MEMORIAL HEALTH SYSTEM: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL HEALTH SYSTEM (EIN 37-0646367)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-13
- IRS object ID
- 202121339349300847
- Schema version
- 2019v5.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-05-13T08:32:41-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 346565596 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 155 N WACKER DRIVE | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 370646367 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MENTAL HEALTH CENTERS | BusinessNameLine1Txt |
| Business Name Line2 | OF CENTRAL ILLINOIS | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MENT | BusinessNameControlTxt |
| Phone | 2177883922 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 NORTH FIRST STREET | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62781 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DIANA KNAEBE | PersonNm |
| Person Title | SYSTEM ADMIN BEHAVIORAL HEALTH | PersonTitleTxt |
| Phone | 2175887704 | PhoneNum |
| Signature | 2021-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JESSICA A WAGENER | PreparerPersonNm |
| PTIN | P01622613 | PTIN |
| Phone | 3128792000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL BEHAVIORAL HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DIANA KNAEBE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 NORTH FIRST STREET | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62781 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,296,111 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 5670 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MEMORIALBEHAVIORALHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1962 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 360 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,312,794 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,135,125 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,686,328 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,024,721 | CYProgramServiceRevenueAmt |
| PY Investment Income | $362,556 | PYInvestmentIncomeAmt |
| CY Investment Income | $210,344 | CYInvestmentIncomeAmt |
| PY Other Revenue | $261,294 | PYOtherRevenueAmt |
| CY Other Revenue | $368,976 | CYOtherRevenueAmt |
| PY Total Revenue | $13,622,972 | PYTotalRevenueAmt |
| CY Total Revenue | $13,739,166 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $23,053 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $19,440 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,971,054 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,581,741 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,515,798 | PYOtherExpensesAmt |
| CY Other Expenses | $2,455,250 | CYOtherExpensesAmt |
| PY Total Expenses | $13,509,905 | PYTotalExpensesAmt |
| CY Total Expenses | $13,056,431 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $113,067 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $682,735 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,990,586 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,762,092 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,864,114 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,607,196 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,126,472 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $18,154,896 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO IMPROVE THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,705,494 | ExpenseAmt |
| Revenue | $2,374,903 | RevenueAmt |
| Desc | LINCOLN CENTER FOR DEVELOPMENTAL REHABILITATION (LCDR) PROVIDES DEVELOPMENTAL TRAINING SERVICES FOR DEVELOPMENTALLY DISABLED ADULTS. THE SERVICES ARE DESIGNED TO ENHANCE THE INDIVIDUAL'S SKILLS IN ACTIVITIES OF DAILY LIVING, TO LEAD THE INDIVIDUAL TO INDEPENDENCE AND ECONOMIC SELF-SUFFICIENCY THROUGH INSTRUCTION AND TRAINING. THE INDIVIDUAL IS PREPARED FOR LESS RESTRICTIVE INSTRUCTIONAL AND WORK SETTINGS. DEVELOPMENTAL TRAINING PROVIDES A THREE-FOLD APPROACH TO MEETING THE NEEDS OF THE DEVELOPMENTALLY DISABLED ADULT. THESE OBJECTIVES ARE (1) THERAPEUTIC DEVELOPMENTAL, (2) HUMAN INTERACTION DEVELOPMENT, AND (3) VOCATIONAL SKILLS. SERVICE UNITS ARE MEASURED BY CLIENT HOURS. LCDR OPERATED 167 DAYS AND PROVIDED 142,852 CLIENT HOURS OF SERVICE IN FISCAL YEAR 2020. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,376,567 | ExpenseAmt |
