STATEMENT THAT THIS IS A TAX RETURN NOT A FINANCIAL STATEMENT The accompanying federal income tax return does NOT constitute a financial statement. We have not audited, reviewed or compiled the accompanying income tax return and, accordingly, do not express an opinion or any other form of assurance on it. An income tax return is not intended to constitute financial statements prepared in accordance with generally accepted accounting principles. Accordingly, it does not necessarily include all financial information or disclosures required by generally accepted accounting principles. If the omitted financial information or disclosures were included with the tax return, they might influence the users’ conclusions about the taxpayer’s financial position, results of operations and cash flows. Accordingly, this income tax return is not designed to be used in lieu of financial statements. RECORD RETENTION Our policy is to dispose of our copies of tax returns and workpapers, and other tax information that is more than eight years old. Your responsibility for retention of your own tax records varies, depending upon the type of tax return or other information involved. We suggest that you keep your tax information and supporting documents for a minimum of eight years. We also recommend that you keep all records that pertain to a carryover amount, such as net operating loss carryovers and charitable contribution carryovers as well as capital loss carryovers, until eight years after the carryover has been consumed. Also, we suggest that you maintain, indefinitely, copies of income tax returns, records supporting your tax basis in your personal, investment, and business assets, and documentation pertaining to gifts that you make. Your copies of the returns are enclosed for your files. We suggest that you retain these copies indefinitely. Touchstone Mental Health RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX FORM YEAR ENDED DECEMBER 31, 2012
61
Embed
Touchstone Mental Health · March 26, 2013 Touchstone Mental Health 1925 Nicollet Ave S Minneapolis, MN 55403 Dear Lynette, Enclosed are the 2012 Exempt Organization returns, as
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
STATEMENT THAT THIS IS A TAX RETURN NOT A FINANCIAL STATEMENT
The accompanying federal income tax return does NOT constitute a financial statement. We have not audited, reviewed or compiled the accompanying income tax return and, accordingly, do not express an opinion or any other form of assurance on it. An income tax return is not intended to constitute financial statements prepared in accordance with generally accepted accounting principles. Accordingly, it does not necessarily include all financial information or disclosures required by generally accepted accounting principles. If the omitted financial information or disclosures were included with the tax return, they might influence the users’ conclusions about the taxpayer’s financial position, results of operations and cash flows. Accordingly, this income tax return is not designed to be used in lieu of financial statements.
RECORD RETENTION Our policy is to dispose of our copies of tax returns and workpapers, and other tax information that is more than eight years old. Your responsibility for retention of your own tax records varies, depending upon the type of tax return or other information involved. We suggest that you keep your tax information and supporting documents for a minimum of eight years. We also recommend that you keep all records that pertain to a carryover amount, such as net operating loss carryovers and charitable contribution carryovers as well as capital loss carryovers, until eight years after the carryover has been consumed. Also, we suggest that you maintain, indefinitely, copies of income tax returns, records supporting your tax basis in your personal, investment, and business assets, and documentation pertaining to gifts that you make. Your copies of the returns are enclosed for your files. We suggest that you retain these copies indefinitely.
Touchstone Mental Health
RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX FORM
Enclosed are the 2012 Exempt Organization returns, asfollows...
2012 FORM 990
2012 MINNESOTA ANNUAL REPORT
2012 IRS E-FILE SIGNATURE AUTHORIZATION FOR AN EXEMPTORGANIZATION (FORM 8879-EO)
Please review the return for completeness and accuracy.
We recommend that you use certified mail with post markedreceipt for proof of timely filing.
In addition, the enclosed CD includes a public disclosurecopy of the Form 990. An exempt organization is required tohave a copy of its current year Form 990 and two prior yearreturns available for public inspection. If the returnincludes a Schedule of Contributors (Schedule B), we haveremoved the names and addresses of contributors from thisreturn as this information is not open to public inspection.The Pension Protection Act of 2006 also requires Form 990-Tto be open for public inspection for organizations exemptunder Section 501(c)(3). You should sign this copy of thereturn and keep it available at your primary office location.
We have prepared the return from information you furnished uswithout verification. Upon examination of the return by taxauthorities, requests may be made for underlying data. Wetherefore recommend that you preserve all records which youmay be called upon to produce in connection with suchpossible examinations.
The state of Minnesota requires that certain entities,(Corporations, Limited Liability Companies, Limited LiabilityPartnerships etc.), that receive their separate lives from
the state, make annual or other periodic filings to maintaintheir legal status. A failure to make these filings canresult in loss of status as a separate legal entity. A lossof separate legal status can result in significant tax andlegal ramifications. Taxable liquidation, and loss of legalliability protection can both stem from delayed filing ofperiodic registrations. Furthermore, other jurisdictions mayrequire that registrations be made to gain access to theirlegal systems for purposes of bringing suit for collection,legal liability protection, and other matters. The filing ofthese registrations is a legal matter and as such is notwithin the scope of Eide Bailly's accounting and taxpractice. Eide Bailly LLP can not, and will not, beresponsible for making sure that you have fully complied withMinnesota's or other jurisdictions' legal filingrequirements. In the past we may have completed one or moreof these forms for you in the process of preparing yourincome tax returns. We have not completed any of thesefilings for you this year. You will be responsible forcompleting any current or future required filings. TheMinnesota Secretary of State has a website where most filingscan be done on-line. The website is located at:https://online.sos.state.mn.us/abr/corp_annual_filing.asp.Legal counsel should be contacted if you are unsure of whatfiling requirements you may have.
We sincerely appreciate the opportunity to serve you. Pleasecontact us if you have any questions concerning the taxreturn.
This return has qualified for electronic filing. After youhave reviewed the return for completeness and accuracy,please sign, date and return Form 8879-EO to our office. Wewill transmit the return electronically to the IRS and nofurther action is required. Return Form 8879-EO to us by May15, 2013.
Checkifself-employed
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Check ifapplicable:
AddresschangeNamechangeInitialreturn
Termin-atedAmendedreturn Gross receipts $
Applica-tionpending
232001 12-10-12
Beginning of Current Year
Paid
Preparer
Use Only
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lungbenefit trust or private foundation)
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning and ending
B C D Employer identification number
E
G
H(a)
H(b)
H(c)
F Yes No
Yes No
I
J
K
Website: |
L M
1
2
3
4
5
6
7
3
4
5
6
7a
7b
a
b
Ac
tivi
tie
s &
Go
vern
an
ce
Prior Year Current Year
8
9
10
11
12
13
14
15
16
17
18
19
Re
ven
ue
a
b
Ex
pe
ns
es
End of Year
20
21
22
Sign
Here
Yes No
For Paperwork Reduction Act Notice, see the separate instructions.
|
(or P.O. box if mail is not delivered to street address) Room/suite
Are all affiliates included?
)501(c)(3) 501(c) ( (insert no.) 4947(a)(1) or 527
|Corporation Trust Association OtherForm of organization: Year of formation: State of legal domicile:
|
|
Net
Ass
ets
orFu
nd B
alan
ces
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.
Signature of officer Date
Type or print name and title
Date PTINPrint/Type preparer's name Preparer's signature
Firm's name Firm's EIN
Firm's address
Phone no.
Form
The organization may have to use a copy of this return to satisfy state reporting requirements.
Name of organization
Doing Business As
Number and street Telephone number
City, town, or post office, state, and ZIP code
Is this a group return
for affiliates?Name and address of principal officer:
If "No," attach a list. (see instructions)
Group exemption number |
Tax-exempt status:
Briefly describe the organization's mission or most significant activities:
Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets.
Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of individuals employed in calendar year 2012 (Part V, line 2a)
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Total number of volunteers (estimate if necessary)
Total unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, line 34
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
����������������������
Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~
Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~
Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) ���
Grants and similar amounts paid (Part IX, column (A), lines 1-3)
Benefits paid to or for members (Part IX, column (A), line 4)
KIM HUNWARDSEN, CPA KIM HUNWARDSEN, CPA 03/26/13 P00484560EIDE BAILLY LLP 45-0250958800 NICOLLET MALL, STE. 1300MINNEAPOLIS, MN 55402-7033 612-253-6500
X
Code: Expenses $ including grants of $ Revenue $
Code: Expenses $ including grants of $ Revenue $
Code: Expenses $ including grants of $ Revenue $
Expenses $ including grants of $ Revenue $
23200212-10-12
1
2
3
4
Yes No
Yes No
4a
4b
4c
4d
4e Total program service expenses
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part III �����������������������������
Briefly describe the organization's mission:
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ?
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?
If "Yes," describe these changes on Schedule O.
~~~~~~
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
( ) ( ) ( )
( ) ( ) ( )
( ) ( ) ( )
Other program services (Describe in Schedule O.)
( ) ( )
Form (2012)
2Statement of Program Service AccomplishmentsPart III
990
J
TOUCHSTONE MENTAL HEALTH 41-1920740
X
TOUCHSTONE MENTAL HEALTH IS A CENTER OF EXCELLENCE PROVIDING QUALITYPROGRAMS TO ASSURE PEOPLE LIVING WITH MENTAL ILLNESS CAN ENJOY THEHIGHEST QUALITY OF LIFE.
