JGB MENTAL HEALTH AND RETARDATION SERVICES INC. INC

User Manual: JGB-MENTAL-HEALTH-AND-MENTAL-RETARDATION-SERVICES-INC.

Open the PDF directly: View PDF .
Page Count: 38

Download
Open PDF In Browser	View PDF

Form

990

A For the 2012 calendar year, or tax year beginning

Address
change
Name
change
Initial
return
Terminated
Amended
return
Application
pending

Doing Business As
Number and street (or P.O. box if mail is not delivered to street address)

20-1480790
212-769-6200
4,517,511.

City, town, or post office, state, and ZIP code

10023

F Name and address of principal officer:ALAN

G
H(a) Is this a group return
for affiliates?
H(b) Are all affiliates included?
Gross receipts $

R. MORSE

) § (insert no.)
Association

4947(a)(1) or
Other |

Briefly describe the organization's mission or most significant activities:

VISUALLY IMPAIRED OR LEGALLY BLIND.

Yes X No
Yes
No
527
If "No," attach a list. (see instructions)
H(c) Group exemption number |
L Year of formation: 2004 M State of legal domicile: NY

MENTAL HEALTH SERVICES FOR THE

Check this box |
if the organization discontinued its operations or disposed of more than 25% of its net assets.
5
Number of voting members of the governing body (Part VI, line 1a) ~~~~~~~~~~~~~~~~~~~~
3
5
Number of independent voting members of the governing body (Part VI, line 1b) ~~~~~~~~~~~~~~
4
59
Total number of individuals employed in calendar year 2012 (Part V, line 2a) ~~~~~~~~~~~~~~~~
5
28
Total number of volunteers (estimate if necessary) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6
0.
Total unrelated business revenue from Part VIII, column (C), line 12 ~~~~~~~~~~~~~~~~~~~~ 7a
0.
Net unrelated business taxable income from Form 990-T, line 34 •••••••••••••••••••••• 7b
Prior Year
Current Year
10,150.
50,000.
8 Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~
5,055,692.
4,467,511.
9 Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~
0.
0.
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) ~~~~~~~~~~~~~
0.
0.
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~
5,065,842.
4,517,511.
12 Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) •••
0.
0.
13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) ~~~~~~~~~~~
0.
0.
14 Benefits paid to or for members (Part IX, column (A), line 4) ~~~~~~~~~~~~~
4,542,158.
4,818,903.
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ~~~
0.
0.
16a Professional fundraising fees (Part IX, column (A), line 11e)~~~~~~~~~~~~~~
6,402.
|
b Total fundraising expenses (Part IX, column (D), line 25)

AF

T

2
3
4
5
6
7a
b

DR

Activities & Governance
Revenue
Expenses
Net Assets or
Fund Balances

D Employer identification number

Room/suite E Telephone number

15 WEST 65TH STREET
NEW YORK, NY

Open to Public
Inspection

JUN 30, 2013

and ending

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

SAME AS C ABOVE
501(c) (
I Tax-exempt status: X 501(c)(3)
J Website: | WWW.GUILDHEALTH.ORG
Trust
K Form of organization: X Corporation
Part I Summary
1

JUL 1, 2012

C Name of organization

Check if
applicable:

2012

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation)
| The organization may have to use a copy of this return to satisfy state reporting requirements.

Department of the Treasury
Internal Revenue Service

B

OMB No. 1545-0047

Return of Organization Exempt From Income Tax

17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) ~~~~~~~~~~~~~
18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ~~~~~~~
19 Revenue less expenses. Subtract line 18 from line 12 ••••••••••••••••

2,219,712.
1,957,865.
6,761,870.
6,776,768.
<1,696,028.> <2,259,257.>

Beginning of Current Year
20 Total assets (Part X, line 16) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
21 Total liabilities (Part X, line 26) ~~~~~~~~~~~~~~~~~~~~~~~~~~~
22 Net assets or fund balances. Subtract line 21 from line 20 ••••••••••••••

Part II

End of Year

1,570,300.
623,868.
15,061,143. 16,373,968.
<13,490,843.><15,750,100.>

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign
Here

=
=

Signature of officer
Type or print name and title

Print/Type preparer's name

Paid
Preparer
Use Only

Date

ELLIOT J. HAGLER, CHIEF FINANCIAL OFFICER
Preparer's signature

FREDERICK H. ROTHMAN
LOEB AND TROPER LLP
Firm's name
655 THIRD AVENUE
Firm's address
NEW YORK, NY 10017

9
9

Date

Check
if
self-employed

Firm's EIN

9

PTIN

P01275277
13-1517563

(212) 867-4000
X Yes
May the IRS discuss this return with the preparer shown above? (see instructions) •••••••••••••••••••••
No
232001 12-10-12
LHA For Paperwork Reduction Act Notice, see the separate instructions.
Form 990 (2012)
Phone no.

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part III Statement of Program Service Accomplishments
1

20-1480790

Check if Schedule O contains a response to any question in this Part III •••••••••••••••••••••••••••••
Briefly describe the organization's mission:

Page 2

X

TO ASSIST VISUALLY IMPAIRED ADULTS, WITH EMOTIONAL PROBLEMS, ACHIEVE
LIVES OF DIGNITY AND INDEPENDENCE.

4a

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes X No
If "Yes," describe these new services on Schedule O.
Did the organization cease conducting, or make significant changes in how it conducts, any program services?~~~~~~
Yes X No
If "Yes," describe these changes on Schedule O.
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
5,398,462. including grants of $
4,467,511. )
(Code:
) (Expenses $
) (Revenue $

4b

(Code:

) (Expenses $

4c

(Code:

) (Expenses $

4d

Other program services (Describe in Schedule O.)
including grants of $
(Expenses $
5,398,462.
Total program service expenses J

2

3

SEE SCHEDULE O

AF

T

4

) (Revenue $

)

) (Revenue $

)

DR

including grants of $

4e

232002
12-10-12

16010424 132497 MHMR

including grants of $

) (Revenue $

)

Form 990 (2012)
SEE SCHEDULE O FOR CONTINUATION(S)
2
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part IV Checklist of Required Schedules

20-1480790

Page 3
Yes

5
6
7
8
9

10
11
a
b
c
d
e
f
12a
b
13
14a
b

15
16

T

4

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office? If "Yes," complete Schedule C, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year? If "Yes," complete Schedule C, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or
similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III ~~~~~~~~~~~~~~
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II~~~~~~~~~~~~~~
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete
Schedule D, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for
amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?
If "Yes," complete Schedule D, Part IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent
endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V ~~~~~~~~~~~~~~~~~~~~~~~~
If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X
as applicable.
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete Schedule D,
Part VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total
assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII ~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total
assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII ~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in
Part X, line 16? If "Yes," complete Schedule D, Part IX ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X ~~~~~~
Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X ~~~~
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization included in consolidated, independent audited financial statements for the tax year?
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional ~~~~~
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ~~~~~~~~~~~~~~
Did the organization maintain an office, employees, or agents outside of the United States? ~~~~~~~~~~~~~~~~
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,
investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000
or more? If "Yes," complete Schedule F, Parts I and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization
or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV ~~~~~~~~~~~~~~~~~
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals
located outside the United States? If "Yes," complete Schedule F, Parts III and IV ~~~~~~~~~~~~~~~~~~~~~

AF

2
3

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
If "Yes," complete Schedule A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization required to complete Schedule B, Schedule of Contributors? ~~~~~~~~~~~~~~~~~~~~~~

DR

1

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,
column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1c and 8a? If "Yes," complete Schedule G, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes,"
complete Schedule G, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H ~~~~~~~~~~~~~~~~
b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ••••••••••

1
2

16010424 132497 MHMR

X
X

3

X

4

X

5

X

6

X

7

X

8

X

9

X

10

X

11a

X

11b

X

11c

X

11d
11e

X

11f

X

12a

X

X

12b
13
14a

X
X
X

14b

X

15

X

16

X

17

X

18

X

17

232003
12-10-12

No

X
19
X
20a
20b
Form 990 (2012)

3
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part IV Checklist of Required Schedules (continued)

20-1480790

Page 4
Yes

24a

b
c
d
25a
b

26
27

28
a
b
c
29
30
31
32
33
34
35a
b
36
37
38

232004
12-10-12

16010424 132497 MHMR

T

23

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX,
column (A), line 2? If "Yes," complete Schedule I, Parts I and III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete
Schedule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b through 24d and complete
Schedule K. If "No", go to line 25 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? ~~~~~~~~~~~
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? ~~~~~~~~~~~
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a
disqualified person during the year? If "Yes," complete Schedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete
Schedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified
person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II ~~~~~~~~~~~
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial
contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member
of any of these persons? If "Yes," complete Schedule L, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ~~~~~~~~~~~
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ~~
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,
director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV~~~~~~~~~~~~~~~~~~~~~
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M ~~~~~~~~~
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions? If "Yes," complete Schedule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization liquidate, terminate, or dissolve and cease operations?
If "Yes," complete Schedule N, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete
Schedule N, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and
Part V, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a controlled entity within the meaning of section 512(b)(13)? ~~~~~~~~~~~~~~~~~~
If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ~~~~~~~~~~~~~~~~~~~
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization?
If "Yes," complete Schedule R, Part V, line 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI ~~~~~~~~
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19?
Note. All Form 990 filers are required to complete Schedule O •••••••••••••••••••••••••••••••