| Revenue | $1,442,073 | RevenueAmt |
| Desc | THE CRISIS/ACCESS PROGRAM PROVIDES RAPID RESPONSE TO INDIVIDUALS IN MENTAL HEALTH CRISIS, TO MEMBERS OF HIS/HER SUPPORT SYSTEM, AND THE COMMUNITY 24-HOURS/DAY. THE PROGRAM PROVIDES CRISIS INTERVENTION SERVICES, WALK-INS, & MOBILE SERVICES. SHORT-TERM CRISIS INTERVENTION OF THERAPY/COUNSELING AND PSYCHIATRIC CARE IS DESIGNED TO ADDRESS THE PRESENTING SYMPTOMS OF A PSYCHIATRIC EMERGENCY & TO AMELIORATE A CLIENT'S DISTRESS SO THAT RESOURCES & SUPPORTS CAN BE MOBILIZED & PLANNING FOR FURTHER TREATMENT CAN OCCUR. CRISIS WALK-IN IS SUPPORT & INTERVENTION OFFERED AT AN IDENTIFIED LOCATION ON AN UNSCHEDULED BASIS FOR THE PURPOSE OF STABILIZING OR RESOLVING A CRISIS SITUATION. MOBILE CRISIS SERVICE IS DELIVERED WHERE & WHEN THE CRISIS OCCURS TO ASSURE SERVICE BY MENTAL HEALTH PROFESSIONALS. MBH PROVIDED 5,388 CLIENT HOURS IN FISCAL YEAR 2020. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,107,667 | ExpenseAmt |
| Revenue | $1,403,773 | RevenueAmt |
| Desc | MBH-CHILD BEHAVIORAL THERAPY (MBH-CBT) IS THE OUTPATIENT BEHAVIORAL HEALTH PROVIDER OF CHOICE FOR PEDIATRIC MEDICAID RECIPIENTS FOR SANGAMON AND MENARD COUNTIES. MBH-CBT THERAPISTS PROVIDE OFFICE-BASED SERVICES AND ARE COMMITTED TO THE DEVELOPMENT OF COORDINATED NETWORKS OF COMPREHENSIVE SERVICES, WHICH PROVIDES CARE IN THE LEAST RESTRICTIVE, MOST NORMATIVE ENVIRONMENT CLINICALLY APPROPRIATE. THERAPISTS ALSO PROVIDE AFTER-HOURS AND WEEKEND ON-CALL COVERAGE FOR THE SASS (SCREENING, ASSESSMENT, AND SUPPORT SERVICES) PROGRAM TO MEET THE CONTRACTUAL REQUIREMENTS SET BY THE STATE OF ILLINOIS FOR CRISIS INTERVENTION. MBH PROVIDED 12,868 CLIENT HOURS IN FISCAL YEAR 2020. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (3 entries)
| ExpenseExpenseAmt | GrantGrantAmt | RevenueRevenueAmt | DescDesc |
|---|---|---|---|
| $477,071 | $604 | $634,273 | OTHER DEVELOPMENTAL DISABILITY PROGRAMS |
| $5,680,057 | $18,836 | $4,321,031 | OTHER MENTAL HEALTH PROGRAMS |
| $19,328 | $13,937 | HOUSING SERVICES |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $6,176,456 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $19,440 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $4,969,241 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $10,366,184 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 360 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Form1098 C Filed | Yes (1) | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAURA RAPAPORT DIRECTOR AMBULATORY ACCOUNTING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2175887759 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 NORTH FIRST STREET | AddressLine1Txt |
| City | SPRINGFIELD | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 62781 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| SANDY ROBINSON II | |||||||||
| DIRECTOR (THRU FEB 20) | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| DR VIRGINIA DOLAN | |||||||||
| DIRECTOR & MPS PHYSICIAN | 0.70 | Yes (X) | $0 | $515,542 | $87,907 | 49.30 | |||
| VEA CRAWFORD | |||||||||
| DIRECTOR (FROM MAR 20) | 0.20 | Yes (X) | $0 | $0 | $0 | ||||
| ANNE MORGAN PHD | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| ERICA SMITH | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| SCOTT SABIN | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| JANET S STOVER | |||||||||
| DIRECTOR (THRU FEB 20) | 0.50 | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL WRIGHT | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| SAIF MOUILISH | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| DR NICOLE FLORENCE | |||||||||
| DIRECTOR & MPS PHYSICIAN | 0.70 | Yes (X) | $0 | $502,781 | $105,538 | 49.30 | |||
| IRIS WESLEY | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| KENNETH WINSLOW | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| DR KARI WOLF | |||||||||
| DIRECTOR | 0.70 | Yes (X) | $0 | $0 | $0 | ||||
| LEIGH STEINER PHD | |||||||||
| CHAIR | 0.35 | Yes (X) | $0 | $0 | $375 | 0.35 | Yes (X) | ||
| BRENT BORAH | |||||||||
| VICE CHAIR | 0.35 | Yes (X) | $0 | $0 | $0 | 0.35 | Yes (X) | ||
| WANDA LEE ROHLFS | |||||||||
| TREASURER | 0.35 | Yes (X) | $0 | $0 | $0 | 0.35 | Yes (X) | ||
| TIFFANY NIELSON PHD | |||||||||
| SECRETARY | 0.35 | Yes (X) | $0 | $0 | $0 | 0.35 | Yes (X) | ||
| JANICE GAMBACH | |||||||||