X
X
1,126,014. 1,298,165.TOUCHSTONE RESIDENTIAL TREATMENT IS AN INTENSIVE RESIDENTIAL TREATMENTSERVICE PROVIDING CONSISTENT 24-HOUR SERVICE, 7 DAYS A WEEK. THESERVICE IMPLEMENTS AN INTEGRATED TREATMENT APPROACH GUIDED BY THEDEVELOPMENT OF AN INDIVIDUALIZED AND MEANINGFUL TREATMENT PLAN FOCUSINGON RECOVERY GOALS.
997,592. 1,130,379.TOUCHSTONE ASSISTED LIVING APARTMENTS IS A COMMUNITY ALTERNATIVE FORDISABLED INDIVIDUALS WHICH OFFERS LONG-TERM HOUSING HELPING CLIENTSMAINTAIN STABILITY THROUGH SUPPORTIVE SERVICES.
730,686. 844,782.TOUCHSTONE INTENSIVE COMMUNITY REHABILITATION SERVICES OFFER CLIENTS AMULTIDISCIPLINARY TEAM THAT INCLUDES A CORE GROUP OF CLINICIANS THATWORK WITH CLIENTS TO IDENTIFY PERSONAL RECOVERY GOALS AND DEVELOP AREHABILITATION PLAN TO MEET THOSE GOALS.
1,410,492. 1,427,298.4,264,784.
2
23200312-10-12
Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1
2
3
4
5
6
7
8
9
10
Section 501(c)(3) organizations.
a
b
c
d
e
f
a
b
11a
11b
11c
11d
11e
11f
12a
12b
13
14a
14b
15
16
17
18
19
20a
20b
a
b
a
b
If "Yes," complete Schedule ASchedule B, Schedule of Contributors
If "Yes," complete Schedule C, Part I
If "Yes," complete Schedule C, Part II
If "Yes," complete Schedule C, Part III
If "Yes," complete Schedule D, Part I
If "Yes," complete Schedule D, Part IIIf "Yes," complete
Schedule D, Part III
If "Yes," complete Schedule D, Part IV
If "Yes," complete Schedule D, Part V
If "Yes," complete Schedule D,Part VI
If "Yes," complete Schedule D, Part VII
If "Yes," complete Schedule D, Part VIII
If "Yes," complete Schedule D, Part IXIf "Yes," complete Schedule D, Part X
If "Yes," complete Schedule D, Part XIf "Yes," complete
Schedule D, Parts XI and XII
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optionalIf "Yes," complete Schedule E
If "Yes," complete Schedule F, Parts I and IV
If "Yes," complete Schedule F, Parts II and IV
If "Yes," complete Schedule F, Parts III and IV
If "Yes," complete Schedule G, Part I
If "Yes," complete Schedule G, Part IIIf "Yes,"
complete Schedule G, Part IIIIf "Yes," complete Schedule H
Form 990 (2012) Page
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization required to complete ?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office?
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year?
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?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts?
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
If "Yes," indicate the number of Forms 8282 filed during the year
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
~~~~~~~~~~~~~~~~
~~~~~~~
~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
~
Did the organization make any taxable distributions under section 4966?
Did the organization make a distribution to a donor, donor advisor, or related person?
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Enter:
Initiation fees and capital contributions included on Part VIII, line 12
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
~~~~~~~~~~~~~~~
~~~~~~
Enter:
Gross income from members or shareholders
Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.)
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization filing Form 990 in lieu of Form 1041?
If "Yes," enter the amount of tax-exempt interest received or accrued during the year ������
Is the organization licensed to issue qualified health plans in more than one state?
See the instructions for additional information the organization must report on Schedule O.
~~~~~~~~~~~~~~~~~~~~~
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
Enter the amount of reserves on hand
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization receive any payments for indoor tanning services during the tax year?
If "Yes," has it filed a Form 720 to report these payments?
~~~~~~~~~~~~~~~~
����������
5Part V Statements Regarding Other IRS Filings and Tax Compliance
990
J
TOUCHSTONE MENTAL HEALTH 41-1920740
100
X
105X
X
X
XX
X
XX
X
XX
X
5
23200612-10-12
Yes No
1a
1b
1
2
3
4
5
6
7
8
9
a
b
2
3
4
5
6
7a
7b
8a
8b
9
a
b
a
b
Yes No
10
11
a
b
10a
10b
11a
12a
12b
12c
13
14
15a
15b
16a
16b
a
b
12a
b
c
13
14
15
a
b
16a
b
17
18
19
20
For each "Yes" response to lines 2 through 7b below, and for a "No" responseto line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
If "Yes," provide the names and addresses in Schedule O(This Section B requests information about policies not required by the Internal Revenue Code.)
If "No," go to line 13
If "Yes," describein Schedule O how this was done
(explain in Schedule O)
If there are material differences in voting rights among members of the governing body, or if the governing
body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
Form (2012)
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part VI �����������������������������
Enter the number of voting members of the governing body at the end of the tax year
Enter the number of voting members included in line 1a, above, who are independent
~~~~~~
~~~~~~
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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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? ~~~~~~~~~~~~~~
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization's assets?
Did the organization have members or stockholders?
~~~~~
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or
more members of the governing body?
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The governing body?
Each committee with authority to act on behalf of the governing body?
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
organization's mailing address? �����������������
Did the organization have local chapters, branches, or affiliates?
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,
and branches to ensure their operations are consistent with the organization's exempt purposes?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
Describe in Schedule O the process, if any, used by the organization to review this Form 990.
Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization regularly and consistently monitor and enforce compliance with the policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
Did the process for determining compensation of the following persons include a review and approval by independent
persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation
in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's
exempt status with respect to such arrangements? ������������������������������������
List the states with which a copy of this Form 990 is required to be filed
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available
for public inspection. Indicate how you made these available. Check all that apply.
Own website Another's website Upon request Other
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: |
6Part VI Governance, Management, and Disclosure
Section A. Governing Body and Management
Section B. Policies
Section C. Disclosure
990
J
TOUCHSTONE MENTAL HEALTH 41-1920740
X
9
9
X
XXXX
X
X
XX
X
X
X
XX
XXX
XX
X
MN
X
LYNETTE ANDERSON - 612-767-21621925 NICOLLET, MINNEAPOLIS, MN 55403
6
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Key
empl
oyee
Hig
hest
com
pens
ated
empl
oyee
Form
er
(do not check more than onebox, unless person is both anofficer and a director/trustee)
232007 12-10-12
current
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
current
current
former
former directors or trustees
(A) (B) (C) (D) (E) (F)
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 the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received reportablecompensation (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
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part VII�����������������������������
¥ List all of the organization's 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 key employees, if any. See instructions for definition of "key employee."¥
.
¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations.
¥ List all of the organization's 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.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
PositionName and Title Average hours per
week (list any
hours forrelated
organizationsbelowline)
Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
Form (2012)
7Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
990
TOUCHSTONE MENTAL HEALTH 41-1920740
LESLIE CONNELLY 5.00CHAIR X X 0. 0. 0.DONNA LANGER-HANSEN 1.00TREASURER - CURRENT X X 0. 0. 0.JOANN MEYER 1.00TREASURER - PREVIOUS X X 0. 0. 0.DARREN BENOIT 1.00BOARD MEMBER X 0. 0. 0.TAMRA KRAMER 1.00BOARD MEMBER X 0. 0. 0.JOHN SJAASTAD 1.00BOARD MEMBER X 0. 0. 0.LEIGH-ERIN IRONS 1.00BOARD MEMBER X 0. 0. 0.DARRELL WASHINGTON 1.00BOARD MEMBER X 0. 0. 0.ERICA TAYLOR 1.00BOARD MEMBER X 0. 0. 0.MERRIE KAAS 1.00BOARD MEMBER (PARTIAL YEAR) X 0. 0. 0.KATIE LICHTY 1.00BOARD MEMBER (PARTIAL YEAR) X 0. 0. 0.MARTHA LANTZ 40.00EXECUTIVE DIRECTOR/SECRETARY X 113,260. 0. 13,542.LYNETTE ANDERSON (FROM 2/29/2012) 40.00FINANCE DIRECTOR X 64,129. 0. 8,975.THOM PITZ (THRU 2/29/2012) 40.00FINANCE DIRECTOR X 16,564. 0. 1,416.
7
Form
er
Indi
vidu
al tr
uste
e or
dire
ctor
Inst
itutio
nal t
rust
ee
Offi
cer
Hig
hest
com
pens
ated
empl
oyee
Key
empl
oyee
(do not check more than onebox, unless person is both anofficer and a director/trustee)
23200812-10-12
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(B) (C)(A) (D) (E) (F)
1b
c
d
Sub-total
Total from continuation sheets to Part VII, Section A
Total (add lines 1b and 1c)
2
Yes No
3
4
5
former
3
4
5
Section B. Independent Contractors
1
(A) (B) (C)
2
(continued)
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such person
Page Form 990 (2012)
PositionAverage hours per
week(list any
hours forrelated
organizationsbelowline)
Name and title Reportablecompensation
from the
organization(W-2/1099-MISC)
Reportablecompensationfrom related
organizations(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
~~~~~~~~ |
���������������������� |
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization |
Did the organization list any officer, director, or trustee, key employee, or highest compensated employee on
line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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? ~~~~~~~~~~~~~
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? ������������������������
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organization's tax year.
Name and business address Description of services Compensation
Total number of independent contractors (including but not limited to those listed above) who received more than
$100,000 of compensation from the organization |
Form (2012)
8Part VII
990
TOUCHSTONE MENTAL HEALTH 41-1920740
193,953. 0. 23,933.0. 0. 0.