AF

22

Did the organization report more than $5,000 of grants and other assistance to any government or organization in the
United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II ~~~~~~~~~~~~~~~~~~

DR

21

No

21

X

22

X

23

X
X

24a
24b
24c
24d
25a

X

25b

X

26

X

27

X

28a
28b

X
X

28c
29

X
X

30

X

31

X

32

X

33

X

34
35a

X

X

35b
36

X

37

X

X
38
Form 990 (2012)

4
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part V Statements Regarding Other IRS Filings and Tax Compliance

20-1480790

Page 5

Check if Schedule O contains a response to any question in this Part V •••••••••••••••••••••••••••••

9

DR

AF

T

3
1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~
1a
0
b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~
1b
c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners? •••••••••••••••••••••••••••••••••••••••••••
1c
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
59
filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~
2a
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?~~~~~~~~~~
2b
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
3a Did the organization have unrelated business gross income of $1,000 or more during the year? ~~~~~~~~~~~~~~
3a
b If "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule O ~~~~~~~~~~~~~~~
3b
4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~
4a
b If "Yes," enter the name of the foreign country: J
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ~~~~~~~~~~~~
5a
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?~~~~~~~~~
5b
c If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5c
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions? ~~~~~~~~~~~~~~~~~~~~~~~~
6a
b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6b
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a
b If "Yes," did the organization notify the donor of the value of the goods or services provided? ~~~~~~~~~~~~~~~
7b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282? ••••••••••••••••••••••••••••••••••••••••••••••••••••
7c
d If "Yes," indicate the number of Forms 8282 filed during the year ~~~~~~~~~~~~~~~~
7d
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~
7e
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ~~~~~~~~~
7f
g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?~
7g
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 7h
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting
organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?
8
Sponsoring organizations maintaining donor advised funds.
a Did the organization make any taxable distributions under section 4966?~~~~~~~~~~~~~~~~~~~~~~~~~~
b Did the organization make a distribution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~~~~~~~
10 Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contributions included on Part VIII, line 12 ~~~~~~~~~~~~~~~ 10a
b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ~~~~~~ 10b
11 Section 501(c)(12) organizations. Enter:
a Gross income from members or shareholders ~~~~~~~~~~~~~~~~~~~~~~~~~~ 11a
b Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11b
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
b If "Yes," enter the amount of tax-exempt interest received or accrued during the year •••••• 12b
13 Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue qualified health plans in more than one state? ~~~~~~~~~~~~~~~~~~~~~
Note. See the instructions for additional information the organization must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans ~~~~~~~~~~~~~~~~~~~~~~ 13b
c Enter the amount of reserves on hand ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13c
14a Did the organization receive any payments for indoor tanning services during the tax year? ~~~~~~~~~~~~~~~~
b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O ••••••••••

232005
12-10-12

16010424 132497 MHMR

Yes

No

X
X
X
X
X
X

X
X
X
X

9a
9b

12a

13a

X
14a
14b
Form 990 (2012)

5
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790
Form 990 (2012)
Page 6
For
each
"Yes"
response
to
lines
2
through
7b
below,
and for a "No" response
Part VI Governance, Management, and Disclosure
to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response to any question in this Part VI •••••••••••••••••••••••••••••

Section A. Governing Body and Management
1a Enter the number of voting members of the governing body at the end of the tax year ~~~~~~
If there are material differences in voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

1a

Yes

5

5
1b
b Enter the number of voting members included in line 1a, above, who are independent ~~~~~~
2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other
officer, director, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2
3 Did the organization delegate control over management duties customarily performed by or under the direct supervision
of officers, directors, or trustees, or key employees to a management company or other person? ~~~~~~~~~~~~~~
3
4
4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ~~~~~
5
5 Did the organization become aware during the year of a significant diversion of the organization's assets? ~~~~~~~~~
6
6 Did the organization have members or stockholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7a
b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7b
8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

T

a The governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
b Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
organization's mailing address? If "Yes," provide the names and addresses in Schedule O •••••••••••••••••
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

AF

9

DR

10a Did the organization have local chapters, branches, or affiliates? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes? ~~~~~~~~~~~~~
11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
b Describe in Schedule O the process, if any, used by the organization to review this Form 990.
12a Did the organization have a written conflict of interest policy? If "No," go to line 13 ~~~~~~~~~~~~~~~~~~~~
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ~~~~~~
c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe
in Schedule O how this was done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
13
14
15
a
b
16a
b

Did the organization have a written whistleblower policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~~
Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management official ~~~~~~~~~~~~~~~~~~~~~~~~~~
Other officers or key employees of the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
exempt status with respect to such arrangements? ••••••••••••••••••••••••••••••••••••

Section C. Disclosure
17
18

19
20

8a
8b

X
No

X

X

X
X
X

X
X
X
X
X

9
Yes
10a
10b
11a

X

12a
12b

X
X

12c
13
14

X
X
X

15a
15b

X
X

16a

No

X

X

16b

List the states with which a copy of this Form 990 is required to be filed JNY
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available
for public inspection. Indicate how you made these available. Check all that apply.
X Upon request
Own website
Another's website
Other (explain in Schedule O)
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: |

ELLIOT J. HAGLER, CPA - 212-769-6200
15 WEST 65TH STREET, NEW YORK, NY 10023

232006
12-10-12

16010424 132497 MHMR

Form 990 (2012)
6
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790
Form 990 (2012)
Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors

Page 7

Check if Schedule O contains a response to any question in this Part VII •••••••••••••••••••••••••••••
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.
¥ List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.
Enter -0- in columns (D), (E), and (F) if no compensation was paid.
¥ List all of the organization's current key employees, if any. See instructions for definition of "key employee."
¥ List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable
compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations .
¥ List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of
reportable compensation from the organization and any related organizations.
¥ List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization,
more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees;
and former such persons.

232007 12-10-12

16010424 132497 MHMR

Former

T

Highest compensated
employee

AF

Key employee

Officer

Institutional trustee

0.50
5.00
0.50
4.00
0.50
4.00
0.50
4.00
0.50
4.00
0.80
39.20
4.00
36.00
3.50
36.50
40.00
0.00
0.40
39.60
4.00
36.00
3.60
36.40
0.40
39.60
3.60
36.40
3.50
36.50
3.40
36.60

(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations

X

X

0.

0.

0.

X

X

0.

0.

0.

X

X

0.

0.

0.

0.

0.

0.

0.

0.

0.

DR

(1) JAMES M. DUBIN
CHAIRMAN
(2) LAWRENCE E. GOLDSCHMIDT
TREASURER
(3) PAULINE RAIFF
CHAIRMAN, EXEC COMMITTEE
(4) ROBERT B. OKUN
SECRETARY
(5) RONALD G. WEINER
DIRECTOR
(6) ALAN R. MORSE
PRESIDENT & CEO
(7) PHILIP ROSENTHAL
CHIEF OPERATING OFFICER
(8) ELLIOT J. HAGLER
CHIEF FINANCIAL OFFICER
(9) GOLDIE DERSH
VP-BEHAVIOR HEALTH SCIENCE
(10) SARAH SPICEHANDLER
ASSISTANT SECRETARY
(11) BRUCE MASTALINSKI
CHIEF COMPLIANCE OFFICER
(12) KELLYANNE CAIVANO
SENIOR VP FINANCE
(13) BARBARA KLEIN
DIRECTOR OF DEVELOPMENT
(14) MELISSA FARBER
VP HUMAN RESOURCES
(15) LARRY CARR
DIR. OF PROG. INTEGRITY & COMPLIANCE
(16) SARA PITTERMAN
DIRECTOR OF FINANCE

Individual trustee or director

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
(B)
(C)
(D)
(E)
Position
Name and Title
Average
Reportable
Reportable
(do not check more than one
hours per box, unless person is both an
compensation
compensation
officer and a director/trustee)
week
from
from related
(list any
the
organizations
hours for
organization
(W-2/1099-MISC)
related
(W-2/1099-MISC)
organizations
below
line)

X

X

X

X

20,215.

990,492. 135,378.

X

45,058.

405,527.

X

30,102.

326,027. 108,569.

X

158,040.

0.

31,977.

X

779.

77,087.

36,098.

X

39,280.

353,516.

49,426.

X

20,722.

224,426.

61,135.

X

1,694.

167,701.

33,978.

X

14,451.

148,738.

68,076.

X

12,352.

128,012.

5,577.

X

11,586.

125,486.

52,118.

90,041.

Form 990 (2012)
7
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

354,279. 2,947,012.
Sub-total ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
0.
0.
Total from continuation sheets to Part VII, Section A ~~~~~~~~ |
354,279.
2,947,012.
Total (add lines 1b and 1c) •••••••••••••••••••••• |
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization |

DR

1b
c
d
2

AF

T

Former

Highest compensated
employee

Officer

Key employee

Institutional trustee

Individual trustee or director

20-1480790
Page 8
Form 990 (2012)
(continued)
Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(B)
(C)
(A)
(D)
(E)
(F)
Position
Average
Name and title
Reportable
Reportable
Estimated
(do not check more than one
hours per box, unless person is both an
compensation
compensation
amount of
officer
and a director/trustee)
week
from
from related
other
(list any
the
organizations
compensation
hours for
organization
(W-2/1099-MISC)
from the
related
(W-2/1099-MISC)
organization
organizations
and related
below
organizations
line)

3

X

3
4

No

X

5

X

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organization's tax year.
(A)
(B)
(C)
Name and business address
Description of services
Compensation

D-J AMBULETTE SERVICE D/B/A CITICARE
1200 ZEREGA AVENUE, BRONX, NY 10462

2

1
Yes

Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on
line 1a? If "Yes," complete Schedule J for such individual ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual~~~~~~~~~~~~~
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? If "Yes," complete Schedule J for such person ••••••••••••••••••••••••
Section B. Independent Contractors
1

672,373.
0.
672,373.