| PRESIDENT (THRU DEC 19) | 47.50 | $0 | $222,235 | $27,438 | 2.50 | Yes (X) | |||
| DIANA KNAEBE | |||||||||
| SYSTEM ADMINISTRATOR (FROM MAR 20) | 47.50 | $0 | $0 | $0 | 2.50 | Yes (X) | |||
| KATIE KEIM | |||||||||
| CHIEF FINANCIAL OFFICER | 5.00 | $0 | $616,905 | $106,609 | 45.00 | Yes (X) | |||
| JAMESON ROSZHART | |||||||||
| PRESIDENT MHS AMBULATORY GROUP | 5.00 | $0 | $460,078 | $90,502 | 45.00 | Yes (X) | |||
| CYNTHIA A BUTLER | |||||||||
| ADMINISTRATOR CLINICAL SERVICES | 50.00 | $138,925 | $0 | $25,866 | Yes (X) | ||||
| CYNTHIA MESTER | |||||||||
| SYSTEM DIRECTOR | 50.00 | $118,787 | $0 | $26,639 | Yes (X) | ||||
| ROBYN LUKE | |||||||||
| ADMINISTRATOR ADMINISTRATIVE SERVICES | 50.00 | $116,079 | $0 | $13,977 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $373,791 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,317,541 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $484,851 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $15,569 | FederatedCampaignsAmt |
| Related Organizations | $319,055 | RelatedOrganizationsAmt |
| Government Grants | $2,632,105 | GovernmentGrantsAmt |
| All Other Contributions | $168,396 | AllOtherContributionsAmt |
| Noncash Contributions | $92,655 | NoncashContributionsAmt |
| Total Contributions | $3,135,125 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MENTAL HEALTH SERVICES | 621400 | $7,303,370 | $7,303,370 |
| DD SERVICES | 621400 | $2,707,414 | $2,707,414 |
| HOUSING SERVICES | 621400 | $13,937 | $13,937 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,024,721 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $135,931 | TotalRevenueColumnAmt |
| Exclusion | $135,931 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $206,852 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $8,522 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $198,330 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $198,330 | TotalRevenueColumnAmt |
| Exclusion | $198,330 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $562,053 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $487,640 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $74,413 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,413 | TotalRevenueColumnAmt |
| Exclusion | $74,413 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $205,894 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $60,783 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $145,111 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $145,111 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| TRAINING REIMBURSEMENT | 900099 | $9,385 | $9,385 | |
| RECORD FEES | 900099 | $5,784 | $5,784 | |
| PROMPT PAY INTEREST PE | 900099 | $5,377 | $5,377 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,989 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,989 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $25,535 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,739,166 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,189,990 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $414,051 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,440 | TotalAmt |
| Program Services | $19,440 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,097 | TotalAmt |
| Program Services | $100,984 | ProgramServicesAmt |
| Management And General | $144,113 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,787,613 | TotalAmt |
| Program Services | $6,621,729 | ProgramServicesAmt |
| Management And General | $1,165,884 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,898 | TotalAmt |
| Program Services | $324,172 | ProgramServicesAmt |
| Management And General | $49,726 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,555,184 | TotalAmt |
| Program Services | $1,290,801 | ProgramServicesAmt |
| Management And General | $264,383 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $619,949 | TotalAmt |
| Program Services | $542,404 | ProgramServicesAmt |
| Management And General | $77,545 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,109 | TotalAmt |
| Program Services | $4,109 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,571 | TotalAmt |
| Program Services | $10,019 | ProgramServicesAmt |
| Management And General | $28,552 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,415 | TotalAmt |
| Management And General | $1,415 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,423 | TotalAmt |