193,953. 0. 23,933.
1
X
X
X
NONE
0
8
Noncash contributions included in lines 1a-1f: $
23200912-10-12
Total revenue.
(A) (B) (C) (D)
1 a
b
c
d
e
f
g
h
1
1
1
1
1
1
a
b
c
d
e
f
Co
ntr
ibu
tio
ns
, G
ifts
, G
ran
tsa
nd
Oth
er
Sim
ila
r A
mo
un
ts
Total.
a
b
c
d
e
f
g
2
Pro
gra
m S
erv
ice
Re
ven
ue
Total.
3
4
5
6 a
b
c
d
a
b
c
d
7
a
b
c
8
a
b
9 a
b
c
a
b
10 a
b
c
a
b
11 a
b
c
d
e Total.
Oth
er
Re
ven
ue
12
Revenue excludedfrom tax undersections 512,513, or 514
All other contributions, gifts, grants, and
similar amounts not included above
See instructions.
Form (2012)
Page Form 990 (2012)
Check if Schedule O contains a response to any question in this Part VIII ���������������������������
Total revenue Related orexempt function
revenue
Unrelatedbusinessrevenue
Federated campaigns
Membership dues
~~~~~~
~~~~~~~~
Fundraising events
Related organizations
~~~~~~~~
~~~~~~
Government grants (contributions)
~~
Add lines 1a-1f ����������������� |
Business Code
All other program service revenue ~~~~~
Add lines 2a-2f ����������������� |
Investment income (including dividends, interest, and
other similar amounts)
Income from investment of tax-exempt bond proceeds
~~~~~~~~~~~~~~~~~ |
|
Royalties ����������������������� |
(i) Real (ii) Personal
Gross rents
Less: rental expenses
Rental income or (loss)
Net rental income or (loss)
~~~~~~~
~~~
~~
�������������� |
Gross amount from sales of
assets other than inventory
(i) Securities (ii) Other
Less: cost or other basis
and sales expenses
Gain or (loss)
~~~
~~~~~~~
Net gain or (loss) ������������������� |
Gross income from fundraising events (not
including $ of
contributions reported on line 1c). See
Part IV, line 18 ~~~~~~~~~~~~~
Less: direct expenses~~~~~~~~~~
Net income or (loss) from fundraising events ����� |
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Grants and other assistance to governments and
organizations in the United States. See Part IV, line 21
Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
Professional fundraising services. See Part IV, line 17
(If line 11g amount exceeds 10% of line 25,
column (A) amount, list line 11g expenses on Sch O.)
Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line24e amount exceeds 10% of line 25, column (A)amount, list line 24e expenses on Schedule O.)
Add lines 1 through 24e
Complete this line only if the organization
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation.
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part IX ��������������������������
Total expenses Program serviceexpenses
Management andgeneral expenses
Fundraisingexpenses
Grants and other assistance to individuals in
the United States. See Part IV, line 22 ~~~
Grants and other assistance to governments,
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16 ~
Benefits paid to or for members ~~~~~~~
Compensation of current officers, directors,
trustees, and key employees ~~~~~~~~
~~~
Other salaries and wages ~~~~~~~~~~
Other employee benefits ~~~~~~~~~~
Payroll taxes ~~~~~~~~~~~~~~~~
Fees for services (non-employees):
Management
Legal
Accounting
Lobbying
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
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
~~
~~~~~~~~~~~~~~~~~
~~
All other expenses
|
Form (2012)
Do not include amounts reported on lines 6b,7b, 8b, 9b, and 10b of Part VIII.
Organizations that follow SFAS 117 (ASC 958), check here and
complete lines 27 through 29, and lines 33 and 34.
27
28
29
Organizations that do not follow SFAS 117 (ASC 958), check here
and complete lines 30 through 34.
30
31
32
33
34
Ne
t A
ss
ets
or
Fu
nd
Ba
lan
ce
s
Form 990 (2012) Page
Check if Schedule O contains a response to any question in this Part X ������������������������������
Beginning of year End of year
Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees. Complete
Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from other disqualified persons (as defined under
section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing
employers and sponsoring organizations of section 501(c)(9) voluntary
employees' beneficiary organizations (see instr). Complete Part II of Sch L ~~
Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D
Less: accumulated depreciation
~~~
~~~~~~
Investments - publicly traded securities
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~
Add lines 1 through 15 (must equal line 34) ����������
Accounts payable and accrued expenses
Grants payable
Deferred revenue
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
Loans and other payables to current and former officers, directors, trustees,
key employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~
Secured mortgages and notes payable to unrelated third parties ~~~~~~
Unsecured notes and loans payable to unrelated third parties ~~~~~~~~
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X of
Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 17 through 25 ������������������
|
Unrestricted net assets
Temporarily restricted net assets
Permanently restricted net assets
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
|
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 ����������������
Form (2012)
11Balance SheetPart X
990
TOUCHSTONE MENTAL HEALTH 41-1920740
1,300.1,793,434. 1,592,733.
201,300.764,457. 440,913.
92,130. 97,153.
1,022,031.387,883. 254,548. 634,148.
61,754. 170,554.
15,097. 6,366.2,982,720. 3,143,167.
262,468. 297,702.
66,271.
262,468. 363,973.X
2,223,945. 2,545,503.496,307. 233,691.
2,720,252. 2,779,194.2,982,720. 3,143,167.
11
23201212-10-12
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Yes No
1
2
3
a
b
c
2a
2b
2c
a
b
3a
3b
Form 990 (2012) Page
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))
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Net unrealized gains (losses) on investments
Donated services and use of facilities
Investment expenses
Prior period adjustments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other changes in net assets or fund balances (explain in Schedule O)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
column (B))
~~~~~~~~~~~~~~~~~~~
�����������������������������������������������
Check if Schedule O contains a response to any question in this Part XII�����������������������������
Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.
Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~
If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule O and describe any steps taken to undergo such audits ����������������
Form (2012)
12Part XI Reconciliation of Net Assets
Part XII Financial Statements and Reporting
990
TOUCHSTONE MENTAL HEALTH 41-1920740
4,763,856.4,710,288.
53,568.2,720,252.
5,374.
0.
2,779,194.
X
X
X
X
X
X
12
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23202112-04-12
(iii)
(see instructions)
(iv) (i)
(v)
(i)
(vi)
(i)
(i) (ii) (vii)
(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.
Open to PublicInspection
Name of the organization Employer identification number
1
2
3
4
5
6
7
8
9
10
11
section 170(b)(1)(A)(i).
section 170(b)(1)(A)(ii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iv).
section 170(b)(1)(A)(v).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(vi).
section 509(a)(2).
section 509(a)(4).
section 509(a)(3).
a b c d
e
f
g
h
(i)
(ii)
(iii)
Yes No
11g(i)
11g(ii)
11g(iii)
Yes No Yes No Yes No
Total
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Schedule A (Form 990 or 990-EZ) 2012
Type of organization (described on lines 1-9 above or IRC section
)
Is the organizationin col. listed in yourgoverning document?
Did you notify theorganization in col.
of your support?
Is theorganization in col.
organized in theU.S.?
Name of supportedorganization
EIN Amount of monetarysupport
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
A church, convention of churches, or association of churches described in
A school described in (Attach Schedule E.)
A hospital or a cooperative hospital service organization described in
A medical research organization operated in conjunction with a hospital described in Enter the hospital's name,
city, and state:
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
(Complete Part II.)
A federal, state, or local government or governmental unit described in
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
(Complete Part II.)
A community trust described in (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 (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See
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 Check the box that
describes the type of supporting organization and complete lines 11e through 11h.
Type I Type II Type III - Functionally integrated Type III - Non-functionally integrated
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III
supporting organization, check this box
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below,
the governing body of the supported organization?
A family member of a person described in (i) above?
A 35% controlled entity of a person described in (i) or (ii) above?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~
Provide the following information about the supported organization(s).
LHA
SCHEDULE A
Part I Reason for Public Charity Status
Public Charity Status and Public Support 2012
TOUCHSTONE MENTAL HEALTH 41-1920740
X
13
Subtract line 5 from line 4.
23202212-04-12
Calendar year (or fiscal year beginning in)
Calendar year (or fiscal year beginning in) |
2
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
Total.
6 Public support.
(a) (b) (c) (d) (e) (f)
7
8
9
10
11
12
13
Total support.
12
First five years.
stop here
14
15
14
15
16
17
18
a
b
a
b
33 1/3% support test - 2012.
stop here.
33 1/3% support test - 2011.
stop here.
10% -facts-and-circumstances test - 2012.
stop here.
10% -facts-and-circumstances test - 2011.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2012
|
Add lines 7 through 10
Schedule A (Form 990 or 990-EZ) 2012 Page
(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.)
2008 2009 2010 2011 2012 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
Add lines 1 through 3 ~~~
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) ~~~~~~~~~~~~
2008 2009 2010 2011 2012 Total
Amounts from line 4 ~~~~~~~
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources ~
Net income from unrelated business
activities, whether or not the
business is regularly carried on ~
Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.) ~~~~
Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~
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 ��������������������������������������������� |
~~~~~~~~~~~~Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
Public support percentage from 2011 Schedule A, Part II, line 14
%
%~~~~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
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 The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
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 Explain in Part IV how the organization
meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ |
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 Explain in Part IV how the
organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ��� |
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
TOUCHSTONE MENTAL HEALTH 41-1920740
17,515. 46,451. 73,014. 630,271. 52,035. 819,286.