TRANSPORTATION

904,725.

Total number of independent contractors (including but not limited to those listed above) who received more than
1
$100,000 of compensation from the organization |

232008
12-10-12

16010424 132497 MHMR

Form 990 (2012)

8
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part VIII
Statement of Revenue

20-1480790

Page 9

Contributions, Gifts, Grants
and Other Similar Amounts

1 a
b
c
d
e
f

Program Service
Revenue

Check if Schedule O contains a response to any question in this Part VIII •••••••••••••••••••••••••••
(A)
(B)
(C)
(D)
Revenue excluded
Related or
Unrelated
Total revenue
from
tax
under
exempt function
business
sections 512,
revenue
revenue
513, or 514

2

6

Other Revenue

7

8

9

10

11

12

1f

50,000.

232009
12-10-12

16010424 132497 MHMR

T

g Noncash contributions included in lines 1a-1f: $
50,000.
h Total. Add lines 1a-1f ••••••••••••••••• |
Business Code
621400 4,150,019.4,150,019.
a MEDICARE/MEDICAID
PRIVATE
AND
OTHERS
621400
250,059. 250,059.
b
CACFP
MEAL
SUBSIDY
621400
67,433.
67,433.
c
d
e
f All other program service revenue ~~~~~
g Total. Add lines 2a-2f ••••••••••••••••• | 4,467,511.
Investment income (including dividends, interest, and
other similar amounts)~~~~~~~~~~~~~~~~~ |
Income from investment of tax-exempt bond proceeds
|
Royalties ••••••••••••••••••••••• |
(i) Real
(ii) Personal
a Gross rents ~~~~~~~
b Less: rental expenses ~~~
c Rental income or (loss) ~~
d Net rental income or (loss) •••••••••••••• |
a Gross amount from sales of
(i) Securities
(ii) Other
assets other than inventory
b Less: cost or other basis
and sales expenses ~~~
c Gain or (loss) ~~~~~~~
d Net gain or (loss) ••••••••••••••••••• |
a Gross income from fundraising events (not
including $
of
contributions reported on line 1c). See
Part IV, line 18 ~~~~~~~~~~~~~ a
b Less: direct expenses~~~~~~~~~~ b
c Net income or (loss) from fundraising events ••••• |
a Gross income from gaming activities. See
Part IV, line 19 ~~~~~~~~~~~~~ a
b Less: direct expenses ~~~~~~~~~ b
c Net income or (loss) from gaming activities •••••• |
a Gross sales of inventory, less returns
and allowances ~~~~~~~~~~~~~ a
b Less: cost of goods sold ~~~~~~~~ b
c Net income or (loss) from sales of inventory •••••• |
Miscellaneous Revenue
Business Code
a
b
c
d All other revenue ~~~~~~~~~~~~~
e Total. Add lines 11a-11d ~~~~~~~~~~~~~~~ |
Total revenue. See instructions. ••••••••••••• | 4,517,511.4,467,511.

AF

4
5

1a
1b
1c
1d
1e

DR

3

Federated campaigns ~~~~~~
Membership dues ~~~~~~~~
Fundraising events ~~~~~~~~
Related organizations ~~~~~~
Government grants (contributions)
All other contributions, gifts, grants, and
similar amounts not included above ~~

0.

0.

Form 990 (2012)
9
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part IX Statement of Functional Expenses

20-1480790

Page 10

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Check if Schedule O contains a response to any question in this Part IX ••••••••••••••••••••••••••
(A)
(B)
(C)
(D)
Total expenses
Program service
Management and
Fundraising
expenses
general expenses
expenses
Grants and other assistance to governments and
organizations in the United States. See Part IV, line 21

Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.

3

4
5
6

Grants and other assistance to individuals in
the United States. See Part IV, line 22 ~~~
Grants and other assistance to governments,
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16 ~
Benefits paid to or for members ~~~~~~~
Compensation of current officers, directors,
trustees, and key employees ~~~~~~~~
Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B) ~~~

7
8

Other salaries and wages ~~~~~~~~~~
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)

9
10
11
a
b
c
d
e
f
g

Other employee benefits ~~~~~~~~~~
Payroll taxes ~~~~~~~~~~~~~~~~
Fees for services (non-employees):
Management ~~~~~~~~~~~~~~~~
Legal ~~~~~~~~~~~~~~~~~~~~
Accounting ~~~~~~~~~~~~~~~~~
Lobbying ~~~~~~~~~~~~~~~~~~
Professional fundraising services. See Part IV, line 17

12
13
14
15
16
17
18

Advertising and promotion ~~~~~~~~~
Office expenses~~~~~~~~~~~~~~~
Information technology ~~~~~~~~~~~
Royalties ~~~~~~~~~~~~~~~~~~

19
20
21
22
23
24

195,544.

159,065.

2,952,979.

2,648,793.

299,331.

4,855.

329,489.
860,209.
321,617.

310,035.
801,827.
292,780.

19,213.
57,548.
28,438.

241.
834.
399.

15,232.

DR

Investment management fees ~~~~~~~~
Other. (If line 11g amount exceeds 10% of line 25,
column (A) amount, list line 11g expenses on Sch O.)

354,609.

T

2

AF

1

Occupancy ~~~~~~~~~~~~~~~~~
Travel ~~~~~~~~~~~~~~~~~~~

Payments of travel or entertainment expenses
for any federal, state, or local public officials
Conferences, conventions, and meetings ~~
Interest ~~~~~~~~~~~~~~~~~~
Payments to affiliates ~~~~~~~~~~~~
Depreciation, depletion, and amortization ~~
Insurance ~~~~~~~~~~~~~~~~~
Other expenses. Itemize expenses not covered
above. (List miscellaneous expenses in line 24e. If line
24e amount exceeds 10% of line 25, column (A)
amount, list line 24e expenses on Schedule O.) ~~

a BAD DEBT EXPENSE
b
c
d
e All other expenses
25 Total functional expenses. Add lines 1 through 24e
26 Joint costs. Complete this line only if the organization
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation.
Check here

|

15,232.

70,709.

18,240.

52,469.

214,100.
165,134.

181,653.

32,374.
165,134.

532,265.
862,102.

862,102.

148.

148.

8,375.
33,091.

8,375.
22,256.

56,009.

56,009.

700.
6,776,768.

700.
5,398,462.

73.

532,265.

10,835.

1,371,904.

6,402.

if following SOP 98-2 (ASC 958-720)

232010 12-10-12

16010424 132497 MHMR

Form 990 (2012)
10
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Form 990 (2012)

Part X

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

20-1480790

Balance Sheet

Page 11

Check if Schedule O contains a response to any question in this Part X ••••••••••••••••••••••••••••••
(A)
(B)
Beginning of year
End of year
Cash - non-interest-bearing ~~~~~~~~~~~~~~~~~~~~~~~~~
Savings and temporary cash investments ~~~~~~~~~~~~~~~~~~
Pledges and grants receivable, net ~~~~~~~~~~~~~~~~~~~~~
Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees. Complete
Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6 Loans and other receivables from other disqualified persons (as defined under
section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing
employers and sponsoring organizations of section 501(c)(9) voluntary
employees' beneficiary organizations (see instr). Complete Part II of Sch L ~~
7 Notes and loans receivable, net ~~~~~~~~~~~~~~~~~~~~~~~
8 Inventories for sale or use ~~~~~~~~~~~~~~~~~~~~~~~~~~
9 Prepaid expenses and deferred charges ~~~~~~~~~~~~~~~~~~
10 a Land, buildings, and equipment: cost or other
330,207.
basis. Complete Part VI of Schedule D ~~~ 10a
283,934.
b Less: accumulated depreciation ~~~~~~ 10b
11 Investments - publicly traded securities ~~~~~~~~~~~~~~~~~~~
12 Investments - other securities. See Part IV, line 11 ~~~~~~~~~~~~~~
13 Investments - program-related. See Part IV, line 11 ~~~~~~~~~~~~~
14 Intangible assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
15 Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~
16 Total assets. Add lines 1 through 15 (must equal line 34) ••••••••••
17 Accounts payable and accrued expenses ~~~~~~~~~~~~~~~~~~
18 Grants payable ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
19 Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
20 Tax-exempt bond liabilities ~~~~~~~~~~~~~~~~~~~~~~~~~
21 Escrow or custodial account liability. Complete Part IV of Schedule D ~~~~
22 Loans and other payables to current and former officers, directors, trustees,
key employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~

42,178.
837,027.
651,441.

39,654.