| Program Services | $83,111 | ProgramServicesAmt |
| Management And General | $2,312 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $348 | TotalAmt |
| Program Services | $348 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,357 | TotalAmt |
| Program Services | $210,456 | ProgramServicesAmt |
| Management And General | $59,901 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,097 | TotalAmt |
| Program Services | $81,957 | ProgramServicesAmt |
| Management And General | $22,140 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $429,953 | TotalAmt |
| Program Services | $363,180 | ProgramServicesAmt |
| Management And General | $66,773 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $171,731 | TotalAmt |
| Program Services | $155,331 | ProgramServicesAmt |
| Management And General | $16,400 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,198 | TotalAmt |
| Program Services | $365 | ProgramServicesAmt |
| Management And General | $10,833 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $338,885 | TotalAmt |
| Program Services | $308,962 | ProgramServicesAmt |
| Management And General | $29,923 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,098 | TotalAmt |
| Program Services | $88,098 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| MANAGEMENT FEES | $724,005 | $724,005 | |
| PROVISION FOR UNCOLLECT | $82,636 | $82,636 | |
| FOOD & DIETARY SUPPLIES | $65,758 | $4,630 | $61,128 |
| MEMBERSHIP DUES | $25,147 | $21,712 | $3,435 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,519 | TotalAmt |
| Program Services | $13,519 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,056,431 | TotalAmt |
| Program Services | $10,366,184 | ProgramServicesAmt |
| Management And General | $2,690,247 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $415 | BOYAmt |
| EOY | $415 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,720,069 | BOYAmt |
| EOY | $1,230,000 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,320,401 | BOYAmt |
| EOY | $1,990,490 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,615 | BOYAmt |
| EOY | $144,541 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,166,582 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,197,675 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,990,316 | BOYAmt |
| EOY | $2,968,907 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,737,458 | BOYAmt |
| EOY | $13,320,133 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,312 | BOYAmt |
| EOY | $40,000 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $67,606 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,990,586 | BOYAmt |
| EOY | $19,762,092 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,791,683 | BOYAmt |
| EOY | $1,421,093 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,431 | BOYAmt |
| EOY | $165,667 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $20,436 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,864,114 | BOYAmt |
| EOY | $1,607,196 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,126,472 | BOYAmt |
| EOY | $18,154,896 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,126,472 | BOYAmt |
| EOY | $18,154,896 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,990,586 | BOYAmt |
| EOY | $19,762,092 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $682,735 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $345,689 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,630,471 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,593,354 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,334,466 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,312,794 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,135,125 | CurrentTaxYearAmt |
| Total | $17,006,210 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,630,471 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,593,354 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,334,466 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,312,794 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,135,125 | CurrentTaxYearAmt |
| Total | $17,006,210 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $2,075,459 | SubstantialContributorsTotAmt |
