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PARK PLACE MEDICAL & BEHAVIORAL HEALTH CARE INC: Form 990EZ, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
PARK PLACE MEDICAL & BEHAVIORAL HEALTH CARE INC (EIN 83-3269602)
Tax period
2020-07-01 to 2021-06-30
Filed
2022-03-18
IRS object ID
202200779349200125
Schema version
2020v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-03-18T13:39:17-05:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN261472386PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1SCHAFER TSCHOPP WHITCOMB ET ALBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1541 S ORLANDO AVENUE SUITE 312AddressLine1Txt
CityMAITLANDCityNm
State AbbreviationFLStateAbbreviationCd
ZIP32751ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN833269602EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PARK PLACE MEDICAL & BEHAVIORAL HEALTHBusinessNameLine1Txt
Business Name Line2CARE INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlPARKBusinessNameControlTxt
Phone4078752760PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1206 PARK PLACE BLVDAddressLine1Txt
CityKISSIMMEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP34741ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKELLY VELASCOPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone4078752760PhoneNum
Signature2022-03-18SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKELLYPersonFirstNm
Person LastVELASCOPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTHOMAS V WHITCOMBPreparerPersonNm
PTINP00836897PTIN
Phone4078752760PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Website AddressWWW.PPBH.ORGWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Gross Receipts$0GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Contributions Gifts Grants Etc$0ContributionsGiftsGrantsEtcAmt
Program Service Revenue$0ProgramServiceRevenueAmt
Total Revenue$0TotalRevenueAmt
Fees And Other Pymt To Ind Cntrct$750FeesAndOtherPymtToIndCntrctAmt
Other Expenses Total$1,163OtherExpensesTotalAmt
Total Expenses$1,913TotalExpensesAmt
Excess Or Deficit For Year-$1,913ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY-$13,000NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY-$14,913NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIYes (X)InfoInScheduleOPartIIInd

Other Assets Total Detail OtherAssetsTotalDetail

FieldValueIRS element (for citing)
BOY$1,949BOYAmt
EOY$1,451EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,949BOYAmt
EOY$1,451EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,949BOYAmt
EOY$16,364EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY-$13,000BOYAmt
EOY-$14,913EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
Primary Exempt PurposeTHE ORGANIZATION IS A NONPROFIT CORPORATION ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES, SPECIFICALLY TO PROVIDE INTEGREATED PRIMARY HELATH CARE AND SPECIALTY BEHAVIORAL HEALTH CARE SERVICES FOR ALL WHO SEEK SERVICES INLCUDING MEDICAL UNDERSERVED AND UNINSURED INDIVIDUALS SEEKING SUCH SERVICES. THE ORGANIZATION WILL SERVE COMMERICAL INSURANCE, MEDICARE AND MEDICAID RECIPIENTS AS WELL AS THOSE SELF PAY, UNDERSERVED AND UNINSURED INDIVIDUALS WITHIN THE COMMUNITY.PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp (2 entries)

Description Program Srvc AccomDescriptionProgramSrvcAccomTxtGrants And AllocationsGrantsAndAllocationsAmtProgram Service ExpensesProgramServiceExpensesAmt
THE PROVISION OF OUTPATIENT THERAPY, OUTPATIENT MEDICATION MANAGEMENT/PSYCHIATRIC, PEER RECOVERY SUPPORT$0$0
THE PROVISION OF CASE MANAGEMENT PRIMARY CARE SERVICES PROVIDED IN A FAMILY PRACTICE MODEL$0$0
FieldValueIRS element (for citing)
Total Program Service Expenses$0TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (6 entries)

TitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
RICHARD BARLOW
PRESIDENT OF THE BOARD/DIR5.00$0$0$0
KELLY VELASCO
CHIEF FINANCIAL OFFICER5.00$0$0$0
NATALIE MULLETT
SECRETARY/DIRECTOR3.00$0$0$0
JARED DORN
TREASURER1.00$0$0$0
STEVEN SPEISER MD
MEDICAL DIRECTOR10.00$0$0$0
JAMES A SHANKS
CHIEF EXECUTIVE OFFICER7.00$0$0$0
FieldValueIRS element (for citing)
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt0ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI0OrganizationHadUBIInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Direct Indirect Pltcl Expend$0DirectIndirectPltclExpendAmt
Made Loans To From Officers0MadeLoansToFromOfficersInd
Tax Imposed Under IRC4911$0TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912$0TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955$0TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr$0TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization$0TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KELLY VELASCOBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1206 PARK PLACE BLVDAddressLine1Txt
CityKISSIMMEECityNm
State AbbreviationFLStateAbbreviationCd
ZIP34741ZIPCd
FieldValueIRS element (for citing)
Phone4078752760PhoneNum
FieldValueIRS element (for citing)
Foreign Financial Account0ForeignFinancialAccountInd
Foreign Office0ForeignOfficeInd
Donor Advised Fnds0DonorAdvisedFndsInd
Operate Hospital0OperateHospitalInd
Tanning Services Provided0TanningServicesProvidedInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
School Operating0SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof SrvcNONEPartVIHghstPdCntrctProfSrvcTxt
Filed Schedule AYes (1)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year$0CurrentTaxYearAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$0PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year$0CurrentTaxYearAmt
FieldValueIRS element (for citing)
Total Support$0TotalSupportAmt
First5 Years170Yes (X)First5Years170Ind

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSESDESCRIPTION: DEPRECIATION. AMOUNT: 498. DESCRIPTION: PURCHASED SERVICES. AMOUNT: 665. TOTAL TO FORM 990-EZ, LINE 16: 1,163.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETSDESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 1,949. END OF YEAR AMOUNT: 1,451.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIESDESCRIPTION: ACCOUNTS PAYABLE - OSCEOLA MENTAL HEALTH. BEG. OF YEAR AMOUNT: 14,949. END OF YEAR AMOUNT: 16,364.

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

FieldValueIRS element (for citing)
DeclarationTHE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.DeclarationDesc

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