2020-07-10T16:25:56-05:00 2019-09-30 341884125 CBIZ MHM LLC 4722 N 24TH ST STE 300 PHOENIX AZ 85016 990 2018-10-01 860214457 MOHAVE MENTAL HEALTH CLINIC INC MOHA 9287574250 3707 N STOCKTON HILL RD STE B KINGMAN AZ 86409 DAWN ABBOTT CEO 9287574250 2020-06-29 1 AMY A O'LOUGHLIN P00869687 6022646835 12.221.96.220 2020-06-29 15:59:55 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1212D86953DF9911D4E957E54162B84DD93DFAA7 2018 2021-01-29 14:40:06Z DAWN ABBOTT 3707 N STOCKTON HILL RD STE B KINGMAN AZ 86409 43078822 0 X MMHC-INC.ORG X 1968 AZ TO IMPROVE, ENHANCE AND PROMOTE THE EMOTIONAL WELL-BEING OF MOHAVE COUNTY RESIDENTS WHO EXPERIENCE LIFE-DISRUPTING PROBLEMS AND TO STRENGTHEN THE QUALITY OF PERSONAL, FAMILY AND COMMUNITY LIFE. 5 5 410 7 80681 -21928 40526922 34435784 2010595 3976884 85263 120426 21633 106918 42644413 38640012 58339 31417 0 0 17786941 18668391 0 0 0 25503694 24123623 43348974 42823431 -704561 -4183419 28667891 23810891 6213210 6102385 22454681 17708506 TO IMPROVE, ENHANCE AND PROMOTE THE EMOTIONAL WELL-BEING OF MOHAVE COUNTY RESIDENTS WHO EXPERIENCE LIFE-DISRUPTING PROBLEMS AND TO STRENGTHEN THE QUALITY OF PERSONAL, FAMILY AND COMMUNITY LIFE. 0 0 20412463 24347 1316413 SERIOUSLY MENTALLY ILL - THIS PROGRAM PROVIDES PSYCHAITRIC SERVICES, MEDICATION MANAGEMENT, CASE MANAGEMENT, CRISIS SERVICES, INDIVIDUAL & GROUP THERAPY, PEER SUPPORT, LIVING AND VOCATIONAL SKILLS TRAINING, SUPERVISED RESIDENTIAL LIVING AND SEMISUPERVISED RESIDENTIAL LIVING HOMES. THIS PROGRAM CONTINUES ITS HEALTH COACHING PROGRAM TO PROVIDE INTEGRATED HEALTHCARE SERVICES TO THESE INDIVIDUALS WITH MULTIPLE SERIOUS CONDITIONS. CURRENTLY SERVING 1,951 11288307 833707 CHILDREN'S PROGRAM - THIS PROGRAM PROVIDES PSYCHIATRIC SERVICES, MEDICATION MANAGEMENT, CASE MANAGEMENT, CRISIS SERVICES, INDIVIDUAL, FAMILY & GROUP THREAPY, BEHAVIOR MANAGEMENT, INHOME SERVICES, FAMILY SUPPORT SERVICES, LIVING SKILLS TRAINING AND SUMMER PROGRAMS. THIS PROGRAM CONTINUES ITS INFANT & TODDLER INTERVENTIONS ACROSS THE CHILDREN'S PROGRAM, RESULTING IN IMPROVED CARE TO VERY YOUNG BEHAVIORAL HEALTH RECIPIENTS. CURRENTLY SERVING 1,495 10306793 7070 1826764 GENERAL MENTAL HEALTH SUBSTANCE ABUSE - THIS PROGRAM PROVIDES PSYCHIATRIC SERVICES, MEDICATION MANAGEMENT, CASE MANAGEMENT, CRISIS SERVICES, INDIVIDUAL & GROUP THERAPY, AND INTENSIVE OUTPATIENT PROGRAMS FOR SUBSTANCE ABUSE TREATMENT. CURRENTLY SERVING 2,268 42007563 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 7 0 1 410 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JANET RETTMANN CFO 9287578111 3707 N STOCKTON HILL RD STE B KINGMAN AZ 86409 CAROLYN STEWART PRESIDENT 1.00 X X 0 0 0 AMY SUGAMELE VICE PRESIDENT 1.00 X X 0 