| Public Support Total170 | $14,930,751 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $257,036 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $257,485 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $238,855 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $255,255 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $342,783 | CurrentTaxYearAmt |
| Total | $1,351,414 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $33,744 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $245,155 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $136,824 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $70,557 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $25,535 | CurrentTaxYearAmt |
| Total | $511,815 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $18,869,439 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $50,874,131 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.79130 | PublicSupportCY170Pct |
| Public Support PY170 | 0.81410 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | REIMBURSEMENT FROM SUBSIDIARY - 2016 AMOUNT: $ 182,273. MENTAL HEALTH TRAINING - REGISTRATION FEES - 2015 AMOUNT: $ 7,770. 2016 AMOUNT: $ 11,952. 2017 AMOUNT: $ 47,483. 2018 AMOUNT: $ 13,323. 2019 AMOUNT: $ 9,385. RECORD COPY FEES - 2015 AMOUNT: $ 12,002. 2016 AMOUNT: $ 11,576. 2017 AMOUNT: $ 8,220. 2018 AMOUNT: $ 18,525. 2019 AMOUNT: $ 5,784. OTHER REVENUE - 2015 AMOUNT: $ 3,772. 2016 AMOUNT: $ 3,504. 2017 AMOUNT: $ 17,585. 2018 AMOUNT: $ 35,371. 2019 AMOUNT: $ 26,301. PROMPT PAY INTEREST - 2015 AMOUNT: $ 6,657. 2016 AMOUNT: $ 25,232. 2017 AMOUNT: $ 12,067. 2018 AMOUNT: $ 12,835. 2019 AMOUNT: $ 5,377. PARTNERSHIP INCOME - 2015 AMOUNT: $ -11,645. 2016 AMOUNT: $ -17,500. 2017 AMOUNT: $ 18,935. 2018 AMOUNT: $ -9,497. 2019 AMOUNT: $ -21,312. NON-RECORD FEES - 2015 AMOUNT: $ 8,578. 2016 AMOUNT: $ 12,577. 2017 AMOUNT: $ 13,297. TRAINING CONFERENCES - 2015 AMOUNT: $ 6,610. 2016 AMOUNT: $ 15,541. 2017 AMOUNT: $ 19,237. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $1,415 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $1,415 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | MBH IS A DUES PAYING MEMBER OF THE ILLINOIS ASSOCIATION OF REHABILITATION FACILITIES, INC. (IARF). A PERCENTAGE OF MBH'S DUES TO IARF GO TOWARDS LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $996,667 | OtherCostOrOtherBasisAmt |
| Book Value | $996,667 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,368,452 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,920,407 | DepreciationAmt |
| Book Value | $1,448,045 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,753 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,700 | DepreciationAmt |
| Book Value | $8,053 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,290,655 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,985,815 | DepreciationAmt |
| Book Value | $304,840 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $499,055 | OtherCostOrOtherBasisAmt |
| Depreciation | $287,753 | DepreciationAmt |
| Book Value | $211,302 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,968,907 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RENTAL PROPERTY - NON-CURRENT | Desc |
| Amt | $20,436 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $20,436 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | MBH IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE UNITED STATE INTERNAL REVENUE CODE. MBH IS NOT CONSIDERED A PRIVATE FOUNDATION. IN ACCORDANCE WITH FASB ACS 740-10 WHICH ADDRESSES INCOME TAXES, MBH BELIEVES THERE ARE NO SIGNIFICANT UNCERTAIN TAX POSITIONS RESULTING IN LIABILITIES THAT WOULD HAVE BEEN REQUIRED FOR THE YEAR ENDED JUNE 30, 2020. MBH'S FORM 990 FOR 2017, 2018, AND 2019 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS), GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| EDUCATIONAL GRANTS | 1 | $3,500 |
| TUITION REIMBURSEMENT | 2 | $15,286 |