AF

Net Assets or Fund Balances

26

27
28
29

30
31
32
33
34

Secured mortgages and notes payable to unrelated third parties ~~~~~~
Unsecured notes and loans payable to unrelated third parties ~~~~~~~~
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X of
Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Total liabilities. Add lines 17 through 25 ••••••••••••••••••
X and
Organizations that follow SFAS 117 (ASC 958), check here |
complete lines 27 through 29, and lines 33 and 34.
Unrestricted net assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~
Temporarily restricted net assets ~~~~~~~~~~~~~~~~~~~~~~
Permanently restricted net assets ~~~~~~~~~~~~~~~~~~~~~
Organizations that do not follow SFAS 117 (ASC 958), check here |
and complete lines 30 through 34.
Capital stock or trust principal, or current funds ~~~~~~~~~~~~~~~
Paid-in or capital surplus, or land, building, or equipment fund ~~~~~~~~
Retained earnings, endowment, accumulated income, or other funds ~~~~
Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~
Total liabilities and net assets/fund balances ••••••••••••••••

232011
12-10-12

16010424 132497 MHMR

42,645.
534,950.

6
7
8
9

1,570,300.
72,081.

DR

Liabilities

23
24
25

1
2
3
4

5

T

Assets

1
2
3
4
5

10c
11
12
13
14
15
16
17
18
19
20
21

46,273.

623,868.
71,296.

22
23
24

14,989,062.
15,061,143.

25
26

<13,490,843.>27

16,302,672.
16,373,968.
<15,750,100.>

28
29

30
31
32
<13,490,843.>33
1,570,300. 34

<15,750,100.>
623,868.
Form 990 (2012)

11
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Form 990 (2012)
Part XI Reconciliation of Net Assets

20-1480790

Page 12

Check if Schedule O contains a response to any question in this Part XI •••••••••••••••••••••••••••••
1
2
3
4
5
6
7
8
9
10

Total revenue (must equal Part VIII, column (A), line 12) ~~~~~~~~~~~~~~~~~~~~~~~~~~
Total expenses (must equal Part IX, column (A), line 25) ~~~~~~~~~~~~~~~~~~~~~~~~~~
Revenue less expenses. Subtract line 2 from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ~~~~~~~~~~
Net unrealized gains (losses) on investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Investment expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other changes in net assets or fund balances (explain in Schedule O) ~~~~~~~~~~~~~~~~~~~
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
column (B)) •••••••••••••••••••••••••••••••••••••••••••••••

Part XII Financial Statements and Reporting

1
2
3
4
5
6
7
8
9
10

4,517,511.
6,776,768.
<2,259,257.>
<13,490,843.>

0.
<15,750,100.>

Check if Schedule O contains a response to any question in this Part XII •••••••••••••••••••••••••••••
Yes

c

3a
b

232012
12-10-12

16010424 132497 MHMR

T

b

AF

2a

X Accrual
Accounting method used to prepare the Form 990:
Cash
Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
X Separate basis
Consolidated basis
Both consolidated and separate basis
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule O and describe any steps taken to undergo such audits ••••••••••••••••

DR

1

X

2a

2b

X

2c

X

3a

X
No

X

3b
Form 990 (2012)

12
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

SCHEDULE A

Public Charity Status and Public Support

(Form 990 or 990-EZ)

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
| Attach to Form 990 or Form 990-EZ. | See separate instructions.

Department of the Treasury
Internal Revenue Service

OMB No. 1545-0047

2012

Open to Public
Inspection

JGB MENTAL HEALTH AND MENTAL RETARDATION
Employer identification number
SERVICES, INC.
20-1480790
Reason for Public Charity Status (All organizations must complete this part.) See instructions.

Name of the organization

Part I

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)
3
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name,
4
city, and state:
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from
activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
See section 509(a)(2). (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or
more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that
describes the type of supporting organization and complete lines 11e through 11h.
a
Type I
b
Type II
c
Type III - Functionally integrated
d
Type III - Non-functionally integrated
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III
supporting organization, check this box ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below,
Yes No
the governing body of the supported organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11g(i)
(ii) A family member of a person described in (i) above? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11g(ii)
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ~~~~~~~~~~~~~~~~~~~~~~~~ 11g(iii)
Provide the following information about the supported organization(s).

e
f
g

h

(i) Name of supported
organization

DR

10
11

AF

T

X

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
section 170(b)(1)(A)(vi). (Complete Part II.)
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

(ii) EIN

(vi) Is the
(iii) Type of organization (iv) Is the organization (v) Did you notify the organization
in col. (vii) Amount of monetary
in
col.
(i)
listed
in
your
organization
in
col.
(described on lines 1-9
support
(i) organized in the
above or IRC section governing document? (i) of your support?
U.S.?
(see instructions))
Yes
No
Yes
No
Yes
No

Total
LHA For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
232021
12-04-12

16010424 132497 MHMR

Schedule A (Form 990 or 990-EZ) 2012

13
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Schedule A (Form 990 or 990-EZ) 2012

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

Page 2

(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization
fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support
Calendar year (or fiscal year beginning in) |

(a) 2008

(b) 2009

(a) 2008

(b) 2009

(c) 2010

(d) 2011

(e) 2012

(f) Total

(e) 2012

(f) Total

1 Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
2 Tax revenues levied for the organization's benefit and either paid to
or expended on its behalf ~~~~

4 Total. Add lines 1 through 3 ~~~
5 The portion of total contributions
by each person (other than a
governmental unit or publicly
supported organization) included
on line 1 that exceeds 2% of the
amount shown on line 11,
column (f) ~~~~~~~~~~~~
6 Public support. Subtract line 5 from line 4.

7 Amounts from line 4 ~~~~~~~
8 Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources ~
9 Net income from unrelated business
activities, whether or not the
business is regularly carried on ~
10 Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.) ~~~~
11 Total support. Add lines 7 through 10

(c) 2010

(d) 2011

DR

Calendar year (or fiscal year beginning in) |

AF

Section B. Total Support

T

3 The value of services or facilities
furnished by a governmental unit to
the organization without charge ~

12 Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~ 12
13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here ••••••••••••••••••••••••••••••••••••••••••••• |

Section C. Computation of Public Support Percentage

14 Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) ~~~~~~~~~~~~ 14
%
15 Public support percentage from 2011 Schedule A, Part II, line 14 ~~~~~~~~~~~~~~~~~~~~~ 15
%
16a 33 1/3% support test - 2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
stop here. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
b 33 1/3% support test - 2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
17a 10% -facts-and-circumstances test - 2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,
and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization
meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ |
b 10% -facts-and-circumstances test - 2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or
more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the
organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~ |
18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ••• |
Schedule A (Form 990 or 990-EZ) 2012

232022
12-04-12

16010424 132497 MHMR

14
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
20-1480790
Schedule A (Form 990 or 990-EZ) 2012 SERVICES, INC.
Part III Support Schedule for Organizations Described in Section 509(a)(2)

Page 3

(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to
qualify under the tests listed below, please complete Part II.)

Section A. Public Support
Calendar year (or fiscal year beginning in) |
1 Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
2 Gross receipts from admissions,
merchandise sold or services performed, or facilities furnished in
any activity that is related to the
organization's tax-exempt purpose
3 Gross receipts from activities that
are not an unrelated trade or business under section 513 ~~~~~

(a) 2008

51,000.

(b) 2009

(c) 2010

53,500.

3,000.

(d) 2011

(e) 2012

10,150.

(f) Total

50,000. 167,650.

4835764. 4629442. 4324548. 5055692. 4467511.23312957.

4 Tax revenues levied for the organization's benefit and either paid to
or expended on its behalf ~~~~

4886764. 4682942. 4327548. 5065842. 4517511.23480607.

T

6 Total. Add lines 1 through 5 ~~~
7 a Amounts included on lines 1, 2, and
3 received from disqualified persons
b Amounts included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% of the
amount on line 13 for the year ~~~~~~

c Add lines 7a and 7b ~~~~~~~
8 Public support (Subtract line 7c from line 6.)

Section B. Total Support

9 Amounts from line 6 ~~~~~~~
10a Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources ~
b Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975 ~~~~
c Add lines 10a and 10b ~~~~~~
11 Net income from unrelated business
activities not included in line 10b,
whether or not the business is
regularly carried on ~~~~~~~
12 Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.) ~~~~
13 Total support. (Add lines 9, 10c, 11, and 12.)

(a) 2008

(b) 2009

DR

Calendar year (or fiscal year beginning in) |

AF

5 The value of services or facilities
furnished by a governmental unit to
the organization without charge ~

(c) 2010

0.
0.
0.
23480607.

(d) 2011

(e) 2012

(f) Total

4886764. 4682942. 4327548. 5065842. 4517511.23480607.

50,768.
50,768.
4886764. 4733710. 4327548. 5065842. 4517511.23531375.

14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here •••••••••••••••••••••••••••••••••••••••••••••••••••• |

Section C. Computation of Public Support Percentage

15 Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) ~~~~~~~~~~~~
16 Public support percentage from 2011 Schedule A, Part III, line 15 ••••••••••••••••••••

Section D. Computation of Investment Income Percentage

15
16

99.78
99.78

%
%

.00 %
17 Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ~~~~~~~~ 17
18 Investment income percentage from 2011 Schedule A, Part III, line 17 ~~~~~~~~~~~~~~~~~~ 18
%
19 a 33 1/3% support tests - 2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not
more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ~~~~~~~~~~ | X
b 33 1/3% support tests - 2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization~~~~ |
20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions •••••••• |
232023 12-04-12
Schedule A (Form 990 or 990-EZ) 2012
16010424 132497 MHMR

15
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Schedule B

Schedule of Contributors

(Form 990, 990-EZ,
or 990-PF)

| Attach to Form 990, Form 990-EZ, or Form 990-PF.