17,515. 46,451. 73,014. 630,271. 52,035. 819,286.
426,360.392,926.
17,515. 46,451. 73,014. 630,271. 52,035. 819,286.
26,449. 16,082. 8,422. 9,426. 6,722. 67,101.
886,387.21,223,963.
44.3341.98
X
14
(Subtract line 7c from line 6.)
Amounts included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% of the
amount on line 13 for the year
(Add lines 9, 10c, 11, and 12.)
232023 12-04-12
Calendar year (or fiscal year beginning in) |
Calendar year (or fiscal year beginning in) |
Total support.
3
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
6
7
Total.
a
b
c
8 Public support
(a) (b) (c) (d) (e) (f)
9
10a
b
c11
12
13
14 First five years.
stop here
15
16
15
16
17
18
19
20
2012
2011
17
18
a
b
33 1/3% support tests - 2012.
stop here.
33 1/3% support tests - 2011.
stop here.
Private foundation.
Schedule A (Form 990 or 990-EZ) 2012
Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975
Schedule A (Form 990 or 990-EZ) 2012 Page
(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.)
2008 2009 2010 2011 2012 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") ~~
Gross receipts from admissions,merchandise sold or services per-formed, or facilities furnished inany activity that is related to theorganization's tax-exempt purpose
Gross receipts from activities that
are not an unrelated trade or bus-
iness under section 513 ~~~~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
~~~ Add lines 1 through 5
Amounts included on lines 1, 2, and
3 received from disqualified persons
~~~~~~
Add lines 7a and 7b ~~~~~~~
2008 2009 2010 2011 2012 Total
Amounts from line 6 ~~~~~~~Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ~
~~~~
Add lines 10a and 10b ~~~~~~Net income from unrelated businessactivities not included in line 10b, whether or not the business is regularly carried on ~~~~~~~Other income. Do not include gainor loss from the sale of capitalassets (Explain in Part IV.) ~~~~
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 ���������������������������������������������������� |
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
Public support percentage from 2011 Schedule A, Part III, line 15
~~~~~~~~~~~~ %
%��������������������
Investment income percentage for (line 10c, column (f) divided by line 13, column (f))
Investment income percentage from Schedule A, Part III, line 17
~~~~~~~~ %
%~~~~~~~~~~~~~~~~~~
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 The organization qualifies as a publicly supported organization ~~~~~~~~~~ |
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 The organization qualifies as a publicly supported organization~~~~ |
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions �������� |
Part III Support Schedule for Organizations Described in Section 509(a)(2)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Section D. Computation of Investment Income Percentage
15
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
22345112-21-12
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(Form 990, 990-EZ,or 990-PF) | Attach to Form 990, Form 990-EZ, or Form 990-PF.
Name of the organization Employer identification number
Organization type
Filers of: Section:
not
General Rule Special Rule.
Note.
General Rule
Special Rules
(1) (2)
General Rule
Caution.
must
For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF.
exclusively
exclusively exclusively
(check one):
Form 990 or 990-EZ 501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust treated as a private foundation
527 political organization
Form 990-PF 501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
Check if your organization is covered by the or a
Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one
contributor. Complete Parts I and II.
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections
509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of $5,000 or 2%
of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
total contributions of more than $1,000 for use for religious, charitable, scientific, literary, or educational purposes, or
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
contributions for use for religious, charitable, etc., purposes, but these contributions did not total to more than $1,000.
If this box is checked, enter here the total contributions that were received during the year for an religious, charitable, etc.,
purpose. Do not complete any of the parts unless the applies to this organization because it received nonexclusively
religious, charitable, etc., contributions of $5,000 or more during the year ~~~~~~~~~~~~~~~~~ | $
An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF),
but it answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on Part I, line 2 of its Form 990-PF, to
certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA
Schedule B Schedule of Contributors
2012
TOUCHSTONE MENTAL HEALTH 41-1920740
X 3
X
223452 12-21-12
Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
Person
Payroll
Noncash
Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page
(see instructions). Use duplicate copies of Part I if additional space is needed.
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
$
(Complete Part II if thereis a noncash contribution.)
2
Part I Contributors
TOUCHSTONE MENTAL HEALTH 41-1920740
1 MARTHA LANTZ X
8008 PENNSLYVANIA ROAD 5,200.
BLOOMINGTON, MN 55438
2 JOHN AND LIZ SJAASTAD X
1037 PORTLAND AVENUE 10,450.
ST. PAUL, MN 55104
3 MERRI KAAS X
1605 NORWOOD DRIVE 5,700.
EAGAN, MN 55122
17
223453 12-21-12
Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
(a)
No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page
(see instructions). Use duplicate copies of Part II if additional space is needed.
$
$
$
$
$
$
3
Part II Noncash Property
TOUCHSTONE MENTAL HEALTH 41-1920740
18
(Enter this information once.)
223454 12-21-12
Name of organization Employer identification number
religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations that total more than $1,000 for theyear. (a) (e) and
$1,000 or less
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
exclusively Complete columns through the following line entry. For organizations completing Part III, enter
the total of religious, charitable, etc., contributions of for the year.
Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page
| $
Use duplicate copies of Part III if additional space is needed.
Exclusively
4
Part III
TOUCHSTONE MENTAL HEALTH 41-1920740
19
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23205112-10-12
Held at the End of the Tax Year
(Form 990) | Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
| Attach to Form 990. | See separate instructions.Open to PublicInspection
Name of the organization Employer identification number
(a) (b)
1
2
3
4
5
6
Yes No
Yes No
1
2
3
4
5
6
7
8
9
a
b
c
d
2a
2b
2c
2d
Yes No
Yes No
1
2
a
b
(i)
(ii)
a
b
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2012
Complete if the
organization answered "Yes" to Form 990, Part IV, line 6.
Donor advised funds 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?~~~~~~~~~~~~~~~~~~
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
Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Protection of natural habitat
Preservation of open space
Preservation of an historically important land area
Preservation of a certified historic structure
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.
Total number of conservation easements
Total acreage restricted by conservation easements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
listed in the National Register
~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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? ~~~~~~~~~~~~~~~~~~~~~~~~~
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)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
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:
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
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:
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
LHA
Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Part II Conservation Easements.
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
SCHEDULE D Supplemental Financial Statements 2012
TOUCHSTONE MENTAL HEALTH 41-1920740
20
23205212-10-12
3
4
5
a
b
c
d
e
Yes No
1
2
a
b
c
d
e
f
a
b
Yes No
1c
1d
1e
1f
Yes No
(a) (b) (c) (d) (e)
1
2
3
4
a
b
c
d
e
f
g
a
b
c
a
b
Yes No
(i)
(ii)
3a(i)
3a(ii)
3b
(a) (b) (c) (d)
1a
b
c
d
e
Total.
Schedule D (Form 990) 2012
(continued)
(Column (d) must equal Form 990, Part X, column (B), line 10(c).)
Two years back Three years back Four years back
Schedule D (Form 990) 2012 Page
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):
Public exhibition
Scholarly research
Preservation for future generations
Loan or exchange programs
Other
Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.
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? ������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 9, orreported an amount on Form 990, Part X, line 21.
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X?
If "Yes," explain the arrangement in Part XIII and complete the following table:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amount
Beginning balance
Additions during the year
Distributions during the year
Ending balance
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization include an amount on Form 990, Part X, line 21?
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII
~~~~~~~~~~~~~~~~~~~~~~~~~
�������������
Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
Current year Prior year
Beginning of year balance
Contributions
Net investment earnings, gains, and losses
Grants or scholarships
~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~
Other expenditures for facilities
and programs
Administrative expenses
End of year balance
~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
Board designated or quasi-endowment
Permanent endowment
Temporarily restricted endowment
The percentages in lines 2a, 2b, and 2c should equal 100%.
| %
| %
| %
Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
unrelated organizations
related organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIII the intended uses of the organization's endowment funds.
~~~~~~~~~~~~~~~~~~~~~~
See Form 990, Part X, line 10.
Description of property Cost or otherbasis (investment)
Cost or otherbasis (other)
Accumulateddepreciation
Book value
Land
Buildings
Leasehold improvements
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Equipment
Other
~~~~~~~~~~~~~~~~~
��������������������
Add lines 1a through 1e. |������������
2Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
(Column (b) must equal Form 990, Part X, col. (B) line 15.)
(Column (b) must equal Form 990, Part X, col. (B) line 25.)
Description of security or category
(Col. (b) must equal Form 990, Part X, col. (B) line 12.) |
(Col. (b) must equal Form 990, Part X, col. (B) line 13.) |
Schedule D (Form 990) 2012 Page
See Form 990, Part X, line 12.
Book value Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
Financial derivatives
Closely-held equity interests
Other
~~~~~~~~~~~~~~~
~~~~~~~~~~~
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Description of investment typeSee Form 990, Part X, line 13.
Book value Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
See Form 990, Part X, line 15.
Description Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
���������������������������� |
See Form 990, Part X, line 25.
Description of liability Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Federal income taxes
����� |
FIN 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's
liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ������
3Part VII Investments - Other Securities.
Part VIII Investments - Program Related.
Part IX Other Assets.
Part X Other Liabilities.
TOUCHSTONE MENTAL HEALTH 41-1920740
X
22
23205412-10-12
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d 2e
32e 1
1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d
2e 1
2e
3
1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
Schedule D (Form 990) 2012
(This must equal Form 990, Part I, line 12.)