| SPECIFIC ASSISTANCE | 1 | $654 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | EDUCATIONAL GRANTS - MEMORIAL BEHAVIORAL HEALTH'S EDUCATIONAL GRANT PROGRAM PROVIDES THE OPPORTUNITY FOR EMPLOYEES TO PURSUE ADDITIONAL EDUCATION IN EXCHANGE FOR A WORK COMMITMENT ONCE THE EDUCATION IS COMPLETED. EDUCATIONAL GRANTS ARE AVAILABLE TO THOSE PURSUING HEALTH CARE CAREERS THAT ARE DEEMED CRITICAL TO THE ORGANIZATION'S PRESENT OR PROJECTED STAFFING NEEDS. GRANT APPLICATIONS FOR ALL OTHER CAREERS WILL BE REVIEWED ON A CASE-BY-CASE BASIS WITH A FINAL DETERMINATION TO BE MADE BY THE MHS WORKFORCE STRATEGIES ADVISORY COUNCIL. TUITION REIMBURSEMENT - FUNDING FOR THE EDUCATION OF MBH'S EMPLOYEES IS BASED UPON THE NEEDS OF THE ORGANIZATION AS WELL AS THE EMPLOYEE'S EDUCATIONAL GOALS. EMPLOYEES WILL BE AWARDED TUITION REIMBURSEMENT BASED ON THE EMPLOYEE'S PRESENT JOB SKILL NEEDS OR TO PREPARE THE EMPLOYEE FOR FUTURE ADVANCEMENT WITHIN MEMORIAL HEALTH SYSTEM. THE TUITION REIMBURSEMENT PROCESS REQUIRES EMPLOYEES TO RECEIVE PRIOR APPROVAL FROM THEIR MANAGERS FOR THE COURSEWORK. SPECIFIC ASSISTANCE - MBH PROVIDES ASSISTANCE TO CLIENTS CURRENTLY RECEIVING SERVICES IN ONE OF THE FOLLOWING PROGRAMS: SUPPORTED EMPLOYMENT, PROJECTS IN ASSISTANCE FOR TRANSITION FROM HOMELESSNESS (PATH), COMMUNITY INTEGRATED LIVING ARRANGEMENTS (CILA). THIS INCLUDES BUT IS NOT LIMITED TO, MEDICATIONS, CLOTHING, DOCTOR VISITS, AND DENTAL VISITS. TO BE ELIGIBLE FOR THE ASSISTANCE, THE CLIENT MUST HAVE BEEN DIAGNOSED WITH A MENTAL ILLNESS OR A DEVELOPMENTAL DISABILITY, AND CURRENTLY BE RECEIVING SERVICES AT MBH. THE CLIENT IS ASSIGNED A CASE MANAGER WHO IS RESPONSIBLE FOR DETERMINATION OF THE TYPE OF ASSISTANCE NEEDED. BEFORE THE ASSISTANCE IS PROVIDED, THE SUPERVISOR OF THE CASE MANAGER MUST PRE-APPROVE THE ASSISTANCE TO BE PURCHASED. THE CASE MANAGER INITIATES THE PURCHASE. THE CHECK IS MADE PAYABLE DIRECTLY TO THE VENDOR AND/OR LANDLORD. THE CLIENT IS REQUIRED TO SIGN THE VENDOR RECEIPT TO ACKNOWLEDGE THAT HE OR SHE RECEIVED THE GOODS, SERVICES, OR RENTAL ASSISTANCE. CLIENTS DO NOT DIRECTLY RECEIVE CASH. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR VIRGINIA DOLAN | ||||||||||||||
| DIRECTOR & MPS PHYSICIAN | $0 | $416,723 | $0 | $13,745 | $0 | $85,074 | $0 | $27,312 | $0 | $60,595 | $0 | $603,449 | $0 | $28,245 |
| DR NICOLE FLORENCE | ||||||||||||||
| DIRECTOR & MPS PHYSICIAN | $0 | $348,474 | $0 | $32,666 | $0 | $121,641 | $0 | $24,900 | $0 | $80,638 | $0 | $608,319 | $0 | $0 |
| JANICE GAMBACH | ||||||||||||||
| PRESIDENT (THRU DEC 19) | $0 | $190,741 | $0 | $24,927 | $0 | $6,567 | $0 | $16,364 | $0 | $11,074 | $0 | $249,673 | $0 | $0 |
| KATIE KEIM | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $443,391 | $0 | $162,807 | $0 | $10,707 | $0 | $74,674 | $0 | $31,935 | $0 | $723,514 | $0 | $0 |
| JAMESON ROSZHART | ||||||||||||||
| PRESIDENT MHS AMBULATORY GROUP | $0 | $320,570 | $0 | $129,155 | $0 | $10,353 | $0 | $60,107 | $0 | $30,395 | $0 | $550,580 | $0 | $0 |
| CYNTHIA A BUTLER | ||||||||||||||
| ADMINISTRATOR CLINICAL SERVICES | $122,203 | $0 | $16,191 | $0 | $531 | $0 | $13,414 | $0 | $12,452 | $0 | $164,791 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY OR STUDY; AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| PART I, LINE 4B | MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, PROVIDES CERTAIN SUPPLEMENTAL RETIREMENT BENEFITS TO THE FOLLOWING OFFICER AND KEY EMPLOYEES: KATIE KEIM, $52,631, AND JAMESON ROSZHART, $37,957. THESE BENEFITS ARE PROVIDED THROUGH A NONQUALIFIED DEFERRED COMPENSATION PLAN, UNDER WHICH THE BENEFITS BEING EARNED ARE SUBJECT TO A "SUBSTANTIAL RISK OF FORFEITURE". THE SUPPLEMENTAL RETIREMENT BENEFITS ARE STRUCTURED TO PROVIDE A RETENTION INCENTIVE THAT HAS BEEN DETERMINED BY THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM TO BE OF SUBSTANTIAL VALUE TO THE ORGANIZATION. THE FOLLOWING DIRECTOR AND KEY EMPLOYEES RECEIVED DEFERRED COMPENSATION PAYOUTS IN THE CALENDAR YEAR FROM A RELATED ORGANIZATION: DR. VIRGINIA DOLAN, $84,514, AND DR. NICOLE FLORENCE, $121,388. |
| PART I, LINE 7 | MEMBERS OF SENIOR MANAGEMENT OF MEMORIAL HEALTH SYSTEM, A RELATED ORGANIZATION OF MEMORIAL BEHAVIORAL HEALTH, RECEIVE COMPENSATION UNDER PLANS SPONSORED BY MEMORIAL HEALTH SYSTEM. THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II COLUMN (B) (II). THE PLANS ARE DESIGNED TO CONDITION A PORTION OF COMPENSATION ON PERFORMANCE AGAINST PREDETERMINED FINANCIAL, MISSION, AND INDIVIDUAL GOALS APPROVED IN ADVANCE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM. THE LEADERSHIP COMPENSATION COMMITTEE OF THE BOARD HAS REVIEWED THE REASONABLENESS OF ALL SUCH PAYMENTS, AND HAS CONCLUDED, AS THE RESULT OF A PROCESS THAT IS DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW, THAT ALL SUCH AMOUNTS ARE REASONABLE AND DID NOT EXCEED FAIR MARKET VALUE FOR THE SERVICES RENDERED. |
Schedule M IRS990ScheduleM
