HEALTHSOURCE INTEGRATED SOLUTIONS INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
HEALTHSOURCE INTEGRATED SOLUTIONS INC (EIN 20-8498601)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201301359349307685
Schema version
2011v1.5
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)
Timestamp2013-05-15T15:57:45-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN341857238EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CBIZ MHM LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1990 SW FAIRLAWN ROADAddressLine1
CityTOPEKACity
StateKSState
ZIP Code66606ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN208498601EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1KANSAS HEALTH SOLUTIONS LLCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlKANSNameControl
Phone7852342423Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1534 S KANSAS AVE NO 510AddressLine1
CityTOPEKACity
StateKSState
ZIP Code66603ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMYRON UNRUHName
TitleCEOTitle
Phone7852342423Phone
Date Signed2013-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLORI DOWNINGName
PTINP00625053PTIN
Phone7852723176Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMYRON UNRUHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1534 S KANSAS AVE NO 510AddressLine1
CityTOPEKACity
StateKSState
ZIP Code66603ZIPCode
FieldValueIRS element (for citing)
Gross Receipts197285427GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.KANSASHEALTHSOLUTIONS.ORGWebSite
Type Of Organization OtherXTypeOfOrganizationOther
Type Of Org Other DescriptionSMLLCTypeOfOrgOtherDescription
Year Formation2007YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionTO FUNCTION AS A PREPAID AMBULATORY HEALTH PLAN FOR PEOPLE WITH MEDICAID NEEDING MENTAL HEALTH SERVICES. WE ARE COMMITTED TO DELIVERING SERVICES THAT MEET OR EXCEED COMMUNITY STANDARDS OF ACCESSIBILITY, ACCEPTABILITY, VALUE, IMPACT, AND CULTURAL SENSITIVITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees103TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI296750TotalGrossUBI
Net Unrelated Business Txbl Income-416276NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12231899ProgramServiceRevenuePriorYear
Program Service Revenue CY196810243ProgramServiceRevenueCY
Investment Income Prior Year39240InvestmentIncomePriorYear
Investment Income Current Year178434InvestmentIncomeCurrentYear
Other Revenue Prior Year296750OtherRevenuePriorYear
Other Revenue Current Year296750OtherRevenueCurrentYear
Total Revenue Prior Year12567889TotalRevenuePriorYear
Total Revenue Current Year197285427TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6910768SalariesEtcPriorYear
Salaries Etc Current Year6352000SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6945495OtherExpensePriorYear
Other Expenses Current Year187044034OtherExpensesCurrentYear
Total Expenses Prior Year13856263TotalExpensesPriorYear
Total Expenses Current Year193396034TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1288374RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3889393RevenuesLessExpensesCY
Total Assets BOY23700506TotalAssetsBOY
Total Assets EOY36178043TotalAssetsEOY
Total Liabilities BOY22349286TotalLiabilitiesBOY
Total Liabilities EOY30937430TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1351220NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5240613NetAssetsOrFundBalancesEOY
Mission DescriptionTO FUNCTION AS A PREPAID AMBULATORY HEALTH PLAN FOR PEOPLE WITH MEDICAID NEEDING MENTAL HEALTH SERVICES. WE ARE COMMITTED TO DELIVERING SERVICES THAT MEET OR EXCEED COMMUNITY STANDARDS OF ACCESSIBILITY, ACCEPTABILITY, VALUE, IMPACT, AND CULTURAL SENSITIVITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense192787622Expense
Revenue196810243Revenue
DescriptionKANSAS HEALTH SOLUTIONS, LLC (KHS) IS A NOT-FOR-PROFIT ORGANIZATION FOR THE PURPOSE OF FULFILLING THE FUNCTIONS AND OBLIGATIONS OF A PREPAID HEALTH PLAN, MANAGING A STATEWIDE SYSTEM AS TO BEHAVIORAL HEALTH SERVICES AND OTHERWISE FUNCTIONING IN A MANNER COMPATIBLE WITH THE VALUES, MISSIONS, AND GOALS OF THE MEMBERS OF THE ASSOCIATION OF COMMUNITY MENTAL HEALTH CENTERS OF KANSAS, INC.Description
Total Program Service Expense192787622TotalProgramServiceExpense
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096504NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees103NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledKSStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSYLVIA OBAYANamePerson
Telephone Number7852342423TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1534 S KANSAS AVE STE 510AddressLine1
CityTOPEKACity
StateKSState
ZIP Code66603ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
SHERMAN COLE
MEMBER-AT-LARGE4.00X000
MARILYN COOK
MEMBER-AT-LARGE4.00X000
JULIE DEJEAN
MEMBER-AT-LARGE4.00X000
DOLORES FURTADO
MEMBER-AT-LARGE4.00X000
KERRY MILLER
CONSUMER REPRESENTATIVE4.00X000
SHERRI LUTHE
FAMILY OF CONSUMER REPRESENTATIVE4.00X000
MICHAEL HAMMOND
OWNER REPRESENTATIVE4.00X014560017399
RICHARD DALKE
ACMHCK PRESIDENT-ELECT4.00X000
DAVID JOHNSON
MEMBER-AT-LARGE4.00X000
BILLY PERSINGER
MEMBER-AT-LARGE4.00X000
ROBBIN COLE
VICE CHAIRMAN4.00X000X
ROBERT JACKSON
CHAIRMAN4.00X000X
KEITH RICKARD
SECRETARY/TREASURER4.00X000X
MYRON UNRUH
CEO40.00000X
ANITA STEFANICH
CFO40.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs145600TotalReportableCompFrmRltdOrgs
Total Other Compensation17399TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
VALUEOPTIONS INC
100 SE 9TH STREET STE 501TOPEKAKS66612MANAGEMENT SERVICES560000
PRICE WATERHOUSE COOPERS LLP
1100 WALNUT STREET STE 1300KANSAS CITYMO64106AUDITING309353
