JGBMental Health And Mental Retardsation Services Inc
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Form 990 Return of Organization Exempt From Income Tax 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 A For the 2010 calendar year, or tax year beginning B Address change Name change Initial return Terminated Amended return Application pending JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Doing Business As Number and street (or P.O. box if mail is not delivered to street address) Activities & Governance Revenue Expenses D Employer identification number 20-1480790 212-769-6200 4,327,548. City or town, state or country, and ZIP + 4 NEW YORK, NY JUN 30, 2011 2010 Open to Public Inspection Room/suite E Telephone number 15 WEST 65TH STREET G H(a) Is this a group return for affiliates? H(b) Are all affiliates included? Gross receipts $ 10023 F Name and address of principal officer:ELLIOT SAME AS C ABOVE 501(c) ( I Tax-exempt status: X 501(c)(3) J Website: | WWW.JGB.ORG Trust K Form of organization: X Corporation Part I Summary Net Assets or Fund Balances and ending C Name of organization Check if applicable: 1 JUL 1, 2010 OMB No. 1545-0047 J. HAGLER ) § (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. 4 Number of voting members of the governing body (Part VI, line 1a) ~~~~~~~~~~~~~~~~~~~~ 3 4 Number of independent voting members of the governing body (Part VI, line 1b) ~~~~~~~~~~~~~~ 4 57 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ~~~~~~~~~~~~~~~~ 5 20 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 53,500. 3,000. 8 Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~ 4,629,442. 4,324,548. 9 Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~ 0. 0. 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) ~~~~~~~~~~~~~ 50,768. 0. 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~ 4,733,710. 4,327,548. 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) ~~~~~~~~~~~~~ 4,569,786. 4,466,880. 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)~~~~~~~~~~~~~~ 6,812. | b Total fundraising expenses (Part IX, column (D), line 25) 2 3 4 5 6 7a b 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24f) ~~~~~~~~~~~~~ 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 •••••••••••••••• 1,881,249. 2,124,870. 6,451,035. 6,591,750. <1,717,325.> <2,264,202.> 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 730,846. 573,352. 10,261,459. 12,368,167. <9,530,613.><11,794,815.> 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, EXEC V.P. & CFO Preparer's signature FREDERICK H. ROTHMAN LOEB & TROPER Firm's name 655 THIRD AVENUE Firm's address NEW YORK, NY 10017 9 9 Date Check if self-employed Firm's EIN PTIN 9 (212) 867-4000 X Yes May the IRS discuss this return with the preparer shown above? (see instructions) ••••••••••••••••••••• No 032001 02-22-11 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2010) Phone no. JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) 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 exempt purpose achievements for each of the organization's three largest program services by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. (Code: ) (Expenses $ 4,973,931. including grants of $ ) (Revenue $ 4,324,548. ) 4b (Code: ) (Expenses $ including grants of $ ) (Revenue $ ) 4c (Code: ) (Expenses $ including grants of $ ) (Revenue $ ) 4d Other program services. (Describe in Schedule O.) (Expenses $ including grants of $ 4,973,931. Total program service expenses J 2 3 4 4e 032002 12-21-10 15051119 132497 MHMR ) (Revenue $ ) Form 990 (2010) SEE SCHEDULE O FOR CONTINUATION(S) 2 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) Part IV Checklist of Required Schedules 20-1480790 Page 3 Yes 1 2 3 4 5 6 7 8 9 10 11 a b c d e f 12a b 13 14a b 15 16 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? ~~~~~~~~~~~~~~~~~~~~~~ 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 where 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; 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 term, permanent, 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, XII, and XIII ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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, XII, and XIII 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, and program service activities outside the United States? 