Department of the Treasury
Internal Revenue Service

Name of the organization

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

OMB No. 1545-0047

2012

Employer identification number

20-1480790

Organization type (check one):
Filers of:
Form 990 or 990-EZ

Section:

X

501(c)(

3

) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation
527 political organization
Form 990-PF

501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation

T

501(c)(3) taxable private foundation

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one
contributor. Complete Parts I and II.

Special Rules

DR

X

AF

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections
509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2%
of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not total to more than $1,000.
If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc.,
purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable, etc., contributions of $5,000 or more during the year ~~~~~~~~~~~~~~~~~ | $
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF),
but it must answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on Part I, line 2 of its Form 990-PF, to
certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

223451
12-21-12

Page 2

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name of organization

Employer identification number

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Part I

Contributors

(see instructions). Use duplicate copies of Part I if additional space is needed.

(a)
No.

1

20-1480790

(b)
Name, address, and ZIP + 4

(c)
Total contributions

LEO & LILYAN COLE FUND
C/O JP MORGAN CHASE BANK, 270 PARK
AVENUE

50,000.

$

(b)
Name, address, and ZIP + 4

(c)
Total contributions

T

(c)
Total contributions

AF

(b)
Name, address, and ZIP + 4

DR

(b)
Name, address, and ZIP + 4

(d)
Type of contribution

(Complete Part II if there
is a noncash contribution.)
(d)
Type of contribution
Person
Payroll
Noncash

$

(a)
No.

X

Person
Payroll
Noncash

$

(a)
No.

Person
Payroll
Noncash

(Complete Part II if there
is a noncash contribution.)

NEW YORK, NY 10017
(a)
No.

(d)
Type of contribution

(Complete Part II if there
is a noncash contribution.)

(c)
Total contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there
is a noncash contribution.)
(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Total contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there
is a noncash contribution.)
(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Total contributions

$

(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II if there
is a noncash contribution.)

223452 12-21-12

16010424 132497 MHMR

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

17
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Page 3
Employer identification number

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name of organization

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Part II

Noncash Property

(a)
No.
from
Part I

20-1480790

(see instructions). Use duplicate copies of Part II if additional space is needed.

(b)
Description of noncash property given

(c)
FMV (or estimate)
(see instructions)

(d)
Date received

(c)
FMV (or estimate)
(see instructions)

(d)
Date received

$
(a)
No.
from
Part I

(b)
Description of noncash property given

(a)
No.
from
Part I

(c)
FMV (or estimate)
(see instructions)

(d)
Date received

(c)
FMV (or estimate)
(see instructions)

(d)
Date received

(c)
FMV (or estimate)
(see instructions)

(d)
Date received

(c)
FMV (or estimate)
(see instructions)

(d)
Date received

AF

(b)
Description of noncash property given

DR

(a)
No.
from
Part I

T

$

$

(b)
Description of noncash property given

$
(a)
No.
from
Part I

(b)
Description of noncash property given

$
(a)
No.
from
Part I

(b)
Description of noncash property given

$
223453 12-21-12

16010424 132497 MHMR

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

18
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Page 4
Employer identification number

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Name of organization

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations that total more than $1,000 for the
Part III
year. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter
the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once.) | $
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP + 4

(b) Purpose of gift

(c) Use of gift

(d) Description of how gift is held

AF

T

(a) No.
from
Part I

Relationship of transferor to transferee

(e) Transfer of gift

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

DR

Transferee's name, address, and ZIP + 4

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP + 4

223454 12-21-12

16010424 132497 MHMR

Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

19
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service

OMB No. 1545-0047

Supplemental Financial Statements

2012

| Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
| Attach to Form 990. | See separate instructions.

Open to Public
Inspection

JGB MENTAL HEALTH AND MENTAL RETARDATION
Employer identification number
SERVICES, INC.
20-1480790
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.Complete if the

Name of the organization

Part I

organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds

(b) Funds and other accounts

Total number at end of year ~~~~~~~~~~~~~~~
Aggregate contributions to (during year) ~~~~~~~~
Aggregate grants from (during year) ~~~~~~~~~~
Aggregate value at end of year ~~~~~~~~~~~~~
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds
are the organization's property, subject to the organization's exclusive legal control? ~~~~~~~~~~~~~~~~~~
6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only
for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring
impermissible private benefit? ••••••••••••••••••••••••••••••••••••••••••••
Part II Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
2
3
4
5

Yes

No

Yes

No

Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Preservation of an historically important land area
Protection of natural habitat
Preservation of a certified historic structure
Preservation of open space

2

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
day of the tax year.
Held at the End of the Tax Year

4
5
6
7
8
9

AF

3

Total number of conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2a
Total acreage restricted by conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~
2b
Number of conservation easements on a certified historic structure included in (a) ~~~~~~~~~~~~
2c
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
listed in the National Register ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2d
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year |
Number of states where property subject to conservation easement is located |
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year |
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year | $

DR

a
b
c
d

T

1

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.

Part III

No

No

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.

Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts
relating to these items:
(i) Revenues included in Form 990, Part VIII, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
(ii) Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide
the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a Revenues included in Form 990, Part VIII, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
b Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990.
232051
12-10-12

16010424 132497 MHMR

Schedule D (Form 990) 2012

20
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790 Page 2
Schedule D (Form 990) 2012
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets(continued)
Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items
(check all that apply):
a
Public exhibition
d
Loan or exchange programs
b
Scholarly research
e
Other
c
Preservation for future generations
4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.
5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets
to be sold to raise funds rather than to be maintained as part of the organization's collection? ••••••••••••
Yes
No
Part IV Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990, Part IV, line 9, or
reported an amount on Form 990, Part X, line 21.
3

1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
b If "Yes," explain the arrangement in Part XIII and complete the following table:

Yes

Amount
Beginning balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1c
Additions during the year ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1d
Distributions during the year ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1e
Ending balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1f
Did the organization include an amount on Form 990, Part X, line 21? ~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII •••••••••••••
Part V Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

No

T

c
d
e
f
2a
b

No

(a) Current year
(b) Prior year
(c) Two years back (d) Three years back (e) Four years back
Beginning of year balance ~~~~~~~
Contributions ~~~~~~~~~~~~~~
Net investment earnings, gains, and losses
Grants or scholarships ~~~~~~~~~
Other expenditures for facilities
and programs ~~~~~~~~~~~~~
f Administrative expenses ~~~~~~~~
g End of year balance ~~~~~~~~~~
2 Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a Board designated or quasi-endowment |
%
b Permanent endowment |
%
c Temporarily restricted endowment |
%
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
Yes No
(i) unrelated organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3a(i)
(ii) related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3a(ii)
b If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? ~~~~~~~~~~~~~~~~~~~~~~
3b
4 Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI Land, Buildings, and Equipment. See Form 990, Part X, line 10.

DR

AF

1a
b
c
d
e

Description of property

(a) Cost or other
basis (investment)

(b) Cost or other
basis (other)

(c) Accumulated
depreciation

(d) Book value

1a Land ~~~~~~~~~~~~~~~~~~~~
b Buildings ~~~~~~~~~~~~~~~~~~
c Leasehold improvements ~~~~~~~~~~
138,876.
112,980.
25,896.
d Equipment ~~~~~~~~~~~~~~~~~
191,331.
170,954.
20,377.
e Other ••••••••••••••••••••
46,273.
(Column
(d)
must
equal
Form
990,
Part
X,
column
(B),
line
10(c).)
Total. Add lines 1a through 1e.
•••••••••••• |
Schedule D (Form 990) 2012

232052
12-10-12

16010424 132497 MHMR

21
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Schedule D (Form 990) 2012
Part VII Investments - Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category (including name of security)

(b) Book value

20-1480790

Page 3

(c) Method of valuation: Cost or end-of-year market value

(1) Financial derivatives ~~~~~~~~~~~~~~~
(2) Closely-held equity interests ~~~~~~~~~~~
(3) Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Col. (b) must equal Form 990, Part X, col. (B) line 12.) |

Part VIII Investments - Program Related. See Form 990, Part X, line 13.
(b) Book value

AF

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Col. (b) must equal Form 990, Part X, col. (B) line 13.) |
Part IX Other Assets. See Form 990, Part X, line 15.
(a) Description

(c) Method of valuation: Cost or end-of-year market value

T

(a) Description of investment type

(b) Book value

DR

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 15.) •••••••••••••••••••••••••••• |
Part X Other Liabilities. See Form 990, Part X, line 25.
(a) Description of liability
(b) Book value
1.
(1) Federal income taxes
(2) DUE TO THE JEWISH GUILD FOR THE
(3) BLIND D/B/A JEWISH GUILD
15,794,819.
(4) HEALTHCARE
OTHER
LIABILITIES
507,853.
(5)
(6)
(7)
(8)
(9)
(10)
(11)
16,302,672.
Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.) ••••• |
2. FIN 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's
X
liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ••••••
Schedule D (Form 990) 2012
232053
12-10-12

16010424 132497 MHMR

22
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790 Page 4
Schedule D (Form 990) 2012
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
4,464,693.
1 Total revenue, gains, and other support per audited financial statements ~~~~~~~~~~~~~~~~~~~
1
2
a
b
c
d
e
3
4
a
b
c
5

Amounts included on line 1 but not on Form 990, Part VIII, line 12:
Net unrealized gains on investments ~~~~~~~~~~~~~~~~~~~~~~
2a
3,191.
Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~
2b
Recoveries of prior year grants ~~~~~~~~~~~~~~~~~~~~~~~~~
2c
Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~~~~~
2d
Add lines 2a through 2d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2e
Subtract line 2e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3
Amounts included on Form 990, Part VIII, line 12, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b ~~~~~~~~
4a
56,009.
Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~~~~~
4b
Add lines 4a and 4b ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4c
Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) •••••••••••••••••
5

1
2
a
b
c
d
e
3
4
a
b
c
5

Total expenses and losses per audited financial statements ~~~~~~~~~~~~~~~~~~~~~~~~~~
1
Amounts included on line 1 but not on Form 990, Part IX, line 25:
3,191.
Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~
2a
Prior year adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2b
Other losses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2c
Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~~~~~
2d
Add lines 2a through 2d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2e
Subtract line 2e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3
Amounts included on Form 990, Part IX, line 25, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b ~~~~~~~~
4a
56,009.
Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~~~~~
4b
Add lines 4a and 4b ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4c
Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ••••••••••••••••
5

Part XIII Supplemental Information

AF

T

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

3,191.
4,461,502.