(This must equal Form 990, Part I, line 18.)
Schedule D (Form 990) 2012 Page
Total revenue, gains, and other support per audited financial statements
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
~~~~~~~~~~~~~~~~~~~
Net unrealized gains on investments
Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part VIII, line 12, but not on line :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total revenue. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
�����������������
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
~~~~~~~~~~~~~~~~~~~~~~~~~~
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through
Subtract line from line
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part IX, line 25, but not on line :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total expenses. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
����������������
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part
X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
4Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
Part XIII Supplemental Information
TOUCHSTONE MENTAL HEALTH 41-1920740
4,776,216.
5,374.
6,986.12,360.
4,763,856.
0.4,763,856.
4,717,274.
6,986.6,986.
4,710,288.
0.4,710,288.
PART V, LINE 4: THE INCOME DERIVED FROM THE ENDOWMENT FUND IS TO BE
USED FOR FUTURE PROGRAM DEVELOPMENT. THE BOARD OF DIRECTORS HAS THE
AUTHORITY TO RELEASE THE PRINCIPAL UNDER EMERGENCY CONDITIONS.
PART X, LINE 2: TOUCHSTONE MENTAL HEALTH IS ORGANIZED AS A MINNESOTA
NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE
SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF
THE INTERNAL REVENUE CODE AS AN ORGANIZATION DESCRIBED IN SECTION
23
23205512-10-12
5
Schedule D (Form 990) 2012
(continued)Schedule D (Form 990) 2012 Page Part XIII Supplemental Information
TOUCHSTONE MENTAL HEALTH 41-1920740
501(C)(3), QUALIFY FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION
170(B)(1)(A)(VI), AND HAS BEEN DETERMINED NOT TO BE A PRIVATE FOUNDATION
UNDER SECTIONS 509(A)(1). THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A
RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN
ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS
DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE.
THE ORGANIZATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS
INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX
RETURN (FORM 990-T) WITH THE IRS.
THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX
POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH,
DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE
FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED
INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND
LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE
INCURRED.
PART XI, LINE 2D - OTHER ADJUSTMENTS:
FUNDRAISING EXPENSES OFFSET AGAINST REVENUE ON TAX RETURN 6,986.
PART XII, LINE 2D - OTHER ADJUSTMENTS:
FUNDRAISING EXPENSES OFFSET AGAINST REVENUE ON TAX RETURN 6,986.
24
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Didfundraiser
have custodyor control of
contributions?
23208101-07-13
Schedule G (Form 990 or 990-EZ) 2012
(Form 990 or 990-EZ)
Open To PublicInspection
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
| Attach to Form 990 or Form 990-EZ. | See separate instructions.Employer identification number
1
a
b
c
d
a
b
e
f
g
2
Yes No
(i) (ii)
(iii) (iv)
(v)
(i)
(vi)
Yes No
Total
3
Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Name of the organization
Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are notrequired to complete this part.
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
Mail solicitations
Internet and email solicitations
Phone solicitations
In-person solicitations
Solicitation of non-government grants
Solicitation of government grants
Special fundraising events
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or
key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
Name and address of individualor entity (fundraiser)
ActivityGross receipts
from activity
Amount paidto (or retained by)
fundraiserlisted in col.
Amount paidto (or retained by)
organization
�������������������������������������� |
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registrationor licensing.
LHA
SCHEDULE G
Fundraising Activities. Part I
Supplemental Information RegardingFundraising or Gaming Activities 2012
TOUCHSTONE MENTAL HEALTH 41-1920740
X
X
CROWLEY WHITE & HELMER INC. -1619 W DAYTON AVE, ST. PAUL, CAPITAL CAMPAIGN X 52,201. 36,000. 16,201.
52,201. 36,000. 16,201.
MN
SEE PART IV FOR CONTINUATIONS
25
232082 01-07-13
2
(d)
(a)
(c)
(a) (b) (c)
1
2
3
4
5
6
7
8
9
10
11
(a) (b)
(c) (d)
(a) (c)
1
2
3
4
5
6
7
8
Yes Yes Yes
No No No
9
10
a
b
Yes No
a
b
Yes No
Schedule G (Form 990 or 990-EZ) 2012
Pull tabs/instantbingo/progressive bingo
Schedule G (Form 990 or 990-EZ) 2012 Page Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000
of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
Total events
(add col. through
col. )
Re
ven
ue
Event #1 Event #2 Other events
(event type) (event type) (total number)
Gross receipts
Less: Contributions
~~~~~~~~~~~~~~
~~~~~~~~~~~
Gross income (line 1 minus line 2)
Dir
ec
t E
xpe
nse
s
����
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs ~~~~~~~~~~~~
Food and beverages
Entertainment
~~~~~~~~~~
~~~~~~~~~~~~~~
Other direct expenses ~~~~~~~~~~
Direct expense summary. Add lines 4 through 9 in column (d)
Net income summary. Combine line 3, column (d), and line 10
~~~~~~~~~~~~~~~~~~~~~~~~ | ( )
������������������������� |Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than
$15,000 on Form 990-EZ, line 6a.
Re
ven
ue Bingo Other gaming
Total gaming (addcol. through col. )
Dir
ec
t E
xpe
nse
s
Gross revenue ��������������
Cash prizes
Noncash prizes
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Rent/facility costs
Other direct expenses
~~~~~~~~~~~~
����������
% % %
Volunteer labor ~~~~~~~~~~~~~
Direct expense summary. Add lines 2 through 5 in column (d)
Net gaming income summary. Combine line 1, column d, and line 7
~~~~~~~~~~~~~~~~~~~~~~~~ | ( )
��������������������� |
Enter the state(s) in which the organization operates gaming activities:
Is the organization licensed to operate gaming activities in each of these states?
If "No," explain:
~~~~~~~~~~~~~~~~~~~~
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?
If "Yes," explain:
~~~~~~~~~
Part II Fundraising Events.
Part III Gaming.
TOUCHSTONE MENTAL HEALTH 41-1920740
NONENOTES OFINSPIRATION
27,878. 27,878.
20,327. 20,327.
7,551. 7,551.
200. 200.
6,772. 6,772.
14. 14.6,986.
565.
26
232083 01-07-13
3
11
12
13
14
15
Yes No
Yes No
a
b
13a
13b
Yes Noa
b
c
16
17
a
b
Yes No
Supplemental Information.
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012 Page
Does the organization operate gaming activities with nonmembers?
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed
to administer charitable gaming?
~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Indicate the percentage of gaming activity operated in:
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name |
Address |
Does the organization have a contract with a third party from whom the organization receives gaming revenue?
If "Yes," enter the amount of gaming revenue received by the organization |
~~~~~~
$ and the amount
of gaming revenue retained by the third party | $ .
If "Yes," enter name and address of the third party:
Name |
Address |
Gaming manager information:
Name |
Gaming manager compensation |
Description of services provided |
$
Director/officer Employee Independent contractor
Mandatory distributions:
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year | $
Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III,
lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Part IV
TOUCHSTONE MENTAL HEALTH 41-1920740
SCHEDULE G, PART I, LINE 2B, LIST OF TEN HIGHEST PAID FUNDRAISERS:
(I) NAME OF FUNDRAISER: CROWLEY WHITE & HELMER INC.
(I) ADDRESS OF FUNDRAISER: 1619 W DAYTON AVE, ST. PAUL, MN 55104
27
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
23221101-04-13
(Form 990 or 990-EZ) Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.
| Attach to Form 990 or 990-EZ.Open to PublicInspection
Employer identification number
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2012)
Name of the organization
LHA
SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2012
TOUCHSTONE MENTAL HEALTH 41-1920740
FORM 990, PART III, LINE 4D, OTHER PROGRAM SERVICES:
TOUCHSTONE INTENTIONAL COMMUNITIES ARE ADULT REHABILITATIVE MENTAL
HEALTH SERVICES PROVIDING SOCIAL INDEPENDENT LIVING SKILLS TRAINING,
MENTAL ILLNESS MANAGEMENT AND MEDICATION EDUCATION FOR ADULTS WITH
SERIOUS AND PERSISTENT MENTAL ILLNESS. THE COMMUNITIES PROMOTE A SENSE
OF BELONGING THROUGH SELF-GOVERNANCE, GROUPS AND ACTIVITIES, AND
COMMUNAL MEALS.
TOUCHSTONE CARE COORDINATION SERVES AS ADVOCATES FOR CLIENTS ACROSS THE
SPECTRUM OF PHYSICAL, MENTAL AND SOCIAL SERVICE PROVIDERS, HELPING
MEMBERS NAVIGATE THE WORLD OF MEDICAL HEALTH, MENTAL HEALTH AND SOCIAL
SERVICES.
TOUCHSTONE TARGETED CASE MANAGEMENT SERVICES INCLUDE NEEDS ASSESSMENTS,
SERVICE PLANNING, REFERRALS AND PROGRESS MONITORING TOWARD MENTAL
HEALTH RECOVERY.
TOUCHSTONE HEALTH & WELLNESS AND HOME & COMMUNITY BASED PROGRAMS
PROVIDE ACCESS TO HEALTH AND WELLNESS INFORMATION AND RESOURCES TO HELP
ANYONE LEARN HOW HEALTHY CHOICES CAN IMPROVE THEIR HEALTH AND
WELL-BEING TODAY AND IN THE FUTURE.