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 ~~~~~~~~~~~~~~~~~~~~~ 1 2 X No X 3 X 4 X 5 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 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, X column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 17 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines X 1c and 8a? If "Yes," complete Schedule G, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 18 If "Yes," 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? X complete Schedule G, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 19 X If "Yes," complete Schedule H 20a Did the organization operate one or more hospitals? ~~~~~~~~~~~~~~~~~~~~ 20a b If "Yes" to line 20a, did the organization attach its audited financial statements to this return? Note. Some Form 990 filers that operate one or more hospitals must attach audited financial statements (see instructions) ••••••••••••••••• 20b Form 990 (2010) 17 032003 12-21-10 15051119 132497 MHMR 3 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) Part IV Checklist of Required Schedules (continued) 20-1480790 Page 4 Yes 21 22 23 24a b c d 25a b 26 27 28 a b c 29 30 31 32 33 34 35 a 36 37 38 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II ~~~~~~~~~~~~~~~~~~ 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, highly 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 a grant selection committee member, or to a person related to such an individual? 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, Parts II, III, IV, and V, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is any related organization a controlled entity within the meaning of section 512(b)(13)? ~~~~~~~~~~~~~~~~~~ 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 ~~~~~~~~~~~~~~~~~~~~ Yes X No 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 11 and 19? Note. All Form 990 filers are required to complete Schedule O ••••••••••••••••••••••••••••••• 032004 12-21-10 15051119 132497 MHMR 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 35 X X 36 X 37 X X 38 Form 990 (2010) 4 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) 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 ••••••••••••••••••••••••••••• 4 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, 57 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 Yes No X X X X X X X X X X X 9 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 •••••••••• 032005 12-21-10 15051119 132497 MHMR 9a 9b 12a 13a X 14a 14b Form 990 (2010) 5 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Form 990 (2010) 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 4 1a Enter the number of voting members of the governing body at the end of the tax year ~~~~~~ 1a 4 b Enter the number of voting members included in line 1a, above, who are independent ~~~~~~ 1b 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? ~~~~~~~~~~~~~~ 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ~~~~~ 5 Did the organization become aware during the year of a significant diversion of the organization's assets? ~~~~~~~~~ 6 Does the organization have members or stockholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7a Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Are any decisions of the governing body subject to approval by members, stockholders, or other persons?~~~~~~~~~ 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~ 9 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.) Yes b Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ c Does the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this is done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13 Does the organization have a written whistleblower policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 14 Does the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~ 15 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? a The organization's CEO, Executive Director, or top management official ~~~~~~~~~~~~~~~~~~~~~~~~~~ b Other officers or key employees of the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" to line 15a or 15b, describe the process in Schedule O. (See instructions.) 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization's exempt status with respect to such arrangements? •••••••••••••••••••••••••••••••••••• Section C. Disclosure 17 18 19 20 No 2 X 3 4 5 6 X X X X 7a 7b X X 8a 8b X X X 9 Yes 10a Does the organization have local chapters, branches, or affiliates? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ~~~~~~~~~~~~~~~~~~ 11a Has the organization provided a 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 Does the organization have a written conflict of interest policy? If "No," go to line 13 ~~~~~~~~~~~~~~~~~~~~ X 10a 10b 11a X 12a X No X X 12b 12c 13 14 X X X 15a 15b X X 16a 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 (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply. X Upon request Own website Another's website Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public. 