56,009.
4,517,511.
6,723,950.

3,191.
6,720,759.

56,009.
6,776,768.

DR

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part
X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

PART X, LINE 2: MHS HAS DETERMINED THAT THERE ARE NO MATERIAL

UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE
FINANCIAL STATEMENTS.

PERIODS ENDING JUNE 30, 2010 AND SUBSEQUENT REMAIN

SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES.

PART XI, LINE 4B - OTHER ADJUSTMENTS:
BAD DEBT EXPENSE

56,009.

Schedule D (Form 990) 2012

232054
12-10-12

16010424 132497 MHMR

23
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790
Schedule D (Form 990) 2012
Part XIII Supplemental Information (continued)

Page 5

PART XII, LINE 4B - OTHER ADJUSTMENTS:
56,009.

DR

AF

T

BAD DEBT EXPENSE

232055
12-10-12

16010424 132497 MHMR

Schedule D (Form 990) 2012

24
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

SCHEDULE J
(Form 990)
Department of the Treasury
Internal Revenue Service

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
| Complete if the organization answered "Yes" to Form 990,
Part IV, line 23.
| Attach to Form 990. | See separate instructions.

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
Questions Regarding Compensation

Name of the organization

Part I

Compensation Information

OMB No. 1545-0047

2012

Open to Public
Inspection
Employer identification number

20-1480790

Yes

No

1a Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990,
Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
First-class or charter travel
Housing allowance or residence for personal use
Travel for companions
Payments for business use of personal residence
Tax indemnification and gross-up payments
Health or social club dues or initiation fees
Discretionary spending account
Personal services (e.g., maid, chauffeur, chef)
b If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or
reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain ~~~~~~~~~~~
2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors,
trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ~~~~~~~~~~~~~~~~~~~~~

2

Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's
CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to
establish compensation of the CEO/Executive Director, but explain in Part III.
X Compensation committee
X Written employment contract
X Compensation survey or study
Independent compensation consultant
X Form 990 of other organizations
X Approval by the board or compensation committee

AF

T

3

1b

DR

During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing
organization or a related organization:
a Receive a severance payment or change-of-control payment? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
b Participate in, or receive payment from, a supplemental nonqualified retirement plan? ~~~~~~~~~~~~~~~~~~~~
c Participate in, or receive payment from, an equity-based compensation arrangement?~~~~~~~~~~~~~~~~~~~~
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

4

4a
4b
4c

X

X
X

Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5-9.
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation
contingent on the revenues of:
X
5a
a The organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
X
5b
b Any related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to line 5a or 5b, describe in Part III.
6 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation
contingent on the net earnings of:
X
6a
a The organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
X
6b
b Any related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to line 6a or 6b, describe in Part III.
7 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed payments
X
7
not described in lines 5 and 6? If "Yes," describe in Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
8 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the
X
8
initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III ~~~~~~~~~~~
9 If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in
9
Regulations section 53.4958-6(c)? •••••••••••••••••••••••••••••••••••••••••••••
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Schedule J (Form 990) 2012
5

232111
12-10-12

16010424 132497 MHMR

25
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790

Schedule J (Form 990) 2012
Part II Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

Page 2

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions, on row (ii).
Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(B) Breakdown of W-2 and/or 1099-MISC compensation
(i) Base
compensation

(A) Name and Title

(1) ALAN R. MORSE
PRESIDENT & CEO
(2) PHILIP ROSENTHAL
CHIEF OPERATING OFFICER
(3) ELLIOT J. HAGLER
CHIEF FINANCIAL OFFICER
(4) GOLDIE DERSH
VP-BEHAVIOR HEALTH SCIENCE
(5) BRUCE MASTALINSKI
CHIEF COMPLIANCE OFFICER
(6) KELLYANNE CAIVANO
SENIOR VP FINANCE
(7) BARBARA KLEIN
DIRECTOR OF DEVELOPMENT
(8) MELISSA FARBER
VP HUMAN RESOURCES
(9) SARA PITTERMAN
DIRECTOR OF FINANCE

232112
12-12-12

(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)
(i)
(ii)

16,290.
798,188.
43,304.
389,735.
28,016.
303,439.
158,040.
0.
39,110.
351,989.
19,634.
212,645.
1,684.
166,737.
13,844.
142,499.
11,576.
125,381.

(ii) Bonus &
incentive
compensation

3,000.
147,000.
0.
0.
1,902.
20,598.
0.
0.
0.
0.
845.
9,155.
0.
0.
576.
5,924.
0.
0.

(iii) Other
reportable
compensation

925.
45,304.
1,754.
15,792.
184.
1,990.
0.
0.
170.
1,527.
243.
2,626.
10.
964.
31.
315.
10.
105.

(C) Retirement and
other deferred
compensation

1,928.
94,480.
2,500.
22,500.
3,452.
37,389.
11,377.
0.
2,944.
26,492.
2,639.
28,580.
121.
11,980.
1,837.
18,907.
740.
8,018.

T
F

A
R

D

26

(D) Nontaxable
benefits

(E) Total of columns (F) Compensation
(B)(i)-(D)
reported as deferred
in prior Form 990

779.
22,922.
38,191. 1,123,163.
3,472.
51,030.
61,569.
489,596.
3,938.
37,492.
63,790.
427,206.
20,600.
190,017.
0.
0.
1,999.
44,223.
17,991.
397,999.
1,963.
25,324.
27,953.
280,959.
219.
2,034.
21,658.
201,339.
3,037.
19,325.
44,295.
211,940.
2,945.
15,271.
40,415.
173,919.

0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.

Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Part III Supplemental Information

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

20-1480790

Page 3

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any
additional information.

PART I, LINE 4B: ALAN R. MORSE - $81,205

PART I, LINE 7: AS PART OF THE COMPENSATION FOR 2012, THE COMPENSATION
COMMITTEE GRANTED BONUSES TO THE EXECUTIVE STAFF, BASED ON ITS REVIEW OF

T
F

THEIR PERFORMANCE, AS DOCUMENTED IN THE MINUTES OF THE COMMITTEE. THE

AMOUNTS REFLECTED AS BONUSES ON THIS SCHEDULE REPRESENT AN ALLOCATION OF

A
R

THE BONUS PAID BY A RELATED PARTY.

D

Schedule J (Form 990) 2012
232113
12-10-12

27

SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service

Name of the organization

Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
| Attach to Form 990 or 990-EZ.

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

OMB No. 1545-0047

2012

Open to Public
Inspection
Employer identification number

20-1480790

FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:
JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC.'S CENTER FOR
BEHAVIORAL HEALTH SERVES THE VISUALLY IMPAIRED COMMUNITY BY HELPING
PEOPLE WHO HAVE LOST OR ARE LOSING THEIR VISION AND ARE HAVING
DIFFICULTIES ADJUSTING OR COPING EMOTIONALLY. THE CENTER INCLUDES THREE
COMPONENTS: PSYCHIATRIC CLINIC, A MENTAL HEALTH DAY TREATMENT PROGRAM

T

AND A DEVELOPMENTAL DISABILITIES DAY TREATMENT PROGRAM.

THE PSYCHIATRIC CLINIC IS THE ONLY PSYCHIATRIC SERVICE IN THE UNITED

AF

STATES SPECIFICALLY FOR PEOPLE WHO ARE BLIND AND VISUALLY IMPAIRED.
THE CLINIC SPECIALIZES IN WORKING WITH INDIVIDUALS, FAMILIES AND THEIR
CAREGIVERS WHO ARE HAVING ADJUSTMENT REACTIONS, OR OTHER DIFFICULTIES
IT ALSO SERVES THOSE WHO, IN ADDITION TO VISION LOSS,

DR

TO VISION LOSS.

MAY BE EXPERIENCING SEVERE ANXIETY AND DEPRESSION OR ACUTE SERIOUS AND
PERSISTENT EMOTIONAL PROBLEMS.

THE CLINIC'S ABILITY TO INTEGRATE ITS

MULTIFACETED TREATMENT PLANS WITH THE GUILD'S EXTENSIVE REHABILITATION
SERVICES PROVIDES CLIENTS WITH THE WIDEST POSSIBLE SUPPORT SYSTEM.