Cars And Other Vehicles CarsAndOtherVehiclesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $92,655 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | THE NUMBER OF ITEMS RECEIVED = 1 MULTI-PASSENGER VAN | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERSHIP OF THE CORPORATION CONSISTS OF ONE CORPORATE MEMBER, MEMORIAL HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE MEMBER OF THE CORPORATION ELECTS THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BYLAWS OF THE CORPORATION REQUIRE THE ADVANCE APPROVAL OF THE CORPORATE MEMBER FOR CORPORATE, ADMINISTRATIVE AND OPERATIONAL ACTIONS WHICH INCLUDE, BUT ARE NOT LIMITED TO, THE APPROVAL OF ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATING BUDGET, AMENDMENT, ALTERATION OR REPEAL OF THE ARTICLES OF INCORPORATION OR BYLAWS, CREATION OR ELIMINATION OF A PROGRAM OR SERVICE, APPROVAL OF BORROWING WHICH EXCEEDS $250,000, APPROVAL OF ANY QUANTITY OF DEBT WHICH EXCEEDS $250,000, APPROVAL OF ANY DISSOLUTION, MERGER OR CONSOLIDATION OR SALE OF THE ASSETS OF THE CORPORATION WHICH EXCEED $250,000, APPROVAL OF THE ORGANIZATION OF AN AFFILIATE/SUBSIDIARY, APPROVAL FOR APPLICATION OF CERTIFICATE OF NEED, APPROVAL TO ADOPT ANY LONG-TERM OR MASTER INSTITUTIONAL PLAN, APPROVAL TO SELL OR PURCHASE REAL PROPERTY WHICH EXCEEDS $250,000, APPROVAL TO CHANGE INSURANCE SPECIFICATIONS OR LIMITS, APPROVAL TO SELECT OR CHANGE INDEPENDENT AUDITORS AND LEGAL COUNSEL, APPROVAL TO ENTER INTO, RENEW OR MODIFY CONTRACTS TO PROVIDE COVERED MENTAL HEALTH CARE SERVICES TO BENEFICIARIES OF HEALTH MAINTENANCE ORGANIZATIONS, HEALTH CARE SERVICE PLANS, INDEPENDENT PRACTICE ASSOCIATIONS, PREFERRED PROVIDER ORGANIZATIONS, INSURANCE COMPANIES AND OTHER PURCHASERS OF HEALTH SERVICES, APPROVAL TO ENTER INTO ANY CONTRACT OR AGREEMENT WHICH I) PROVIDES FOR THE PAYMENT OR PERFORMANCE BY EITHER PARTY EXCEEDING AN AGGREGATE VALUE OF $250,000, II) IS NOT TERMINABLE WITHOUT PAYMENT OR PENALTY OF 60 DAYS OR LESS NOTICE III)IS BETWEEN THE CORPORATION OR AN AFFILIATE AND AN OFFICER, DIRECTOR OR KEY EMPLOYEE THEREOF. |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT PREPARES AND REVIEWS THE RETURN. AN OUTSIDE TAX ADVISOR THEN REVIEWS THE RETURN, PROVIDING COMMENTS AND GUIDANCE AS NEEDED. MBH BOARD MEMBERS ARE THEN PROVIDED WITH A FINAL COPY OF FORM 990 AND ITS SUPPORTING SCHEDULES FOR REVIEW AT A REGULARLY SCHEDULED BOARD MEETING. REVIEW, DISCUSSION, AND RATIFICATION OF THE FORM ARE AN AGENDA ITEM. |
| FORM 990, PART VI, SECTION B, LINE 12C | MBH BOARD MEMBERS RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. BOARD MEMBERS COMPLETE CONFLICT OF INTEREST STATEMENTS ON AN ANNUAL BASIS; BOARD MEMBERS ARE REMINDED TO UPDATE THEIR STATEMENTS IF CIRCUMSTANCES CHANGE. BOARD MEMBERS ARE REMINDED OF THE NEED TO ABSTAIN FROM VOTING WHEN BOARD RESOLUTIONS REQUIRE SUCH ACTION. BOARD MEMBERS ARE APPRAISED BY MANAGEMENT OF POTENTIAL CONFLICTS WITH MEETING AGENDA ITEMS. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION DETERMINATIONS OF MBH'S PRESIDENT AND OTHER OFFICERS WERE CONDUCTED BY MEMORIAL HEALTH SYSTEM'S MANAGEMENT, A RELATED ORGANIZATION OF THE FILING ORGANIZATION. MBH'S PRESIDENT IS AN EMPLOYEE OF MEMORIAL HEALTH SYSTEM (MHS). MHS ANNUALLY ENGAGES A CONSULTING FIRM TO CONDUCT A COMPENSATION REVIEW, WHICH INCLUDES A COMPARABILITY STUDY FOR ALL EXECUTIVES. MHS'S LEADERSHIP COMPENSATION COMMITTEE, A PART OF ITS BOARD OF DIRECTORS, REVIEWS THE CONSULTANT REPORT. COMPENSATION COMMITTEE DECISIONS AND REPORTS ARE CONTEMPORANEOUSLY DOCUMENTED IN THE BOARD OF DIRECTOR AND COMPENSATION COMMITTEE MINUTES AS APPROPRIATE. TWO OFFICERS ARE EMPLOYEES OF AN AFFILIATED ORGANIZATION, MEMORIAL PHYSICIANS SERVICES. THEIR COMPENSATION IS REVIEWED BY THE SAME OUTSIDE CONSULTING FIRM THAT REVIEWS THE COMPENSATION OF MBH'S PRESIDENT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS OF MBH, SUCH AS ARTICLES OF INCORPORATION AND ANY AMENDMENTS THERETO, ARE AVAILABLE TO THE GENERAL PUBLIC THROUGH THE ILLINOIS SECRETARY OF STATE'S OFFICE. THESE GOVERNING DOCUMENTS, AS WELL AS THE BYLAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS, ARE AVAILABLE UPON REQUEST FROM THE CORPORATION. THESE DOCUMENTS ARE AVAILABLE FOR THE SAME PERIOD OF TIME AS SET FORTH IN IRC SECTION 6104(D). |