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 032006 12-21-10 15051119 132497 MHMR Form 990 (2010) 6 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Form 990 (2010) 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. JAMES M. DUBIN CHAIRMAN LAWRENCE E. GOLDSCHMIDT TREASURER PAULINE RAIFF CHAIRMAN, EXEC COMMITTEE MARC S. SOLOMON SECRETARY ALAN R. MORSE PRESIDENT AND CEO GOLDIE DERSH VP-BEHAVIOR HEALTH SCIENCE ELLIOT J. HAGLER EXECUTIVE VP AND CFO BRUCE MASTALINSKI EXEC VP PROGRAM OPERATIONS SARAH SPICEHANDLER ASSISTANT SECRETARY KELLYANNE CAIVANO VP FINANCE MELISSA FARBER VP HUMAN RESOURCES LARRY CARR DIRECTOR PROGRAM INTEGRITY SARA PITTERMAN DIRECTOR FINANCE HAROLD LEDERMAN DIRECTOR INTERNAL AUDIT 032007 12-21-10 15051119 132497 MHMR Former Highest compensated employee Key employee Officer Institutional trustee 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) Name and Title Average Position Reportable Reportable hours per (check all that apply) compensation compensation week from from related (describe the organizations hours for organization (W-2/1099-MISC) related (W-2/1099-MISC) organizations in Schedule O) (F) Estimated amount of other compensation from the organization and related organizations 0.30 X X 0. 0. 0. 0.30 X X 0. 0. 0. 0.30 X X 0. 0. 0. 0.30 X X 0. 0. 0. 1.20 X 26,439. 35.00 X 152,539. 0. 20,369. 3.10 X 27,887. 282,578. 75,169. 1.80 X 15,452. 293,587. 34,709. 0.70 X 1,488. 72,930. 31,938. 728,985. 125,517. 3.10 X 17,900. 181,367. 43,120. 3.20 X 15,763. 154,768. 39,071. 3.20 X 15,500. 152,584. 13,870. 3.10 X 11,846. 120,032. 42,333. 3.20 X 11,927. 117,415. 40,160. Form 990 (2010) 7 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 Form 990 (2010) 1b c d 2 20-1480790 Former Highest compensated employee Officer Key employee Institutional trustee Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (B) (C) (A) (D) (E) Average Position Name and title Reportable Reportable hours per (check all that apply) compensation compensation week from from related (describe the organizations hours for organization (W-2/1099-MISC) related (W-2/1099-MISC) organizations in Schedule O) Individual trustee or director Part VII JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 296,741. 2,104,246. Sub-total ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | 0. 0. Total from continuation sheets to Part VII, Section A ~~~~~~~~ | 296,741. 2,104,246. Total (add lines 1b and 1c) •••••••••••••••••••••• | Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organization | Page 8 (F) Estimated amount of other compensation from the organization and related organizations 466,256. 0. 466,256. 1 Yes 3 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 X 3 4 No X 5 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from NONE the organization. (A) (B) (C) Name and business address Description of services Compensation 2 Total number of independent contractors (including but not limited to those listed above) who received more than 0 $100,000 in compensation from the organization | X Form 990 (2010) 032008 12-21-10 15051119 132497 MHMR 8 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) Part VIII Statement of Revenue Contributions, gifts, grants and other similar amounts 1 a b c d e f Program Service Revenue (A) Total revenue 2 3 4 5 6 Other Revenue 7 8 9 10 11 12 Federated campaigns ~~~~~~ Membership dues ~~~~~~~~ Fundraising events ~~~~~~~~ Related organizations ~~~~~~ Government grants (contributions) All other contributions, gifts, grants, and similar amounts not included above ~~ (B) Related or exempt function revenue 15051119 132497 MHMR Page 9 (D) Revenue excluded from tax under sections 512, 513, or 514 (C) Unrelated business revenue 1a 1b 1c 1d 1e 1f 3,000. g Noncash contributions included in lines 1a-1f: $ 3,000. h Total. Add lines 1a-1f ••••••••••••••••• | Business Code 621400 4,150,451.4,150,451. a MEDICARE/MEDICAID PRIVATE AND OTHERS 621400 112,473. 112,473. b CACFP MEAL SUBSIDY 621400 61,624. 61,624. c d e f All other program service revenue ~~~~~ g Total. Add lines 2a-2f ••••••••••••••••• | 4,324,548. 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. ••••••••••••• | 4,327,548.4,324,548. 032009 12-21-10 20-1480790 0. 0. Form 990 (2010) 9 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) 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) but are not required to complete columns (B), (C), and (D). Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII. 1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 ~~ 2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 ~~~~~~~~~ Grants and other assistance to governments, organizations, and individuals outside the U.S. 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) ~~~ 3 4 5 6 7 8 Other salaries and wages ~~~~~~~~~~ Pension plan contributions (include section 401(k) and section 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 19 20 21 22 23 24 Investment management fees ~~~~~~~~ Other ~~~~~~~~~~~~~~~~~~~~ Advertising and promotion ~~~~~~~~~ Office expenses~~~~~~~~~~~~~~~ Information technology ~~~~~~~~~~~ Royalties ~~~~~~~~~~~~~~~~~~ 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 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.) ~~ a BAD DEBT EXPENSE b MISC EXPENSES c d e f All other expenses 25 Total functional expenses. Add lines 1 through 24f if following SOP 26 Joint costs. Check here | 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation •••••••••••••••••• 032010 12-21-10 15051119 132497 MHMR (A) Total expenses (B) Program service expenses (C) Management and general expenses (D) Fundraising expenses 243,658. 