THE

CLINIC PROVIDES TREATMENT TO REDUCE A PERSON'S EMOTIONAL DISTRESS AND
TO HELP THAT PERSON TO ACKNOWLEDGE AND MINIMIZE THE IMPACT OF VISION
LOSS.

TREATMENT INTERVENTIONS INCLUDE: CRISIS INTERVENTION, INDIVIDUAL

THERAPY, PSYCHOPHARMACY INTERVENTION, MEDICAL COORDINATION AND LIAISON,
SHORT TERM PROBLEM RESOLUTION, CASE MANAGEMENT, PSYCHOLOGICAL
REHABILITATION CASE READINESS, TREATMENT MONITORING, MAINTENANCE OF
CLIENTS WITH CHRONIC MENTAL ILLNESS AND SPECIALTY SUPPORT GROUPS. THE
CLINIC PROVIDED 11,403 SESSIONS TO APPROXIMATELY 334 CLIENTS IN 2013.

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
232211
01-04-13

16010424 132497 MHMR

Schedule O (Form 990 or 990-EZ) (2012)

28
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Schedule O (Form 990 or 990-EZ) (2012)
Name of the organization JGB MENTAL

HEALTH AND MENTAL RETARDATION
SERVICES, INC.

Page 2
Employer identification number

20-1480790

THE MENTAL HEALTH DAY TREATMENT PROGRAM IS AVAILABLE FOR BLIND AND
VISUALLY IMPAIRED INDIVIDUALS WHO ARE SERIOUSLY AND PERSISTENTLY
MENTALLY ILL.

THE PROGRAM AIMS TO HELP CLIENTS FUNCTION AS

INDEPENDENTLY AS POSSIBLE THROUGH THE ACQUISITION OF PERSONAL, SOCIAL
AND INTERPERSONAL SKILLS. THESE INDIVIDUALS MAY ALSO HAVE OTHER
DEVELOPMENTAL AND PHYSICAL DISABILITIES. TREATMENT INTERVENTIONS
INCLUDE: CASE MANAGEMENT, GROUP THERAPY AS A PRIMARY TREATMENT METHOD,
CRISIS INTERVENTION, PSYCHOPHARMACOLOGY, MEDICAL COORDINATION AND
LIAISON, SKILL-BUILDING FOR THE MANAGEMENT OF PSYCHIATRIC SYMPTOMS AND

IN 2013, THE PROGRAM PROVIDED 8,260 SESSIONS TO

APPROXIMATELY 56 CLIENTS.

AF

WELL-BEING.

T

INITIATING BEHAVIORAL CHANGES THAT PROMOTE POSITIVE ACTION, HEALTH AND

DR

THE DEVELOPMENTAL DISABILITIES DAY TREATMENT PROGRAM SERVES ADULTS WHO
ARE BLIND OR VISUALLY IMPAIRED WITH DEVELOPMENTAL DISABILITIES, MANY OF
WHOM LIVE IN RESIDENTIAL FACILITIES.

BY TEACHING ESSENTIAL LIFE SKILLS

THROUGH OCCUPATIONAL AND PHYSICAL THERAPY AND SOCIAL WORK, INDIVIDUALS
ARE HELPED TO LIVE MORE FULFILLING AND INDEPENDENT LIVES. CLIENTS
PARTICIPATE IN INNOVATIVE, PERSON-CENTERED DAY PROGRAMS AND ACTIVITIES.
SERVICES INCLUDE: FUNCTIONAL LIFE SKILLS, ORIENTATION AND MOBILITY,
PSYCHOLOGICAL SERVICES, PHYSICAL, OCCUPATIONAL, SPEECH AND LANGUAGE
THERAPY, COUNSELING, SUPPORT GROUPS, ADAPTIVE PHYSICAL EDUCATION, MUSIC
AND RECREATION. IN 2013, THE PROGRAM PROVIDED 19,282 SESSIONS FOR
APPROXIMATELY 94 CLIENTS.

FORM 990, PART VI, SECTION A, LINE 6: THE JEWISH GUILD FOR THE BLIND
D/B/A JEWISH GUILD HEALTHCARE IS THE SOLE MEMBER OF JGB MENTAL HEALTH AND
MENTAL RETARDATION SERVICES, INC.(MHS).
232212
01-04-13

16010424 132497 MHMR

Schedule O (Form 990 or 990-EZ) (2012)

29
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Schedule O (Form 990 or 990-EZ) (2012)
Name of the organization JGB MENTAL

HEALTH AND MENTAL RETARDATION
SERVICES, INC.

Page 2
Employer identification number

20-1480790

FORM 990, PART VI, SECTION A, LINE 7A: THE SOLE MEMBER ELECTS THE BOARD
MEMBERS OF MHS ON AN ANNUAL BASIS.

FORM 990, PART VI, SECTION B, LINE 11: THE FORM 990 IS PREPARED BY THE
STAFF AND REVIEWED BY OUR OUTSIDE AUDITORS.

AFTER ITS APPROVAL, A LINK TO

THE FORM IS EMAILED TO EACH BOARD MEMBER.

FORM 990, PART VI, SECTION B, LINE 12C: OFFICERS, DIRECTORS, AND ALL STAFF

T

ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY. WHEN THERE IS A CHANGE

AF

IN THIS INFORMATION, THEY ARE REQUIRED TO COMPLETE AN UPDATED FORM.
CONFLICTS OF INTEREST ARE REPORTED IN WRITING TO THE PRESIDENT.

ALL

THE

PRESIDENT MAY THEN REQUEST THAT SUCH INTEREST OR ACTIVITY BE DISPOSED OF,

DR

DISCONTINUED OR LIMITED. OFFICERS, DIRECTORS AND DEPARTMENT DIRECTORS
COMPLETE CONFLICT OF INTEREST STATEMENTS ON AN ANNUAL BASIS.

FORM 990, PART VI, SECTION B, LINE 15: THE COMPENSATION COMMITTEE, WHICH
IS COMPRISED OF GUILD AND AFFILIATE BOARD MEMBERS, REVIEWS SALARY DATA FROM
COMPARABLE ORGANIZATIONS THAT HAS BEEN REVIEWED BY OUR AUDITORS AND
ATTORNEYS FOR ACCURACY, COMPLETENESS AND COMPLIANCE WITH APPLICABLE
REGULATIONS AND STATUTORY REQUIREMENTS.

BASED UPON THEIR REVIEW OF THIS

DATA, AND OTHER RELEVANT INFORMATION INCLUDING SPECIFIC JOB PERFORMANCE,
THE COMMITTEE DETERMINES APPROPRIATE COMPENSATION FOR THE CEO, AND OTHER
SENIOR EXECUTIVES AT A MEETING AT WHICH THE AUDITORS AND ATTORNEYS ARE
PRESENT.

MINUTES OF THE COMMITTEE'S MEETINGS ARE MAINTAINED. THIS PROCESS

WAS CONDUCTED IN 2012.

FORM 990, PART VI, SECTION C, LINE 19: THE FORM 990 IS AVAILABLE ON THE
232212
01-04-13

16010424 132497 MHMR

Schedule O (Form 990 or 990-EZ) (2012)

30
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Schedule O (Form 990 or 990-EZ) (2012)
Name of the organization JGB MENTAL

HEALTH AND MENTAL RETARDATION
SERVICES, INC.

Page 2
Employer identification number

20-1480790

GUILD'S WEBSITE. A COPY OF THE FORM 990, GOVERNING DOCUMENTS, CONFLICT OF
INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.

FORM 990, PART XII, LINE 2C
THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT AND SELECTION OF
THE INDEPENDENT ACCOUNTANTS. THERE HAS BEEN NO CHANGE FROM THE PRIOR

FORM 990, PART VII, SECTION A

T

YEAR.

AF

A PORTION OF THE OFFICERS COMPENSATION PAID BY THE JEWISH GUILD FOR THE
BLIND D/B/A JEWISH GUILD HEALTHCARE (EIN# 13-1623854) HAS BEEN
ALLOCATED TO JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC.

DR

AND OTHER SUBSIDIARIES. JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC. EMPLOYEES DID NOT RECEIVE ANY DIRECT COMPENSATION FROM
JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. BUT DID RECEIVE
COMPENSATION FROM THE JEWISH GUILD FOR THE BLIND (EIN# 13-1623854).