0 0 LORI A HOWELL SECRETARY/TREASURER 1.00 X X 0 0 0 MARISUSAN CASSON DIRECTOR 1.00 X 0 0 0 SALLY WALKER DIRECTOR 1.00 X 0 0 0 STEVE CARSPECKEN DIRECTOR 1.00 X 0 0 0 CHUCK PROBST DIRECTOR 1.00 X 0 0 0 DAWN D ABBOTT CEO 40.00 X 294353 0 41666 JANET M RETTMANN CFO 40.00 X 122429 0 13186 MOHAMED RAMADAN MEDICAL DIRECTOR 40.00 X 295772 0 52368 CAROLINE KOCH ASSOC MEDICAL DIRECTOR 40.00 X 255469 0 38609 LAURENCE SELTZER PSYCHIATRIST 40.00 X 268031 0 32174 MARY TULINNYE PSYCHIATRIC NP 40.00 X 164784 0 26541 STEVEN KORONA MEDICAL PRACTICE MANAGER 40.00 X 167519 0 21788 TORRY ZUPKE PSYCHIATRIC NP 40.00 X 147753 0 23272 LARRY MICHAEL STOWERS PSYCHIATRIC NP 40.00 X 167489 0 5161 1883599 0 254765 20 0 1 0 LOVEN CONTRACTING INC 1100 S PINNACLE ST FLAGSTAFF AZ 86001 CONSTRUCTION CONTRACTOR 932046 LOCUMTENENSCOM 2575 NORTHWINDS PKWY APHARETTA GA 30009 PSYCHIATRIC SERVICES 245187 INSIGHT TELEPSYCH LLC 2218 CHINOOK KINGMAN AZ 86401 PSYCHIATRIC SERVICES 234750 KINGMAN TRANSPORT 2250 BUTLER AVE KINGMAN AZ 86409 TRANSPORTATION 183753 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 PSYCHIATRIC SERVICES 178459 5 34125034 310750 310750 34435784 CLIENT FEES 624100 2787013 2787013 FEES - GOVT AGENCIES 624100 836050 836050 MEDICARE/MEDICAID PMTS 624100 252184 252184 RENTAL FEES 531110 71866 71866 RECORDS FEES 900099 29771 29771 3976884 68669 68669 89321 0 89321 89321 80681 8640 4438808 51759 4438808 2 0 51757 51757 51757 MISC INCOME 900099 17597 17597 17597 38640012 3976884 80681 146663 X 31417 31417 1113852 756198 357654 12708671 12708671 626230 626230 3246492 3158103 88389 973146 948616 24530 1957 1957 48093 48093 63050 63050 12449235 12449235 36906 36906 165671 165671 472568 472568 665083 609292 55791 200332 194934 5398 74887 56877 18010 138473 136428 2045 932399 910975 21424 298654 234134 64520 CLIENT MEDICATION COSTS 6992769 6992769 RENTAL/REPAIRS/MAINT 490342 490342 TELEPHONE 237894 237894 CLIENT LABORATORIES EXP 232752 232752 622558 555594 66964 42823431 42007563 815868 0 4954939 1652642 5067195 3534773 2610070 2297861 380348 354196 25154583 9289188 15606702 15865395 48637 106024 28667891 23810891 2005494 2144401 1134732 1436449 3072984 2521535 6213210 6102385 X 22269681 17708506 185000 0 22454681 17708506 28667891 23810891 X -4183419 -562756 X 0 1 X 1 0 X 38854265 37288195 43278754 40526922 34435784 194383920 38854265 37288195 43278754 40526922 34435784 194383920 194383920 17002 26206 50763 79090 77309 250370 1218 1218 4502 1074 1058 16593 17597 40824 194676332 9968303 0.99850 0.99890 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2014 AMOUNT: $ 4,502. 2015 AMOUNT: $ 1,074. 2016 AMOUNT: $ 1,058. 2017 AMOUNT: $ 16,593. 2018 AMOUNT: $ 17,597. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1609708 1609708 20450299 6889015 13561284 13181 13181 0 3081395 2386992 694403 15865395 X 38002965 0 38002965 637047 637047 38640012 42749140 0 42749140 74291 74291 42823431 PART X, LINE 2: MMHC QUALIFIES AS A TAX EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND, THEREFORE, THERE IS NO PROVISION FOR INCOME TAXES. IN ADDITION, MMHC QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170 OF THE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. INCOME DETERMINED TO BE UNRELATED BUSINESS TAXABLE INCOME ("UBTI") WOULD BE TAXABLE. MANAGEMENT DOES NOT BELIEVE MMHC HAS ANY UBTI FOR THE YEAR ENDED SEPTEMBER 30, 2019. MMHC EVALUATES ITS UNCERTAIN TAX POSITIONS, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF ITS POLICIES AND PROCEDURES, REVIEW OF ITS REGULAR TAX FILINGS, AND DISCUSSIONS WITH OUTSIDE EXPERTS. MMHC'S FEDERAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAX (FORM 990) FOR FISCAL 2018, 2017, AND 2016 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 631,056. PRIVILEGE AND USE TAX EXPENSE 5,991. PART XII, LINE 4B - OTHER ADJUSTMENTS: PRIVILEGE AND USE TAX EXPENSE 5,991. CHANGE IN CASH SURRENDER VALUE OF LIFE INSURANCE 68,300. 1 MOVE-IN ASSISTANCE OR EVICTION PREVENTION 63 31417 PART I, LINE 2: MMHC ASSISTS WITH HOUSING ASSISTANCE (INCLUDES RENTS, UTILITIES AND MOVING EXPENSE) TO QUALIFYING CLIENTS. THE NEED IS DISCUSSED WITH A CLINICAL LIAISON WHICH IS DOCUMENTED IN THE CLIENT'S RECORD ON THE BEHAVIORAL HEALTH SERVICE PLAN. IF THE CLIENT MEETS THE REQUIREMENTS AS SET FORTH IN THE DEPARTMENT OF BEHAVIORAL HEALTH COVERED SERVICE GUIDE, A FINANCIAL REQUEST IS MADE THROUGH A SUPERVISOR AND APPROVED BY THE PROGRAM DIRECTOR, WITH FINAL APPROVAL MADE BY THE CHIEF FINANCIAL OFFICER TO ENSURE AVAILABILITY OF FUNDING. X 0 1 X X X 0 0 0 0 0 0 0 1 0 DAWN D ABBOTT CEO 294353 0 0 0 0 0 29642 0 12024 0 336019 0 0 0 MOHAMED RAMADAN MEDICAL DIRECTOR 287972 0 7800 0 0 0 30264 0 22104 0 348140 0 0 0 CAROLINE KOCH ASSOC MEDICAL DIRECTOR 255469 0 0 0 0 0 25697 0 12912 0 294078 0 0 0 LAURENCE SELTZER PSYCHIATRIST 268031 0 0 0 0 0 22238 0 9936 0 300205 0 0 0 MARY TULINNYE PSYCHIATRIC NP 164784 0 0 0 0 0 8553 0 17988 0 191325 0 0 0 STEVEN KORONA MEDICAL PRACTICE MANAGER 167519 0 0 0 0 0 10136 0 11652 0 189307 0 0 0 TORRY ZUPKE PSYCHIATRIC NP 147753 0 0 0 0 0 12184 0 11088 0 171025 0 0 0 LARRY MICHAEL STOWERS PSYCHIATRIC NP 167489 0 0 0 0 0 4273 0 888 0 172650 0 0 0 PART I, LINE 1A BOARD MEMBERS ARE ENCOURAGED TO ATTEND THE NATIONAL CONFERENCE FOR BEHAVIORAL HEALTH ORGANIZATIONS IN ORDER TO EDUCATE THEMSELVES ON CURRENT TRENDS AND CHANGES IN THE INDUSTRY. IF REQUESTED, MMHC PAYS FOR COMPANION