THE TOTAL PROGRAM REVENUES AND EXPENSES FOR THE OTHER PROGRAMS,
INCLUDING TOUCHSTONE INTENTIONAL COMMUNITIES, TOUCHSTONE CARE
COORDINATION, TOUCHSTONE TARGETED CASE MANAGEMENT SERVICES, AND
TOUCHSTONE HEALTH & WELLNESS AND HOME & COMMUNITY BASED PROGRAMS ARE:
28
23221201-04-13
2
Employer identification number
Schedule O (Form 990 or 990-EZ) (2012)
Schedule O (Form 990 or 990-EZ) (2012) Page
Name of the organizationTOUCHSTONE MENTAL HEALTH 41-1920740
EXPENSES $ 1,410,492. INCLUDING GRANTS OF $ 0. REVENUE $ 1,427,298.
FORM 990, PART VI, SECTION A, LINE 8B: THE ORGANIZATION HAS NO COMMITTEES
WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11: THE FORM 990 IS DISTRIBUTED TO THE
BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C: THE CONFLICT OF INTEREST POLICY
COVERS ALL BOARD MEMBERS,THE EXECUTIVE DIRECTOR, OPERATIONS DIRECTOR,
FINANCE DIRECTOR, DEVELOPMENT DIRECTOR AND ALL PROGRAM DIRECTORS. ON AN
ANNUAL BASIS THESE INDIVIDUALS REVIEW AND SIGN THE CONFLICT OF INTEREST
POLICY. THE BOARD REVIEWS ANY POTENTIAL BOARD MEMBER CONFLICTS AND THE
EXECUTIVE DIRECTOR REVIEWS ALL OTHER POTENTIAL CONFLICTS. BOARD MEMBERS
CANNOT VOTE ON CONFLICT ITEMS AND OTHER OFFICERS AND DIRECTORS CANNOT MAKE
DECISIONS IN AREAS WITH CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15A: THE BOARD OF DIRECTORS ANNUALLY
ANALYZES COMPENSATION INFORMATION FROM SIMILARLY SITUATED ORGANIZATIONS
THROUGH THE MINNESOTA COUNCIL OF NONPROFITS SALARY SURVEY AND THE MINNESOTA
ASSOCIATION OF COMMUNITY MENTAL HEALTH PROVIDERS' SALARY SURVEY WHEN
DETERMINING THE EXECUTIVE DIRECTOR'S SALARY.
FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION MAKES ITS
GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND AUDITED FINANCIAL
STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
29
OMB No. 1545-1878
Form
For calendar year 2012, or fiscal year beginning , 2012, and ending ,20
Department of the TreasuryInternal Revenue Service
22305111-05-12
Employer identification number
Enter five numbers, butdo not enter all zeros
ERO firm name
do not enter all zeros
| Do not send to the IRS. Keep for your records.
1a, 2a, 3a, 4a, 5a, 1b, 2b, 3b, 4b, 5b,Do not
1a
2a
3a
4a
5a
| b Total revenue, 1b
2b
3b
4b
5b
| b Total revenue,
| b Total tax
| b Tax based on investment income
| b Balance Due
(a) (b) (c)
Officer's PIN: check one box only
ERO's EFIN/PIN.
Pub. 4163,
For Paperwork Reduction Act Notice, see instructions.
e-file
Name of exempt organization
Name and title of officer
~~~
~~~~~~~~
Officer's signature | Date |
ERO's signature | Date |
Form (2012)
(Whole Dollars Only)
Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount, if any, from the return. If you check the boxon line or below, and the amount on that line for the return being filed with this form was blank, then leave line orwhichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. complete morethan 1 line in Part I.
Form 990 check here
Form 990-EZ check here
Form 1120-POL check here
if any (Form 990, Part VIII, column (A), line 12)~~~~~~~
if any (Form 990-EZ, line 9) ~~~~~~~~~~~~~~
(Form 1120-POL, line 22) ~~~~~~~~~~~~~~~~
Form 990-PF check here
Form 8868 check here
(Form 990-PF, Part VI, line 5)
(Form 8868, Part I, line 3c or Part II, line 8c)
Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 2012electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true, correct, and complete. Ifurther declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent to allow myintermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return to the IRS and to receive from the IRS
an acknowledgement of receipt or reason for rejection of the transmission, the reason for any delay in processing the return or refund, and the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (directdebit) entry to the financial institution account indicated in the tax preparation software for payment of the organization's federal taxes owed on thisreturn, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in theprocessing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to thepayment. I have selected a personal identification number (PIN) as my signature for the organization's electronic return and, if applicable, theorganization's consent to electronic funds withdrawal.
I authorize to enter my PIN
as my signature on the organization's tax year 2012 electronically filed return. If I have indicated within this return that a copy of the returnis being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO toenter my PIN on the return's disclosure consent screen.
As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 2012 electronically filed return. If I haveindicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/Stateprogram, I will enter my PIN on the return's disclosure consent screen.
Enter your six-digit electronic filing identification
number (EFIN) followed by your five-digit self-selected PIN.
I certify that the above numeric entry is my PIN, which is my signature on the 2012 electronically filed return for the organization indicated above. Iconfirm that I am submitting this return in accordance with the requirements of Modernized e-File (MeF) Information for Authorized IRS
Providers for Business Returns.
LHA
e-fileIRS Signature Authorizationfor an Exempt Organization
Part I Type of Return and Return Information
Part II Declaration and Signature Authorization of Officer
Part III Certification and Authentication
ERO Must Retain This Form - See InstructionsDo Not Submit This Form To the IRS Unless Requested To Do So
Statements of Financial Position ............................................................................................................................ 3 Statements of Activities ......................................................................................................................................... 4 Statements of Cash Flows ...................................................................................................................................... 5 Statements of Functional Expenses ........................................................................................................................ 6 Notes to Financial Statements ................................................................................................................................ 7
1
Independent Auditor’s Report The Board of Directors Touchstone Mental Health Minneapolis, Minnesota Report on the Financial Statements We have audited the accompanying financial statements of Touchstone Mental Health, which comprise the statement of financial position as of December 31, 2012, and the related statements of activities, cash flows, and functional expenses for the year then ended, and the related notes to the financial statements. Management’s Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. Auditor’s Responsibility Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Touchstone Mental Health as of December 31, 2012, and the changes in its activities and its cash flows for the year then ended in accordance with accounting principles generally accepted in the United States of America.
www.eidebai l ly.com
US Bancorp Center 800 Nicollet Mall, Ste. 1300 | Minneapolis, MN 55402-7033 | T 612.253.6500 | F 612.253.6600 | EOE
2
Report on Summarized Comparative Information The 2011 financial statements of Touchstone Mental Health were audited by other auditors whose report dated March 7, 2012, expressed an unmodified audit opinion on those audited financial statements. In our opinion, the summarized comparative information presented herein as of and for the year ended December 31, 2011, is consistent, in all material respects, with the audited financial statements from which it has been derived.
Minneapolis, Minnesota March 15, 2013
See Notes to Financial Statements
2012 2011
Assets
Current AssetsCash and cash equivalents 1,592,733$ 1,693,684$ Short-term investments 101,749 101,050 Receivables
Accounts 440,913 454,457 Promises to give 115,402 120,000
Prepaid expenses 97,153 92,130
Total current assets 2,347,950 2,461,321
Property and Equipment 634,148 254,548
Other AssetsInvestments 68,805 61,754 Promises to give, net of current portion 85,898 190,000 Deposits 6,366 15,097
Total other assets 161,069 266,851
Total assets 3,143,167$ 2,982,720$
See Notes to Financial Statements 3
Touchstone Mental Health Statements of Financial Position
December 31, 2012 (With Comparative Totals for 2011)
2012 2011
Liabilities and Net Assets
Current LiabilitiesAccounts payable 43,247$ 40,007$ Accrued expenses 254,455 222,461 Current portion of note payable 23,249 -
Total liabilities and net assets 3,143,167$ 2,982,720$
See Notes to Financial Statements 4
Touchstone Mental Health Statements of Activities
Year Ended December 31, 2012 (With Comparative Totals for 2011)
2012Temporarily Total
Unrestricted Restricted Total 2011
Support and RevenueNet program service fees 4,393,705$ -$ 4,393,705$ 4,342,256$ Rent 261,246 - 261,246 246,318 Investment income 4,347 7,749 12,096 3,821 Contributions 6,144 25,564 31,708 578,536 Special events 1,521 26,357 27,878 40,442 In-kind contributions - - - 750 Other 34,114 15,469 49,583 - Net assets released
from restrictions 337,755 (337,755) - -
Total support and revenue 5,038,832 (262,616) 4,776,216 5,212,123
ExpensesProgram services 4,264,784 - 4,264,784 4,079,193 Management and general 278,905 - 278,905 217,044 Fundraising 173,585 - 173,585 171,918
Total expenses 4,717,274 - 4,717,274 4,468,155
Change in Net Assets 321,558 (262,616) 58,942 743,968
Net Assets, Beginning of Year 2,223,945 496,307 2,720,252 1,976,284
Net Assets, End of Year 2,545,503$ 233,691$ 2,779,194$ 2,720,252$
See Notes to Financial Statements 5
Touchstone Mental Health Statements of Cash Flows
Year Ended December 31, 2012 (With Comparative Totals for 2011)
2012 2011
Operating ActivitiesChange in net assets 58,942$ 743,968$ Adjustments to reconcile change in net assets
to net cash from operating activitiesDepreciation 46,838 47,172 Bad debt expense 32,496 64,750 Interest reinvested (6,926) (2,922) Unrealized loss (gain) on investments (5,374) 5,605 Promises to give (24,500) (434,908)
Net Cash from Operating Activities 121,466 422,275
Investing ActivitiesPurchase of property and equipment (426,438) - Purchase of investments - (355) Redemption of certificates of deposits 104,550 259,987 Purchase of certificates of deposit (100,000) (100,000)
Net Cash from (used for) Investing Activities (421,888) 159,632
Financing ActivitiesPayments received from promises to give for building project 133,200 124,908 Repayment of long-term debt (5,669) - Proceeds from long-term debt 71,940 -
Net Cash from Financing Activities 199,471 124,908
Net Change in Cash and Cash Equivalents (100,951) 706,815
Cash and Cash Equivalents, Beginning of Year 1,693,684 986,869 Cash and Cash Equivalents, End of Year 1,592,733$ 1,693,684$
See Notes to Financial Statements
Intensive Assisted Residential Community Case Care Intentional Living Treatment Rehabilitation Management Coordination Communities
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Note 1 - Principal Activity and Significant Accounting Policies Organization Touchstone Mental Health (Organization) is a non-profit organization providing services for women and men with serious and persistent mental illnesses. The Organization utilizes an integrative treatment and resource approach to support the health of each client's mind, body, and spirit. Services make it possible for clients to survive and thrive in the community, manage their symptoms, avoid frequent hospitalizations, build supportive relationships and work successfully toward well-being.
