year1849911CurrentTaxYear
Total8480395Total
FieldValueIRS element (for citing)
Public Support Total1708480395PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6229CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1836CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3619CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year305CurrentTaxYearMinus1Year
Current Tax Year1376CurrentTaxYear
Total13365Total
FieldValueIRS element (for citing)
Total Support8493760TotalSupport
Gross Receipts From Admissions Etc22610089GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.99840PublicSupportPertcentage170
Public Support Pertcent Prior Year0.99830PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis94126OtherCostOrOtherBasis
Depreciation94126Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis704953OtherCostOrOtherBasis
Depreciation634028Depreciation
Book Value70925BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis153324OtherCostOrOtherBasis
Book Value153324BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings224249TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionREFUNDABLE ADVANCES AND AMOUNTS DUE TO FUNDING SOURCESDescription
Amount$1,002,432Amount
FieldValueIRS element (for citing)
Total Of Amounts1002432TotalOfAmounts

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonSTEVEN RUBINSTEINNamePerson
FieldValueIRS element (for citing)
RelationshipMEMBER OF BOARD OF DIRECTORS OF MID-ERIE, PARTNER OF DAMON & MOREY LAW FIRMRelationship
Amount Of Transaction61532AmountOfTransaction
Description Of TransactionMID-ERIE UTILIZES DAMON & MOREY AS THEIR PRINCIPAL LEGAL COUNCIL.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE IRS FORM 990 IS REVIEWED IN DETAIL BY THE FINANCE COMMITTEE OF THE DIRECTORS. THE FINANCE COMMITTEE THEN REPORTS TO THE FOLLOWING DIRECTORS MEETING WHERE A COPY IS AVAILABLE FOR INSPECTION. IF NO MEETING IS SCHEDULED BETWEEN THE PREPARATION DATE AND THE DUE DATE, THE COMPLETE FORM IS DISTRIBUTED THROUGH EMAIL TO ALL DIRECTORS FOR COMMENT.
CONFLICT OF INTEREST DISCLOSURES ARE SIGNED ANNUALLY BY ALL DIRECTORS AS WELL AS NEW MEMBERS JOINING THE BOARD DURING INTERIM PERIODS. THIS PROCEDURE IS A REGULAR AGENDA ITEM AT THE ANNUAL MEETING.FORM 990, PART VI, SECTION B, LINE 12C
THE EXECUTIVE DIRECTOR'S COMPENSATION IS COMPARED TO OTHER LOCAL ORGANIZATIONS, SCALED FOR APPROPRIATE SIZE, AND ADJUSTED ACCORDING TO PERFORMANCE REVIEWS. ALL OTHER EMPLOYEE SALARIES ARE AT THE DISCRETION OF THE EXECUTIVE DIRECTOR.FORM 990, PART VI, SECTION B, LINE 15
DOCUMENTS ARE MADE AVAILABLE FOR INSPECTIONS AT THE ADMINISTRATIVE OFFICES. COPIES CAN BE OBTAINED AT THE REQUESTING PARTY'S EXPENSE.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:TRANSFER OF NET ASSETS TO FOUNDATION -4,918. TOTAL TO FORM 990, PART XI, LINE 5: -4,918.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1MID-ERIE FOUNDATION INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11520 WALDEN AVENUEAddressLine1
CityCHEEKTOWAGACity
StateNYState
ZIP Code14225ZIPCode
FieldValueIRS element (for citing)
EIN161578172EIN
Primary ActivitiesTO SUPPORT THE PROGRAMS OF MID-ERIE MENTAL HEALTH SERVICES, INC.PrimaryActivities
Legal Domicile StateNYLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11 TYPE IIPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1MID-ERIE FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeQTransactionType
Amount Involved4918AmountInvolved
Method Of Amt DeterminationAMOUNTS RAISED BY THE FOUNDATIONMethodOfAmtDetermination

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