| PART VII, SECTION A | JAN GAMBACH, DIANA KNAEBE AND JAMESON ROSZHART WERE EMPLOYED BY A RELATED ORGANIZATION, MEMORIAL HEALTH SYSTEM (MBH'S CORPORATE PARENT ORGANIZATION), AND THEREFORE ARE REPORTED AS A MEMORIAL HEALTH SYSTEM EMPLOYEE FOR TAX REPORTING PURPOSES (W-2). HOWEVER, THESE THREE OFFICER'S COMPENSATION EXPENSE IS ALLOCATED TO MBH ACCORDING TO THE TIME SPENT IN LEADERSHIP TO MBH AND THEREFORE INCLUDED ON PART IX, LINE 5. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SPRINGFIELD RESIDENTIAL SERVICES | |||||||||||
| 710 NORTH EIGHTH STREET | SPRINGFIELD | IL | 62702 | 371298589 | RESIDENTIAL HUD HOUSING PROJECT FOR MENTALLY ILL | IL | 501(C)(3) | LINE 7 | MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS | Yes (1) | |
| MEMORIAL HEALTH SYSTEM | |||||||||||
| 701 NORTH FIRST ST | SPRINGFIELD | IL | 627810001 | 371110690 | PARENT | IL | 501(C)(3) | LINE 12B, II | 0 | N/A | |
| MEMORIAL MEDICAL CENTER | |||||||||||
| 701 NORTH FIRST ST | SPRINGFIELD | IL | 627810001 | 370661220 | HOSPITAL SERVICES | IL | 501(C)(3) | LINE 3 | MEMORIAL HEALTH SYSTEM | 0 | |
| MEMORIAL HEALTH VENTURES | |||||||||||
| 701 NORTH FIRST ST | SPRINGFIELD | IL | 627810001 | 363492266 | HEALTHCARE ACTIVITIES | IL | 501(C)(3) | LINE 10 | MEMORIAL HEALTH SYSTEM | 0 | |
| ABRAHAM LINCOLN MEMORIAL HOSPITAL | |||||||||||
| 315 EIGHTH ST | LINCOLN | IL | 62656 | 370723793 | HOSPITAL SERVICES | IL | 501(C)(3) | LINE 3 | MEMORIAL HEALTH SYSTEM | 0 | |
| TAYLORVILLE MEMORIAL HOSPITAL | |||||||||||
| 201 EAST PLEASANT | TAYLORVILLE | IL | 62568 | 370661250 | HOSPITAL SERVICES | IL | 501(C)(3) | LINE 3 | MEMORIAL HEALTH SYSTEM | 0 | |
| MEMORIAL HOME SERVICES | |||||||||||
| 720 NORTH BOND | SPRINGFIELD | IL | 627024915 | 370714225 | HOME HEALTH, HOSPICE, AND CONTINUOUS CARE SERVICES | IL | 501(C)(3) | LINE 7 | MEMORIAL HEALTH SYSTEM | 0 | |
| MEMORIAL PHYSICIAN SERVICES | |||||||||||
| 701 NORTH FIRST ST | SPRINGFIELD | IL | 627810001 | 371181194 | HEALTH CLINICS | IL | 501(C)(3) | LINE 10 | MEMORIAL HEALTH SYSTEM | 0 | |
| MEMORIAL MEDICAL CENTER FOUNDATION | |||||||||||
| 1 MEMORIAL PLAZA | SPRINGFIELD | IL | 62781 | 371110301 | GRANTS TO HOSPITALS, OTHER CHARITABLE ORGANIZATIONS, AND SCHOLARSHIPS | IL | 501(C)(3) | LINE 7 | MEMORIAL MEDICAL CENTER | 0 | |
| TAYLORVILLE MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 201 EAST PLEASANT | TAYLORVILLE | IL | 62568 | 371337485 | GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS | IL | 501(C)(3) | LINE 7 | TAYLORVILLE MEMORIAL HOSPITAL | 0 | |
| ABRAHAM LINCOLN HEALTHCARE FOUNDATION | |||||||||||
| 315 EIGHTH ST | LINCOLN | IL | 62656 | 363492268 | GRANTS TO OTHER CHARITABLE ORGANIZATIONS AND HOSPITALS | IL | 501(C)(3) | LINE 7 | MEMORIAL HEALTH SYSTEM | 0 | |
| PASSAVANT MEMORIAL AREA HOSPITAL ASSOCIATION | |||||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 370661230 | HOSPITAL SERVICES | IL | 501(C)(3) | LINE 3 | MEMORIAL HEALTH SYSTEM | 0 | |
| PASSAVANT AREA HOSPITAL FOUNDATION | |||||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 461037396 | SUPPORTING THE HOSPITAL | IL | 501(C)(3) | LINE 7 | PASSAVANT MEMORIAL AREA HOSPITAL | 0 | |
| JACKSONVILLE CRNA'S INC | |||||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 273093265 | CRNA SERVICES | IL | 501(C)(3) | LINE 10 | PASSAVANT MEMORIAL AREA HOSPITAL | 0 | |
| DECATUR MEMORIAL HOSPITAL | |||||||||||
| 2300 NORTH EDWARD STREET | DECATUR | IL | 625264163 | 370661199 | HOSPITAL SERVICES | IL | 501(C)(3) | LINE 3 | MEMORIAL HEALTH SYSTEM | 0 | |
| DECATUR MEMORIAL HEALTH FOUNDATION | |||||||||||
| 2300 NORTH EDWARD STREET | DECATUR | IL | 625264163 | 371169605 | SUPPORTING THE HOSPITAL | IL | 501(C)(3) | LINE 12A, I | DECATUR MEMORIAL HOSPITAL | 0 | |
| HEARTLAND RISK MANAGEMENT | |||||||||||
| 2300 NORTH EDWARD STREET | DECATUR | IL | 625264163 | 454256254 | SUPPORTING THE HOSPITAL | IL | 501(C)(3) | LINE 12A, I | DECATUR MEMORIAL HOSPITAL | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL HOME SERVICES OF CENTRAL ILLINOIS | |||||||||
| 701 NORTH FIRST STREET | SPRINGFIELD | IL | 62781 | 371190216 | PROVIDE DURABLE MEDICAL EQUIPMENT AND SUPPLIES TO PATIENTS | IL | N/A | C | 0 |
| PASSAVANT PHYSICIAN ASSOCIATION | |||||||||
| 1600 WEST WALNUT STREET | JACKSONVILLE | IL | 62650 | 261200566 | PHYSICIAN SERVICES | IL | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| SPRINGFIELD RESIDENTIAL SERVICES | ||
| O | $30,133 | FMV |
| SPRINGFIELD RESIDENTIAL SERVICES | ||
| L | $14,014 | FMV |
| SPRINGFIELD RESIDENTIAL SERVICES | ||
| Q | $14,819 | FMV |
Comments