ASSOCIATION OF CMHCS OF KS INC
534 S KANSAS STE 330TOPEKAKS66603MANAGEMENT SERVICES147803
ESSSENTIAL LEARNING LLC
107 EDINBURGH DRIVE SOUTH STE 206CARYNC27511SOFTWARE TRAINING PROGRAM125664
FOULSTON SIEFKIN
534 S KANSAS AVETOPEKAKS66603LEGAL SERVICES101506
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ADMINISTRATIVE SERVICE561000195761470195761470
MISCELLANEOUS90009910487731048773
FieldValueIRS element (for citing)
Total Program Service Revenue196810243TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column178434TotalRevenueColumn
Exclusion$178,434ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMANAGEMENT FEESDescription
Business Code541610BusinessCode
Total Revenue Column296750TotalRevenueColumn
Unrelated Business Revenue296750UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue296750TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column197285427TotalRevenueColumn
Related Or Exempt Function Income196810243RelatedOrExemptFunctionIncome
Unrelated Business Revenue296750UnrelatedBusinessRevenue
Exclusion$178,434ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4945934Total
Program Services4945934ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total90180Total
Program Services90180ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total906939Total
Program Services906939ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total408947Total
Program Services408947ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total264000Total
Program Services158400ProgramServices
Management And General105600ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total152927Total
Management And General152927ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total307353Total
Management And General307353ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total15800Total
Program Services15800ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total29633Total
Program Services29633ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1351892Total
Program Services1351892ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total333558Total
Program Services333558ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total75619Total
Program Services75619ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total38290Total
Program Services38290ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total302196Total
Program Services302196ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total42532Total
Management And General42532ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL EXPENSE175998545175998545
PAHP SCREENS37511693751169
STAFF TRAINING & RETENT11439531143953
VALUE OPTIONS ADMINISTR960002960002

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2276565Total
Program Services2276565ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total193396034Total
Program Services192787622ProgramServices
Management And General608412ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2912640BOY
EOY8224420EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY16871240BOY
EOY22259069EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1367562BOY
EOY3183607EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2763419LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2249112LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY753666BOY
EOY514307EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1795398BOY
EOY1996640EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY23700506BOY
EOY36178043EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3556066BOY
EOY29885627EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY18793220BOY
EOY1051803EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY22349286BOY
EOY30937430EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY141744BOY
EOY4021455EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1209476BOY
EOY1219158EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1351220BOY
EOY5240613EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23700506BOY
EOY36178043EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses3889393ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis212172OtherCostOrOtherBasis
Depreciation212172Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2551247OtherCostOrOtherBasis
Depreciation2036940Depreciation
Book Value514307BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings514307TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
A/R PROVIDER & OTHER132
INVESTMENT IN SUBSIDIARY559869
OTHER ASSETS217481
ASSETS LIMITED AS TO USE1219158
FieldValueIRS element (for citing)
Total Book Value Other Assets1996640TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLIABILITIES UNDER SRS CONTRACTDescription
Amount$1,051,803Amount
FieldValueIRS element (for citing)
Total Of Amounts1051803TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE COMPANY EVALUATES UNCERTAIN TAX POSITIONS ON AN ONGOING BASIS AND RECORDS A LIABILITY WHEN, BASED ON ALL AVAILABLE EVIDENCE, MANAGEMENT BELIEVES IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES AND THE LIABILITY WOULD BE INCURRED. THE COMPANY HAS CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT REQUIRE A LIABILITY TO BE RECORDED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonMICHAEL HAMMONDNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs138000CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs7600BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs5480DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs11919NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs162999TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 3THE ACTING CFO AND CEO WERE EMPLOYED BY A MANAGEMENT COMPANY.