121,167. 122,491. 2,815,395. 2,525,326. 285,642. 4,427. 352,735. 775,389. 279,703. 333,153. 714,102. 246,252. 19,261. 60,706. 33,078. 321. 581. 373. 24,379. 24,379. 95,594. 34,709. 60,497. 388. 169,856. 144,469. 136,653. 32,785. 144,469. 418. 517,422. 304. 517,726. 823,548. 823,548. 160. 297,172. 160. 8,049. 30,680. 5,309. 20,365. 2,740. 10,315. 13,085. 152. 13,085. 102. 50. 6,591,750. 4,973,931. 1,611,007. 297,172. 6,812. Form 990 (2010) 10 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 Form 990 (2010) Part X JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Balance Sheet (A) Beginning of year Cash - non-interest-bearing ~~~~~~~~~~~~~~~~~~~~~~~~~ Savings and temporary cash investments ~~~~~~~~~~~~~~~~~~ Pledges and grants receivable, net ~~~~~~~~~~~~~~~~~~~~~ Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6 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 instructions) ~~~~~~~~~~~ 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 304,471. basis. Complete Part VI of Schedule D ~~~ 10a 268,859. 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 Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Liabilities Assets 1 2 3 4 5 Net Assets or Fund Balances 23 24 25 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. Complete Part X of Schedule D ~~~~~~~~~~~~~~~ Total liabilities. Add lines 17 through 25 •••••••••••••••••• X and complete Organizations that follow SFAS 117, check here | 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, 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 •••••••••••••••• 032011 12-21-10 15051119 132497 MHMR 34,587. 653,640. Page 11 (B) End of year 1 2 3 4 11,652. 526,088. 5 6 7 8 9 42,619. 730,846. 100,603. 10,160,856. 10,261,459. 10c 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 <9,530,613.>27 35,612. 573,352. 73,604. 12,294,563. 12,368,167. <11,794,815.> 28 29 30 31 32 <9,530,613.>33 730,846. 34 <11,794,815.> 573,352. Form 990 (2010) 11 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Form 990 (2010) Part XI Reconciliation of Net Assets 20-1480790 Page 12 Check if Schedule O contains a response to any question in this Part XI ••••••••••••••••••••••••••••• 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)) ~~~~~~~~~~ Other changes in net assets or fund balances (explain in Schedule O) ~~~~~~~~~~~~~~~~~~~ Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) 1 2 3 4 5 6 Part XII Financial Statements and Reporting 1 2 3 4 5 6 4,327,548. 6,591,750. <2,264,202.> <9,530,613.> 0. <11,794,815.> Check if Schedule O contains a response to any question in this Part XII ••••••••••••••••••••••••••••• Yes 1 2a b c d 3a b 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? ~~~~~~~~~~~~ Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~ 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. If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both: X Separate basis Consolidated basis Both consolidated and separate basis 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. •••••••••••••••• 032012 12-21-10 15051119 132497 MHMR 2a 2b X 2c X 3a X No X X 3b Form 990 (2010) 12 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 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 2010 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 X 10 11 e f g h 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.) 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 - Other 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). (i) Name of supported organization (ii) EIN (iii) Type of (vi) Is the (iv) Is the organization (v) Did you notify the in col. organization in col. (i) listed in your organization in col. organization (described on lines 1-9 governing document? (i) of your support? (i) organized in the U.S.? above or IRC section (see instructions)) Yes No Yes No Yes No Total LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 032021 12-21-10 15051119 132497 MHMR (vii) Amount of support Schedule A (Form 990 or 990-EZ) 2010 13 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 Schedule A (Form 990 or 990-EZ) 2010 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) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (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 ~~~~ 3 The value of services or facilities furnished by a governmental unit to the organization without charge ~ 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. Section B. Total Support Calendar year (or fiscal year beginning in) | 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 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 2010 (line 6, column (f) divided by line 11, column (f)) ~~~~~~~~~~~~ 14 % 15 Public support percentage from 2009 Schedule A, Part II, line 14 ~~~~~~~~~~~~~~~~~~~~~ 15 % 16a 33 1/3% support test - 2010. 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 - 2009. 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 - 2010. 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 - 2009. 