Touchstone Residential Treatment is an intensive residential treatment service providing consistent 24-hour service, 7 days a week. The service implements an integrated treatment approach guided by the development of an individualized and meaningful treatment plan focusing on recovery goals.
Touchstone Targeted Case Management Services include needs assessments, service planning, referrals
and progress monitoring toward mental health recovery.
Touchstone Assisted Living Apartments is a community alternative for disabled individuals which offers long-term housing helping clients maintain stability through supportive services.
Touchstone Intentional Communities are adult rehabilitative mental health services providing social
independent living skills training, mental illness management and medication education for adults with serious and persistent mental illnesses. The communities promote a sense of belonging through self-governance, groups and activities, and communal meals.
Touchstone Intensive Community Rehabilitation Services offer clients a multidisciplinary team that
includes a core group of clinicians that work with clients to identify personal recovery goals and develop a rehabilitation plan to meet those goals.
Touchstone Care Coordination serves as advocates for clients across the spectrum of physical, mental and
social service providers, helping members navigate the world of medical health, mental health and social services.
Touchstone Health & Wellness and Home & Community Based programs provide access to health and
wellness information and resources to help anyone learn how healthy choices can improve their health and well-being today and in the future.
Cash and Cash Equivalents The Organization considers all cash and highly liquid financial instruments with original maturities of three months or less to be cash and cash equivalents. Cash and highly liquid financial instruments restricted for endowments are excluded from this definition.
8
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Accounts Receivable and Credit Policies Accounts receivable are uncollateralized customer and third-party payor obligations outstanding for client services provided. Payments of accounts receivable are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim. The carrying amount of accounts receivable approximates what is expected to be collected based on a contract or agreed upon rates with the third-party payor for the services provided. Management determines the allowance for uncollectible accounts receivable based on historical experience and management’s evaluation of individual outstanding receivables. Management considered all amounts to be collectible; accordingly, there was no allowance for doubtful accounts as of December 31, 2012. Promises to Give Unconditional promises to give expected to be collected in future years are initially recorded at fair value using present value techniques incorporating risk-adjusted discount rates designed to reflect the assumptions market participants would use in pricing the asset. In subsequent years, amortization of the discounts is included in contribution revenue in the statement of activities. Management determines the allowance for uncollectable promises to give based on historical experience, an assessment of economic conditions, and a review of subsequent collections. Promises to give are written off when deemed uncollectable. Management considered all amounts to be collectible; accordingly, there was no allowance for promises to give as of December 31, 2012. Property and Equipment Property and equipment additions over $1,000 are recorded at cost, or if donated, at fair value on the date of donation. Depreciation is determined on a straight-line basis over estimated useful lives as follows:
Furniture and equipment 3-7 yearsLeasehold improvements 20 yearsVehicles 5 years
When assets are sold or otherwise disposed of, the cost and related depreciation or amortization are removed from the accounts, and any remaining gain or loss is included in the statement of activities. Costs of maintenance and repairs that do not improve or extend the useful lives of the respective assets are expensed currently. Investments and Investment Income Investment purchases are recorded at cost or, if donated, at fair value on the date of donation. Investments in equity securities with readily determinable fair values and all investments in debt securities are measured at fair value in the statement of financial position. Net investment gain/(loss) is reported in the statement of activities and consists of interest and dividend income, realized and unrealized gains and losses, less investment management and custodial fees.
9
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Net Assets Net assets, revenues, gains, and losses are classified based on the existence or absence of donor-imposed restrictions. Accordingly, net assets and changes therein are classified and reported as follows:
Unrestricted Net Assets – Net assets available for use in general operations. Unrestricted board-designated net assets consist of net assets designated by the Board of Directors for operating reserve.
Temporarily Restricted Net Assets – Net assets subject to donor restrictions that may or will be met by expenditures or actions of the Organization and/or the passage of time.
Touchstone Mental Health reports contributions as temporarily restricted support if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activities as net assets released from restrictions.
Permanently Restricted Net Assets – Net assets whose use is limited by donor-imposed restrictions that neither expire by the passage of time nor can be fulfilled or otherwise removed by action of the Organization. The restrictions stipulate that resources be maintained permanently but permit the Organization to expend the income generated in accordance with the provisions of the agreements. The Organization had no permanently restricted net assets at December 31, 2012.
Revenue and Revenue Recognition Revenue is recognized when earned. Program service fees and payments under cost-reimbursable contracts received in advance are deferred to the applicable period in which the related services are performed or expenditures are incurred, respectively. Contributions are recognized when cash, securities or other assets, an unconditional promise to give, or notification of a beneficial interest is received. Conditional promises to give are not recognized until the conditions on which they depend have been substantially met. Donated Services and In-kind Contributions The Organization reports gifts of goods and equipment as unrestricted support unless explicit donor stipulations specify how the donated assets must be used. Gifts of long-lived assets with explicit restrictions that specify how the assets are to be used and gifts of cash or other assets that must be used to acquire long-lived assets are reported as restricted support. Absent explicit donor stipulations about how long those long-lived assets must be maintained, the Organization reports expirations of donor restrictions when the donated or acquired long-lived assets are purchased. Advertising Advertising costs are expensed as incurred and approximated $6,500 for the year ended December 31, 2012.
10
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Functional Allocation of Expenses The costs of program and supporting services activities have been summarized on a functional basis in the statements of activities. The statements of functional expenses present the natural classification detail of expenses by function. Expenses are allocated to program and support services directly when possible. Expenses not directly related to programs are allocated based on management's estimate based on related salary expenses. Accordingly, certain costs have been allocated among the programs and supporting services benefited. Income Taxes Touchstone Mental Health is organized as a Minnesota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Section 501(a) of the Internal Revenue Code as an organization described in Section 501(c)(3), qualify for the charitable contribution deduction under Section 170(b)(1)(A)(vi), and has been determined not to be a private foundation under Section 509(a)(1). The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates and those differences could be material. Financial Instruments and Credit Risk The Organization manages deposit concentration risk by placing cash and money market accounts with financial institutions believed by management to be creditworthy. At times, amounts on deposit may exceed insured limits or include uninsured investments in money market mutual funds. To date, the Organization has not experienced losses in any of these accounts. Credit risk associated with accounts receivable and promises to give is considered to be limited due to high historical collection rates and because substantial portions of the outstanding amounts are due from governmental agencies and insurance payors supportive of the Organization’s mission. Investment performance is monitored by management and the Board of Directors. Although the fair values of investments are subject to fluctuation on a year-to-year basis, management and the Board of Directors believe that the investment policies and guidelines are prudent for the long-term welfare of the Organization. Reclassifications Certain reclassifications of amounts previously reported have been made to the accompanying financial statements to maintain consistency between periods presented. The reclassifications had no impact on previously reported net assets.
11
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Note 2 - Investments and Investment Income Short-term investments The composition of short-term investments at December 31, 2012 consists of a certificate of deposit which is stated at cost plus accrued interest. Long-term investments Long-term investments are shown in the following table. Investments in interest bearing cash are stated at cost plus accrued interest. Investments in mutual funds are stated at fair value.
Interest bearing cash 6,959$ Mutual funds 61,846
68,805$
Net investment return consists of the following for the year ended December 31, 2012:
Short-term investmentsInterest and dividends 5,045$
Endowment investments
Interest and dividends 1,677 Unrealized gains 5,374
Endowment investments 7,051
Total investment income 12,096$
Note 3 - Fair Value Measurements and Disclosures Certain assets and liabilities are reported at fair value in the financial statements. Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction in the principal, or most advantageous, market at the measurement date under current market conditions regardless of whether that price is directly observable or estimated using another valuation technique. Inputs used to determine fair value refer broadly to the assumptions that market participants would use in pricing the asset or liability, including assumptions about risk. Inputs may be observable or unobservable. Observable inputs are inputs that reflect the assumptions market participants would use in pricing the asset or liability based on market data obtained from sources independent of the reporting entity. Unobservable inputs are inputs that reflect the reporting entity’s own assumptions about the assumptions market participants would use in pricing the asset or liability based on the best information available. A three-tier hierarchy categorizes the inputs as follows:
Level 1 – Quoted prices (unadjusted) in active markets for identical assets or liabilities that the Organization can access at the measurement date.