FORM 990, PART VI, SECTION A, LINE 6THE ASSOCIATION OF COMMUNITY MENTAL HEALTH CENTERS OF KANSAS, INC (ACMHCKS), A KANSAS NOT-FOR-PROFIT CORPORATION, IS THE SOLE MEMBER OF KANSAS HEALTH SOLUTIONS, LLC.
FORM 990, PART VI, SECTION A, LINE 7AACMHCKS, THE SOLE MEMBER OF KANSAS HEALTH SOLUTIONS, LLC HAS THE RIGHT TO APPOINT THE BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7BTHE OPERATING AGREEMENT OF KANSAS HEALTH SOLUTIONS, LLC REQUIRES APPROVAL BY ACMHCKS, THE SOLE MEMBER, FOR THE FOLLOWING: (1) A MERGER, DISSOLUTION, SALE, TRANSFER, EXCHANGE, OR OTHER CONVEYANCE OF A SUBSTANTIAL PORTION (MORE THAN 50%) OF THE ASSETS OF THE COMPANY; (2) ANY FINANCIAL DECISIONS INVOLVING A DOLLAR AMOUNT IN EXCESS OF THAT SPECIFIED BY THE MEMBER; AND (3) ANY OTHER DECISION OF THE TYPE SPECIFIED IN ADVANCE BY THE MEMBER IN WRITING TO THE COMPANY.
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS REVIEWED BY THE CFO PRIOR TO FILING. THE 990 IS PREPARED BY AN OUTSIDE CPA FIRM.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION SENDS OUT QUESTIONNAIRES ON AN ANNUAL BASIS TO IDENTIFY CONFLICTS TO ALL BOARD OF DIRECTORS, MEMBERS, OFFICERS, AND EMPLOYEES. IF THE KANSAS HEALTH SOLUTIONS, LLC COMPLIANCE OFFICER DETERMINES A CONFLICT OF INTERES EXISTS, THE PARTY INVOLVED ABSTAINS FROM THE VOTE.
FORM 990, PART VI, SECTION B, LINE 15ATHE COMPENSATION OF THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. AN AD HOC COMMITTEE REVIEWS THE CEO'S CONTRACT ANNUALLY AT ITS MAY MEETING AND THAT COMMITTEE NEGOTIATES WITH THE CEO. THE COMMITTEE USES COMPARABLE DATA TO EVALUATE THE COMPENSATION LEVEL. THIS PROCESS IS NOTED IN THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE MINUTES. THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS NOT REVIEWED BY THE BOARD OF DIRECTORS. THE COMPANY'S HUMAN RESOURCES DEPARTMENT, IN CONJUNCTION WITH THE CEO, IS RESPONSIBLE FOR SETTING COMPENSATION RANGE, THIS IS DONE THROUGH YEARLY REVIEW AND USAGE OF SALARY ASSESSOR SOFTWARE. ANY SALARY INCREASES ARE DONE WITH SUPERVISOR INPUT BASED ON PERFORMANCE AND WITH FINAL APPROVAL BY THE CEO.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1ASSOCIATION OF COMMUNITY MENTAL HEALTH OF KSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1720 SE JACKSONAddressLine1
CityTOPEKACity
StateKSState
ZIP Code66603ZIPCode
FieldValueIRS element (for citing)
EIN480876205EIN
Primary ActivitiesHEALTHCAREPrimaryActivities
Legal Domicile StateKSLegalDomicileState
Exempt Code Section501(C)(4)ExemptCodeSection
Public Charity StatusN/APublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1TMHC SERVICES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1515 S KANSAS AVE STE 301AddressLine1
CityTOPEKACity
StateKSState
ZIP Code66603ZIPCode
FieldValueIRS element (for citing)
EIN208115687EIN
Primary ActivityDRUG/ALCOHOL TESTING & EMPLOYEE ASSISTANCEPrimaryActivity
Legal Domicile StateKSLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Share Of Total Income211650ShareOfTotalIncome
Share Of EOY Assets696507ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1TMHC SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeKTransactionType
Amount Involved296750AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination

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