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) 2010 032022 12-21-10 15051119 132497 MHMR 14 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION 20-1480790 Schedule A (Form 990 or 990-EZ) 2010 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) 2006 9,870. (b) 2007 50,000. (c) 2008 51,000. (d) 2009 (e) 2010 53,500. (f) Total 3,000. 167,370. 4109986. 4231241. 4835764. 4629442. 4324548.22130981. 4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ~~~~ 5 The value of services or facilities furnished by a governmental unit to the organization without charge ~ 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 4119856. 4281241. 4886764. 4682942. 4327548.22298351. 0. from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year ~~~~~~ 0. 0. 22298351. c Add lines 7a and 7b ~~~~~~~ 8 Public support (Subtract line 7c from line 6.) Section B. Total Support Calendar year (or fiscal year beginning in) | 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) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total 4119856. 4281241. 4886764. 4682942. 4327548.22298351. 50,768. 50,768. 4119856. 4281241. 4886764. 4733710. 4327548.22349119. 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 2010 (line 8, column (f) divided by line 13, column (f)) ~~~~~~~~~~~~ 16 Public support percentage from 2009 Schedule A, Part III, line 15 •••••••••••••••••••• Section D. Computation of Investment Income Percentage 15 16 99.77 99.77 % % .00 % 17 Investment income percentage for 2010 (line 10c, column (f) divided by line 13, column (f)) ~~~~~~~~ 17 18 Investment income percentage from 2009 Schedule A, Part III, line 17 ~~~~~~~~~~~~~~~~~~ 18 % 19 a 33 1/3% support tests - 2010. 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 - 2009. 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 •••••••• | 032023 12-21-10 Schedule A (Form 990 or 990-EZ) 2010 15051119 132497 MHMR 15 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 SCHEDULE D (Form 990) Department of the Treasury Internal Revenue Service OMB No. 1545-0047 Supplemental Financial Statements 2010 | Complete if the organization answered "Yes," to Form 990, Part IV, line 6, 7, 8, 9, 10, 11, or 12. | 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 1 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 a b c d 3 4 5 6 7 8 9 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 | $ 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 XIV, 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 XIV, 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. 032051 12-20-10 15051119 132497 MHMR Schedule D (Form 990) 2010 16 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Page 2 Schedule D (Form 990) 2010 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 XIV. 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 XIV and complete the following table: Yes No 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? ~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," explain the arrangement in Part XIV. Part V Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10. c d e f 2a b Yes 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 year end balance held as: a Board designated or quasi-endowment | % b Permanent endowment | % c Term endowment | % 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 XIV the intended uses of the organization's endowment funds. Part VI Land, Buildings, and Equipment. See Form 990, Part X, line 10. 1a b c d e Description of investment (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 ~~~~~~~~~~ 139,813. 104,201. 35,612. d Equipment ~~~~~~~~~~~~~~~~~ 164,658. 164,658. 0. e Other •••••••••••••••••••• 35,612. (Column (d) must equal Form 990, Part X, column (B), line 10(c).) Total. Add lines 1a through 1e. •••••••••••• | Schedule D (Form 990) 2010 032052 12-20-10 15051119 132497 MHMR 17 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Schedule D (Form 990) 2010 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. (a) Description of investment type (b) Book value (c) Method of valuation: Cost or end-of-year market value (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 (b) Book value (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) Amount 1. (1) Federal income taxes (2) DUE TO THE JEWISH GUILD FOR THE 11,895,425. (3) BLIND OTHER LIABILITIES 399,138. (4) (5) (6) (7) (8) (9) (10) (11) 12,294,563. Total. (Column (b) must equal Form 990, Part X, col (B) line 25.) ••••• | FIN 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under 2. FIN 48 (ASC 740). 032053 Schedule D (Form 990) 2010 12-20-10 15051119 132497 MHMR 18 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Page 4 Schedule D (Form 990) 2010 Part XI Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements 4,327,548. 1 Total revenue (Form 990, Part VIII, column (A), line 12) ~~~~~~~~~~~~~~~~~~~~~~ 1 6,591,750. 2 Total expenses (Form 990, Part IX, column (A), line 25) ~~~~~~~~~~~~~~~~~~~~~~ 2 <2,264,202.