232212
01-04-13

16010424 132497 MHMR

Schedule O (Form 990 or 990-EZ) (2012)

31
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

Department of the Treasury
Internal Revenue Service

Name of the organization
Part I

Open to Public
Inspection

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

Employer identification number

20-1480790

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

MASSACHUSETTS GUILD FOR THE BLIND, LLC 13-1623854, 101 FEDERAL STREET, BOSTON, MA
02110

(b)
Primary activity

(c)
Legal domicile (state or
foreign country)

(e)
End-of-year assets

T
F

PROVIDE TRAINING & SUPPORT
TO THE VISUALLY IMPAIRED OR
LEGALLY BLIND
MASSACHUSETTS

A
R

D

(d)
Total income

(f)
Direct controlling
entity

THE JEWISH GUILD FOR
THE BLIND D/B/A JEWISH
GUILD HEALTHCARE

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt
organizations during the tax year.)
(a)
Name, address, and EIN
of related organization

THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH
GUILD HEALTHCARE - 13-1623854, 15 WEST 65TH
STREET, NEW YORK, NY 10023
JGB HEALTH FACILITIES CORP - 13-2795647
15 WEST 65TH STREET
NEW YORK, NY 10023
JGB EDUCATION SERVICES - 13-3419981
15 WEST 65TH STREET
NEW YORK, NY 10023
JGB REHABILITATION CORPORATION - 13-3439035
15 WEST 65TH STREET
NEW YORK, NY 10023

(b)
Primary activity

PROVIDES SERVICES TO
VISUALLY IMPAIRED
INCLUDING MULTI-DISABLED
ADULT DAY HEALTH CARE
PROGRAMS AND RESIDENTIAL
HEALTH CARE

(c)
Legal domicile (state or
foreign country)

(e)
Public charity
status (if section
501(c)(3))

501 (C) (3)

9

NEW YORK

501 (C) (3)

9

NEW YORK

501 (C) (3)

2

OUTPATIENT MEDICAL CLINIC NEW YORK

501 (C) (3)

9

PRIVATE NON-RESIDENTIAL
SCHOOL

SEE PART VII FOR CONTINUATIONS

LHA

(d)
Exempt Code
section

NEW YORK

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
232161
12-10-12

2012

| Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
| See separate instructions.
| Attach to Form 990.

(a)
Name, address, and EIN (if applicable)
of disregarded entity

Part II

OMB No. 1545-0047

Related Organizations and Unrelated Partnerships

SCHEDULE R
(Form 990)

(f)
Direct controlling
entity

(g)

Section 512(b)(13)
controlled
entity?

Yes

N/A
THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH
THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH
THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH

No

X
X
X
X

Schedule R (Form 990) 2012

32

Schedule R (Form 990)
Part II

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

Continuation of Identification of Related Tax-Exempt Organizations
(a)
Name, address, and EIN
of related organization

GREATER BOSTON GUILD FOR THE BLIND, INC. 04-2103893, 1980 CENTRE STREET, WEST
ROXBURY, MA 02132
GREATER BOSTON DIABETES SOCIETY, INC. 04-2232419, 1980 CENTRE STREET, WEST
ROXBURY, MA 02132
GUILDNET, INC - 13-3936057
15 WEST 65TH STREET
NEW YORK, NY 10023
NATIONAL ASSOCIATION OF PARENTS OF CHILDREN
WITH VISUAL IMPAIRMENTS, INC. - , 6 BEACON
ST., STE 510, BOSTON, MA 02108

(b)
Primary activity

(c)
Legal domicile (state or
foreign country)

EDUCATION, TRAINING &
SUPPORT TO THE VISUALLY
IMPAIRED OR LEGALLY BLIND MASSACHUSETTS
PUBLIC EDUCATION DIABETES PREVENTION &
MANAGEMENT
MASSACHUSETTS
MANAGED LONG TERM CARE
PLAN
INFORMATION & RESOURCES
FOR PARENTS OF CHILDREN
WITH VISUAL IMPAIRMENTS

T
F

A
R

MASSACHUSETTS

33

(d)
Exempt Code
section

501 (C) (3)

NEW YORK

D
232222
05-01-12

20-1480790

(e)
Public charity
status (if section
501(c)(3))

9

501 (C) (3)

9

501 (C) (3)

9

501 (C) (3)

9

(f)
Direct controlling
entity

THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH
THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH
THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH
THE JEWISH GUILD
FOR THE BLIND
D/B/A JEWISH

(g)

Section 512(b)(13)
controlled
organization?

Yes

X
X
X
X

No

Schedule R (Form 990) 2012
Part III

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

Page 2

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related
organizations treated as a partnership during the tax year.)

(a)
Name, address, and EIN
of related organization

Part IV

20-1480790

(b)
Primary activity

(c)

Legal
domicile
(state or
foreign
country)

(d)
Direct controlling
entity

(e)
Predominant income
(related, unrelated,
excluded from tax under
sections 512-514)

(f)
Share of total
income

(h)
Disproportionate allocations?

Yes

No

(i)
(j)
(k)
General or Percentage
Code V-UBI
amount in box managing ownership
20 of Schedule partner?
K-1 (Form 1065) Yes No

T
F

A
R

D

(g)
Share of
end-of-year
assets

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related
organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN
of related organization

232162 12-10-12

(b)
Primary activity

(c)

Legal domicile
(state or
foreign
country)

34

(d)
Direct controlling
entity

(e)
Type of entity
(C corp, S corp,
or trust)

(f)
Share of total
income

(g)
Share of
end-of-year
assets

(h)
Percentage
ownership

(i)

Section
512(b)(13)
controlled
entity?

Yes

No

Schedule R (Form 990) 2012

Schedule R (Form 990) 2012
Part V

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

20-1480790

Page 3

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
1 During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
b Gift, grant, or capital contribution to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
c Gift, grant, or capital contribution from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
d Loans or loan guarantees to or for related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
e Loans or loan guarantees by related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1a
1b
1c
1d
1e

f
g
h
i
j

Dividends from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sale of assets to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Purchase of assets from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Exchange of assets with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lease of facilities, equipment, or other assets to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1f
1g
1h
1i
1j

k
l
m
n
o

Lease of facilities, equipment, or other assets from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Performance of services or membership or fundraising solicitations for related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Performance of services or membership or fundraising solicitations by related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sharing of paid employees with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1k
1l
1m
1n
1o

p Reimbursement paid to related organization(s) for expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
q Reimbursement paid by related organization(s) for expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1p
1q

r Other transfer of cash or property to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
s Other transfer of cash or property from related organization(s) ••••••••••••••••••••••••••••••••••••••••••••••••••••••••
2 If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

1r
1s

T
F

A
R

(a)
Name of other organization

D

(b)
Transaction
type (a-s)

(c)
Amount involved

Yes

X

No

X
X
X
X
X
X
X
X
X

X
X
X
X

X
X

X
X
X

(d)
Method of determining amount involved

(1)
(2)
(3)
(4)
(5)
(6)
232163 12-10-12

35

Schedule R (Form 990) 2012

Schedule R (Form 990) 2012
Part VI

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.

20-1480790

Page 4

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue)
that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN
of entity

(b)
Primary activity

(c)
(d)
(e)
Are all
Predominant income partners sec.
Legal domicile
501(c)(3)
(related, unrelated,
(state or foreign
orgs.?
excluded from tax
country)
under section 512-514) Yes No

(f)
Share of
total
income

(g)
Share of
end-of-year
assets

(h)

(i)
(j)
(k)
Code V-UBI General or Percentage
amount in box 20 managing ownership
of Schedule K-1 partner?
(Form 1065) Yes No
Yes No
Disproportionate
allocations?

T
F

A
R

D

Schedule R (Form 990) 2012
232164
12-10-12

36

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790
Schedule R (Form 990) 2012
Part VII Supplemental Information

Page 5

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS:

NAME OF RELATED ORGANIZATION:
JGB HEALTH FACILITIES CORP
DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH
GUILD HEALTHCARE

NAME OF RELATED ORGANIZATION:
JGB EDUCATION SERVICES

T

DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH

NAME OF RELATED ORGANIZATION:

DR

JGB REHABILITATION CORPORATION

AF

GUILD HEALTHCARE

DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH
GUILD HEALTHCARE

NAME OF RELATED ORGANIZATION:

GREATER BOSTON GUILD FOR THE BLIND, INC.
DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH
GUILD HEALTHCARE

NAME OF RELATED ORGANIZATION:
GREATER BOSTON DIABETES SOCIETY, INC.
DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH
GUILD HEALTHCARE

NAME OF RELATED ORGANIZATION:
232165 12-10-12

16010424 132497 MHMR

Schedule R (Form 990) 2012

37
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1

JGB MENTAL HEALTH AND MENTAL RETARDATION
SERVICES, INC.
20-1480790
Schedule R (Form 990) 2012
Part VII Supplemental Information

Page 5

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

GUILDNET, INC
DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH
GUILD HEALTHCARE

NAME OF RELATED ORGANIZATION:
NATIONAL ASSOCIATION OF PARENTS OF CHILDREN WITH VISUAL
IMPAIRMENTS, INC.
DIRECT CONTROLLING ENTITY: THE JEWISH GUILD FOR THE BLIND D/B/A JEWISH

SCHEDULE R, PART V

AF

T

GUILD HEALTHCARE

MHS HAS A MANAGEMENT AGREEMENT WITH THE GUILD FOR ALL NECESSARY
MANAGEMENT AND SALARIED STAFFING SERVICES AS WELL AS USE OF FACILITIES,

DR

EQUIPMENT AND OTHER ASSETS.

MHS RECEIVED PAYMENTS FROM GUILDNET, INC. FOR MEDICAL AND HEALTH CARE
SERVICES.

232165 12-10-12

16010424 132497 MHMR

Schedule R (Form 990) 2012

38
2012.04000 JGB MENTAL HEALTH AND MENTA MHMR___1



---

Source Exif Data:

File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.3
Linearized                      : No
Page Count                      : 38
Page Mode                       : UseOutlines
Creator                         : ProSystem fx
Create Date                     : 2014:04:24 16:03:46
Producer                        : CCH, Inc.
Keywords                        : 3

EXIF Metadata provided by EXIF.tools