TRAVEL. COMPANION TRAVEL IS NON-TAXABLE TO THE BOARD MEMBERS AS IT IS CONSIDERED TO BE PART OF THE BUSINESS PURPOSE OF THE ORGANIZATION. PART I, LINE 1B NO POLICY HAS BEEN WRITTEN BUT IT IS PRACTICE TO EXTEND THE INVITATION OF THE GUEST TO EACH PERSON ATTENDING NATIONAL CONFERENCES. PART I, LINE 7 ALL BONUSES WERE PAID OUT IN ACCORDANCE WITH THE ORGANIZATION'S PERFORMANCE BASED INCENTIVE COMPENSATION PLAN AND APPROVED BY THE BOARD OF DIRECTORS. X DEBT FORGIVEN 1 310750 FMV 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY WILL BE MADE AVAILABLE TO ALL MEMBERS OF THE BOARD FOR REVIEW PRIOR TO FILING. FINAL APPROVAL OF FORM 990 WILL BE MADE BY THE CEO PRIOR TO SUBMISSION OF FORM 990. A COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT THE FIRST AVAILABLE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C AS PER THE PERSONNEL POLICY SECTION 719, CONFLICT OF INTEREST, ALL STAFF, INCLUDING MEMBERS OF THE BOARD OF DIRECTORS, ARE MADE AWARE OF THE PROCESS OF REPORTING OF POSSIBLE CONFLICTS OF INTEREST. A CONFLICT OF INTEREST DISCLOSURE IS COMPLETED ANNUALLY BY ALL EMPLOYEES AND BOARD MEMBERS. IN ALL INSTANCES IN WHICH A CONFLICT OF INTEREST IS PRESENT OR MAY APPEAR TO BE PRESENT, FULL WRITTEN DISCLOSURE MUST BE MADE TO THE CEO OR THE PRESIDENT OF THE BOARD, AS MAY BE APPLICABLE. FOR INSTANCES NOT EXPRESSLY FORBIDDEN BY THE POLICY, PERMISSION FROM THE CEO OR BOARD MUST BE OBTAINED BEFORE PROCEEDING WITH PARTICIPATING IN THE SITUATION. FORM 990, PART VI, SECTION B, LINE 15A AN ANNUAL EVALUATION IS REQUESTED FROM THE BOARD OF DIRECTORS AND IS SUMMARIZED AND DISCUSSED IN AN EXECUTIVE SESSION OF THE BOARD MEETING IN THE ANNIVERSARY MONTH OF THE CEO. SALARY IS BASED ON REVIEW OF MARKET AND LOCAL COMPENSATION. EVALUATION OF OTHER OFFICERS ARE COMPLETED BY THE CEO AND SALARIES ARE DETERMINED BASED ON MARKET AND LOCAL COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION, BY-LAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND AUTHORIZED BY BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G CONTRACTED PSYCHIATRIST: PROGRAM SERVICE EXPENSES 634,219. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 634,219. OUTSIDE BEHAVIORAL HEALTH PROVIDERS: PROGRAM SERVICE EXPENSES 11,066,122. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,066,122. CLIENT TRANSPORTATION AND INTERPRETER SERVICES: PROGRAM SERVICE EXPENSES 503,418. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 503,418. TEMPORARY SERVICES: PROGRAM SERVICE EXPENSES 245,476. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 245,476. FORM 990, PART XI, LINE 9: PROVISION OF UNCOLLECTIBLE ACCOUNTS -631,056. CHANGE IN CASH SURRENDER VALUE OF LIFE INSURANCE 68,300.