> 3 Excess or (deficit) for the year. Subtract line 2 from line 1 ~~~~~~~~~~~~~~~~~~~~~ 3 4 5 6 7 8 9 10 Net unrealized gains (losses) on investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Investment expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total adjustments (net). Add lines 4 through 8 ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9 ••••••• 4 5 6 7 8 9 10 0. <2,264,202.> Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return 1 2 a b c d e 3 4 a b c 5 Total revenue, gains, and other support per audited financial statements ~~~~~~~~~~~~~~~~~~~ 1 Amounts included on line 1 but not on Form 990, Part VIII, line 12: Net unrealized gains on investments ~~~~~~~~~~~~~~~~~~~~~~ 2a 2,685. Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~ 2b Recoveries of prior year grants ~~~~~~~~~~~~~~~~~~~~~~~~~ 2c Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 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: 2,685. Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~ 2a Prior year adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2b Other losses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2c Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return 4,330,233. 2,685. 4,327,548. 0. 4,327,548. 6,594,435. 2,685. 6,591,750. 0. 6,591,750. Part XIV Supplemental Information 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, line 8; Part XII, lines 2d and 4b; and Part XIII, 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, 2008 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. 032054 12-20-10 15051119 132497 MHMR Schedule D (Form 990) 2010 19 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 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 2010 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? ~~~~~~~~~~~~~~~~~~~~~ 3 1b 2 Indicate which, if any, of the following the organization uses to establish the compensation of the organization's CEO/Executive Director. Check all that apply. 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 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 from the organization or a related organization? ~~~~~~~~ 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) 2010 5 032111 12-21-10 15051119 132497 MHMR 20 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Schedule J (Form 990) 2010 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) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a. (B) Breakdown of W-2 and/or 1099-MISC compensation (i) Base compensation (A) Name 1 ALAN R. MORSE 2 GOLDIE DERSH 3 ELLIOT J. HAGLER 4 BRUCE MASTALINSKI 5 KELLYANNE CAIVANO 6 MELISSA FARBER 7 LARRY CARR 8 SARA PITTERMAN 9 HAROLD LEDERMAN 10 11 12 13 14 15 16 032112 12-21-10 (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) 26,334. 726,077. 152,539. 0. 27,752. 281,207. 15,379. 292,195. 17,879. 181,159. 15,734. 154,481. 15,424. 151,836. 11,837. 119,944. 11,885. 117,000. (ii) Bonus & incentive compensation 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. (iii) Other reportable compensation 105. 2,908. 0. 0. 135. 1,371. 73. 1,392. 21. 208. 29. 287. 76. 748. 9. 88. 42. 415. 21 (C) Retirement and other deferred compensation 3,181. 87,709. 11,009. 0. 1,607. 16,283. 895. 16,996. 1,218. 12,347. 1,036. 10,170. 1,269. 12,493. 806. 8,162. 811. 7,984. (D) Nontaxable benefits 1,212. 33,415. 9,360. 0. 3,620. 53,659. 841. 15,977. 1,672. 27,883. 2,576. 25,289. 10. 98. 2,503. 30,862. 2,570. 28,795. (E) Total of columns (B)(i)-(D) 30,832. 850,109. 172,908. 0. 33,114. 352,520. 17,188. 326,560. 20,790. 221,597. 19,375. 190,227. 16,779. 165,175. 15,155. 159,056. 15,308. 154,194. (F) Compensation reported in prior Form 990 or Form 990-EZ 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. Schedule J (Form 990) 2010 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 2010 Open to Public Inspection Employer identification number 20-1480790 FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: THREE SPECIALIZED TREATMENT PROGRAMS ARE PROVIDED BY A MULTIDISCIPLINARY PROFESSIONAL STAFF OFFERING INDIVIDUALIZED DIAGNOSTIC AND TREATMENT PLANS. THE PSYCHIATRIC CLINIC IS THE ONLY PSYCHIATRIC SERVICE IN THE UNITED STATES SPECIFICALLY FOR PEOPLE WHO ARE BLIND AND VISUALLY IMPAIRED. THE CLINIC SPECIALIZES IN WORKING WITH PERSONS, AND THEIR CAREGIVERS, WHO ARE HAVING ADJUSTMENT REACTIONS TO VISION LOSS. IT ALSO SERVES THOSE WHO, IN ADDITION 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. IN 2011, THE CLINIC PROVIDED 10,816 VISITS. THE MENTAL HEALTH DAY TREATMENT PROGRAM IS OFFERED TO INDIVIDUALS WHO ARE MODERATELY TO SERIOUSLY 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 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 032211 01-24-11 15051119 132497 MHMR Schedule O (Form 990 or 990-EZ) (2010) 22 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 Schedule O (Form 990 or 990-EZ) (2010) Name of the organization JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Page 2 Employer identification number 20-1480790 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 INITIATING BEHAVIORAL CHANGES THAT PROMOTE POSITIVE ACTION, HEALTH AND WELL-BEING. IN 2011, THE PROGRAM PROVIDED 20,071 VISITS. THE DEVELOPMENTAL DISABILITIES DAY TREATMENT PROGRAM SERVES ADULTS WHO HAVE DEVELOPMENTAL DISABILITIES. 