12
Touchstone Mental Health Notes to Financial Statements
December 31, 2012
Level 2 – Inputs other than quoted prices included within Level 1 that are observable for the asset or liability, either directly or indirectly. These include quoted prices for similar assets or liabilities in active markets, quoted prices for identical or similar assets or liabilities in markets that are not active, inputs other than quoted prices that are observable for the asset or liability, and market-corroborated inputs.
Level 3 – Unobservable inputs for the asset or liability. In these situations, the Organization develops inputs using the best information available in the circumstances.
In some cases, the inputs used to measure the fair value of an asset or a liability might be categorized within different levels of the fair value hierarchy. In those cases, the fair value measurement is categorized in its entirety in the same level of the fair value hierarchy as the lowest level input that is significant to the entire measurement. Assessing the significance of a particular input to entire measurement requires judgment, taking into account factors specific to the asset or liability. The categorization of an asset within the hierarchy is based upon the pricing transparency of the asset and does not necessarily correspond to the Organization’s assessment of the quality, risk or liquidity profile of the asset or liability. All of the Organization’s investment assets are classified within Level 1 because they are comprised of mutual funds. The mutual funds have readily determinable market values based on quoted market prices in an active market. The following table presents assets measured at fair value on a recurring basis at December 31, 2012:
Quoted Prices in Active Significant
Markets for Other Significant Identical Observable UnobservableAssets Inputs Inputs
(Level 1) (Level 2) (Level 3) Total
Mutual fundsShort government 9,843$ -$ -$ 9,843$ Multisector bond 11,170 - - 11,170 World bond 18,215 - - 18,215 International diversified 22,618 - - 22,618
61,846$ -$ -$ 61,846$
Fair Value Measurements at Report Date Using
Fair Value of Financial Instruments Not Required To Be Reported at Fair Value The carrying amounts of cash and cash equivalents, accounts receivable, accounts payable, and accrued expenses approximate fair value due to the short-term nature of the items. The carrying amount of promises to give due in more than one year is based on the discounted net present value of the expected future cash receipts, and approximates fair value. The fair value of the note payable is based on the stated interest rate with the Organization at the measurement date, and approximate its carrying amount.
13
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Note 4 - Promises to Give Unconditional promises to give are estimated to be collected as follows at December 31, 2012:
Within one year 115,402$ In one to five years 91,484
206,886 Less discount to net present value (using a 5% discount rate) (5,586)
201,300$
At December 31, 2012, three donors accounted for 83% of total promises to give. Note 5 - Property and Equipment Property and equipment consists of the following at December 31, 2012:
Construction in progress consists primarily of design costs, technology and preliminary landscaping costs related to a building project which is expected to be completed by July 1, 2013. Estimated remaining costs to complete the project are approximately $300,000, which will be financed with Organization funds. Note 6 - Line of Credit The Organization has a $100,000 revolving line of credit with a bank, secured by the assets of the Organization. Borrowings under the line bear interest at the bank’s prime rate plus 0.75% (4.5% at December 31, 2012). Accrued interest and principal are due at maturity (August 29, 2013). There were no outstanding advances on this line of credit at December 31, 2012.
14
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Note 7 - Note Payable The note payable consists of the following at December 31, 2012:
4% note payable to bank, due in monthly installmentsof $2,125, including interest, to September2015. This note is secured by equipment. 66,271$
Less current maturities (23,249)
Note payable, net of current maturities 43,022$ Future maturities of the note payable are as follows:
23,249$ 24,210 18,812
66,271$
201320142015
Years Ending December 31,
Note 8 - Lease Commitments The Organization leases office facilities, equipment, and a vehicle under operating leases expiring at various dates through June 2015. Future minimum lease payments on the above leases as of December 31, 2012 are as follows:
Total lease expense under all operating leases was approximately $334,000 for the year ended December 31, 2012. Note 9 - Endowment Touchstone Mental Health’s endowment (the Endowment) consists of one individual fund established by a donor to provide annual funding for specific activities and general operations. Net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions.
15
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Touchstone Mental Health’s Board of Directors has interpreted the Minnesota Uniform Prudent Management of Institutional Funds Act (UPMIFA) as requiring the preservation of the fair value of the original gift as of the gift date of the donor-restricted endowment funds, unless there are explicit donor stipulations to the contrary. At December 31, 2012 there were no such donor stipulations. As a result of this interpretation, Touchstone Mental Health would typically classify as permanently restricted net assets (a) the original value of gifts donated to the Endowment, (b) the original value of subsequent gifts donated to the Endowment (including promises to give net of discount and allowance for doubtful accounts, and (c) accumulations to the endowment made in accordance with the direction of the applicable donor gift instrument at the time the accumulation is added. The remaining portion of the donor-restricted endowment would then be classified as temporarily restricted net assets until those amounts are appropriated for expenditure by Touchstone Mental Health in a manner consistent with the standard of prudence prescribed by UPMIFA. Touchstone Mental Health considers the following factors in making a determination to appropriate or accumulate donor-restricted endowment funds:
The duration and preservation of the fund The purposes of the organization and the donor-restricted endowment fund General economic conditions The possible effect of inflation and deflation The expected total return from income and the appreciation of investments Other resources of the organization The investment policies of the organization
The individual donor that initiated the Endowment fund for Touchstone Mental Health stipulated that the income derived from the fund is to be used for future program development. However, the Touchstone Mental Health Board of Directors has the authority to release the principal under emergency conditions therefore, the Endowment fund has been classified as temporarily restricted. As of December 31, 2012, Touchstone Mental Health had the following endowment net asset composition by type of fund:
Temporarily Permanently Unrestricted Restricted Restricted Total
Donor-restricted -$ 68,805$ -$ 68,805$
Investment and Spending Policies The Organization has adopted investment and spending policies for investment assets to support the mission by providing earnings and capital appreciation to support agency programs, capital expenditures, and Board-directed initiatives through a strategic plan that strives to maintain and grow the investment corpus and provide annual operating earnings to support Touchstone Mental Health's mission. Endowment assets include those assets of donor-restricted funds that the Organization intends to hold in perpetuity. Under this policy, as approved by the Board of Directors, the endowment assets are invested in a manner that is intended to produce results that preserve the inflation-adjusted value of the fund, maximize total return within acceptable risk parameters and a goal of at least 500 basis points annually above inflation, exceed the performance of appropriately established benchmarks of various indices, and rank in the top quartile of performance of similarly managed funds while assuming a moderate level of investment risk.
16
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 To satisfy its long-term rate of return objectives, Touchstone Mental Health relies on a total return strategy in which investment returns are achieved through both capital appreciation (realized and unrealized) and current yield (interest and dividends). The Organization targets a diversified asset allocation that places a greater emphasis on equity-based investments to achieve its long-term return objectives within prudent risk constraints. Changes in Endowment net assets for the year ended December 31, 2012 are as follows:
Temporarily Permanently Unrestricted Restricted Restricted Total
Endowment net assets, -$ 61,754$ 61,754$
Investment return:Interest and dividends - 1,677 - 1,677 Realized and unrealized gains - 5,374 - 5,374
Endowment net assets, -$ 68,805$ -$ 68,805$ December 31, 2012
December 31, 2011
Note 10 - Temporarily Restricted Net Assets Temporarily restricted net assets at December 31, 2012 consist of:
Ceil Raleigh fund 68,805$ Capital Campaign 164,886
233,691$ Net assets were released from restrictions as follows during the year ended December 31, 2012:
Capital Campaign 337,755$ Note 11 - Retirement Plan The Organization sponsors a salary reduction plan under Internal Revenue Code Section 401(k) covering all employees meeting minimum eligibility requirements. Eligible employees can elect to participate by contributing pre-tax dollars withheld from payroll checks to the plan. The Organization makes matching contributions up to 3% of the salary of eligible employees. Total employer contributions were $42,359 for the year ended December 31, 2012.
17
Touchstone Mental Health Notes to Financial Statements
December 31, 2012 Note 12 - Net Program Service Fee Revenue The net program service fee revenue for the year ended December 31, 2012 consisted of the following:
Medical assistance 2,010,807$ Managed Care 1,247,740 Hennepin County 965,928
Other third-party payors and clients 156,331Medicare 12,899
4,393,705$
Note 13 - Concentration of Credit Risk The Organization grants credit without collateral to its clients, most of whose care is insured under third-party payor agreements. The mix of receivables from third-party payors and clients at December 31, 2012 was as follows:
Medicaid 37%Managed Care 30%Hennepin County 14%
Other third-party payors and clients 19%
100%
Note 14 - Subsequent Events Subsequent to year end, the Organization entered into a twenty year operating lease commitment. This lease is for the building space that the Organization will occupy upon completion of construction, which is anticipated in July 2013. Under this lease agreement, the Organization will pay rent expense in monthly installments of $10,560, plus an annual fee of $7,504. This annual fee is subject to a 3% increase in each subsequent year of the lease. The Organization has evaluated subsequent events through March 15, 2013, the date the financial statements were available to be issued.