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 2011, THE PROGRAM PROVIDED 7,235 VISITS. FORM 990, PART VI, SECTION B, LINE 11: THE IRS FORM 990 IS PREPARED BY THE STAFF AND REVIEWED IN DETAIL BY A COMMITTEE OF THE BOARD, AFTER IT HAS BEEN REVIEWED BY OUR OUTSIDE AUDITORS. AFTER ITS APPROVAL, THE FORM IS MADE AVAILABLE TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C: OFFICERS, DIRECTORS, AND ALL STAFF ARE REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY. WHEN THERE IS A CHANGE 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, DISCONTINUED OR LIMITED. FORM 990, PART VI, SECTION B, LINE 15: ANNUALLY, THE COMPENSATION COMMITTEE OF THE JEWISH GUILD FOR THE BLIND RECEIVES A SALARY SURVEY OF 032212 01-24-11 15051119 132497 MHMR Schedule O (Form 990 or 990-EZ) (2010) 23 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 Schedule O (Form 990 or 990-EZ) (2010) Name of the organization JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. Page 2 Employer identification number 20-1480790 COMPARABLE ORGANIZATIONS THAT HAS BEEN REVIEWED BY OUR AUDITORS AND ATTORNEYS FOR ACCURACY, COMPLETENESS AND COMPLIANCE WITH APPLICABLE REGULATIONS AND STATUTORY REQUIREMENTS. BASED UPON THE SURVEY, AND ANY OTHER RELEVANT INFORMATION INCLUDING JOB PERFORMANCE, THE COMMITTEE ARRIVES AT ANNUAL SALARIES FOR THE CEO, THREE EXECUTIVE VICE PRESIDENTS AND SENIOR VICE PRESIDENT AT A MEETING AT WHICH THE AUDITORS AND ATTORNEYS ARE PRESENT. MINUTES OF THE COMMITTEE'S MEETINGS ARE MAINTAINED. FORM 990, PART VI, SECTION C, LINE 19: A COPY OF THE FORM 990, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 2C THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT AND SELECTION OF INDEPENDENT ACCOUNTANTS. THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR. FORM 990, PART VII, SECTION A A PORTION OF THE OFFICERS COMPENSATION PAID BY THE JEWISH GUILD FOR THE BLIND (EIN# 13-1623854) HAS BEEN ALLOCATED TO JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 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). FORM 990, PART VII, SECTION A, COLUMN E HOURS PROVIDED TO RELATED ENTITIES: 032212 01-24-11 15051119 132497 MHMR Schedule O (Form 990 or 990-EZ) (2010) 24 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 Schedule O (Form 990 or 990-EZ) (2010) Name of the organization JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. JAMES M. DUBIN 4.1 HOURS LAWRENCE E. GOLDSCHMIDT 2.4 HOURS PAULINE RAIFF 2.4 HOURS MARC S. SOLOMON 2.4 HOURS ALAN R. MORSE 33.8 HOURS ELLIOT J. HAGLER 31.9 HOURS BRUCE MASTALINSKI 33.2 HOURS SARAH SPICEHANDLER 34.3 HOURS KELLYANNE CAIVANO 31.9 HOURS MELISSA FARBER 31.8 HOURS LARRY CARR 31.8 HOURS SARA PITTERMAN 31.9 HOURS HAROLD LEDERMAN 31.8 HOURS Page 2 Employer identification number 20-1480790 SCHEDULE R, PART V MHS HAS A MANAGEMENT AGREEMENT WITH THE GUILD FOR ALL NECESSARY MANAGEMENT AND SALARIED STAFFING SERVICES AS WELL AS USE OF FACILITIES, EQUIPMENT AND OTHER ASSETS. MHS RECEIVED PAYMENTS FROM GUILDNET, INC. FOR MEDICAL AND HEALTH CARE SERVICES. 032212 01-24-11 15051119 132497 MHMR Schedule O (Form 990 or 990-EZ) (2010) 25 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 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.) (b) Primary activity (c) Legal domicile (state or foreign country) (d) Total income (e) End-of-year assets (f) Direct controlling entity 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 - 13-1623854 15 WEST 65TH STREET NEW YORK, NY 10023 JGB HEALTH FACILITIES CORP - 13-2795647 15 WEST 65TH STREET NEW YORK, NY 10023 IN TOUCH NETWORKS, INC. - 23-7396618 15 WEST 65TH STREET NEW YORK, NY 10023 JGB EDUCATION SERVICES - 13-3419981 15 WEST 65TH STREET NEW YORK, NY 10023 (b) Primary activity PROVIDES SERVICES TO THE BLIND/VISUALLY IMPAIRED PEOPLE (c) Legal domicile (state or foreign country) NEW YORK ADULT DAY HEALTH CARE PROGRAMS NEW YORK RADIO READING SERVICE FOR THE BLIND/VISUALLY IMPAIRED NEW YORK PRIVATE NON-RESIDENTIAL SCHOOL, PRESCHOOL & EARLY INTERVENTION NEW YORK For Paperwork Reduction Act Notice, see the Instructions for Form 990. 032161 12-21-10 2010 | 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 of disregarded entity Part II OMB No. 1545-0047 Related Organizations and Unrelated Partnerships SCHEDULE R (Form 990) LHA (d) Exempt Code section (e) Public charity status (if section 501(c)(3)) (f) Direct controlling entity (g) Section 512(b)(13) controlled entity? Yes No 501 (C) (3) 9 N/A X 501 (C) (3) 9 THE JEWISH GUILD FOR THE BLIND X 501 (C) (3) 7 THE JEWISH GUILD FOR THE BLIND X 501 (C) (3) 2 THE JEWISH GUILD FOR THE BLIND X Schedule R (Form 990) 2010 26 Schedule R (Form 990) Part II JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Continuation of Identification of Related Tax-Exempt Organizations (a) Name, address, and EIN of related organization JGB REHABILITATION CORPORATION - 13-3439035 15 WEST 65TH STREET NEW YORK, NY 10023 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 032222 12-30-10 (b) Primary activity (c) Legal domicile (state or foreign country) OUTPATIENT REHAB FACILITY AND DTC FOR BLIND/VISUALLY IMPAIRED NEW YORK REHABILITATIVE TRAINING & SUPPORTING SVCS TO BLIND ADULTS AGED 50 OR OVER MASSACHUSETTS PUBLIC EDUCATION DIABETES PREVENTION & MANAGEMENT MASSACHUSETTS MANAGED LONG TERM CARE PLAN NEW YORK 27 (d) Exempt Code section (e) Public charity status (if section 501(c)(3)) (f) Direct controlling entity (g) Section 512(b)(13) controlled organization? Yes No 501 (C) (3) 9 THE JEWISH GUILD FOR THE BLIND X 501 (C) (3) 9 THE JEWISH GUILD FOR THE BLIND X 501 (C) (3) 9 THE JEWISH GUILD FOR THE BLIND X 501 (C) (3) 9 THE JEWISH GUILD FOR THE BLIND X Schedule R (Form 990) 2010 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 (g) Share of end-of-year assets (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 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 032162 12-21-10 (b) Primary activity (c) Legal domicile (state or foreign country) 28 (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 Schedule R (Form 990) 2010 Schedule R (Form 990) 2010 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, 35, 35a, 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 other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ c Gift, grant, or capital contribution from other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Loans or loan guarantees to or for other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Loans or loan guarantees by other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1a 1b 1c 1d 1e X X X X X f g h i Sale of assets to other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Purchase of assets from other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Exchange of assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lease of facilities, equipment, or other assets to other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1f 1g 1h 1i X X X X j k l m n Lease of facilities, equipment, or other assets from other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Performance of services or membership or fundraising solicitations for other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Performance of services or membership or fundraising solicitations by other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sharing of facilities, equipment, mailing lists, or other assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sharing of paid employees ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1j 1k 1l 1m 1n o Reimbursement paid to other organization for expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ p Reimbursement paid by other organization for expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1o 1p q Other transfer of cash or property to other organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ r Other transfer of cash or property from other 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. 1q 1r (a) Name of other organization (b) Transaction type (a-r) (c) Amount involved Yes X X X X No X X X X X (d) Method of determining amount involved (1) (2) (3) (4) (5) (6) 032163 12-21-10 29 Schedule R (Form 990) 2010 Schedule R (Form 990) 2010 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) Legal domicile (state or foreign country) (d) Are all partners section 501(c)(3) organizations? Yes No (e) Share of end-ofyear assets (f) Disproportionate allocations? Yes No (g) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065) (h) General or managing partner? Yes No Schedule R (Form 990) 2010 032164 12-21-10 30 JGB MENTAL HEALTH AND MENTAL RETARDATION SERVICES, INC. 20-1480790 Schedule R (Form 990) 2010 Part VII Supplemental Information Page 5 Complete this part to provide additional information for responses to questions on Schedule R (see instructions). 032165 12-21-10 15051119 132497 MHMR Schedule R (Form 990) 2010 31 2010.05000 JGB MENTAL HEALTH AND MENTA MHMR___3 2010 DEPRECIATION AND AMORTIZATION REPORT FORM 990 PAGE 10 Asset No. Description Date Acquired Method Life 990 Line No. Unadjusted Cost Or Basis Bus % Excl * Reduction In Basis Basis For Depreciation Accumulated Depreciation Current Sec 179 Current Year Deduction MACHINERY & EQUIPMENT 1EQUIPMENT 070104SL * 990 PAGE 10 TOTAL MACHINERY & EQUIPM .000 16 139,813. 139,813. 96,214. 139,813. 0. 139,813. 96,214. 7,987. 0. 7,987. OTHER 2COMPUTER SOFTWARE 070104SL * 990 PAGE 10 TOTAL OTHER * GRAND TOTAL 990 PAGE 10 DEPR 028102 05-01-10 .000 16 164,658. 164,658. 164,596. 164,658. 0. 164,658. 164,596. 0. 62. 304,471. 0. 304,471. 260,810. 0. 8,049. (D) - Asset disposed 31.1 62. * ITC, Section 179, Salvage, Bonus, Commercial Revitalization Deduction
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