TY 2017 Form 990

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

JOHNSON NICHOLS HEALTH CLINIC INC

Employer identification number

35-1270418

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..	830,227	905,582	746,529	654,444	9,458	3,146,240
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3	830,227	905,582	746,529	654,444	9,458	3,146,240
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.						3,146,240

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..	830,227	905,582	746,529	654,444	9,458	3,146,240
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	297	137	199	201		834
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10						3,147,074

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

99.970 %

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

99.970 %

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

JOHNSON NICHOLS HEALTH CLINIC INC

Employer identification number

35-1270418

Return Reference	Explanation
FORM 990, PART III	JOHNSON NICHOLS HEALTH CLINIC INC. IS A NONPROFIT 501(C)3 THAT OPERATES TWO HEALTH CLINICS LOCATED IN GREENCASTLE AND SPENCER, INDIANA. THE ORGANIZATION PROVIDES AFFORDABLE HEALTH CARE TO LOW INCOME PATIENTS THROUGH ITS WIC, TITLE X FAMILY PLANNING AND COMMUNITY HEALTH CENTER SERVICES. JOHNSON NICHOLS HEALTH CLINIC INC. IS AN AFFILIATE OF CENTERSTONE OF AMERICA. CENTERSTONE OF AMERICA, INC. IS A NATIONAL, PRIVATE, NOT-FOR-PROFIT 501(C)3 BEHAVIORAL HEALTHCARE ORGANIZATION WITH A MISSION TO, DELIVER CARE THAT CHANGES PEOPLES LIVES. IN ADDITION TO PROVIDING A COMPREHENSIVE SCOPE OF BEHAVIORAL HEALTH SERVICES AND INTEGRATED PRIMARY CARE, WE OFFER SPECIALIZED LIFE SKILLS DEVELOPMENT, EMPLOYMENT AND HOUSING SERVICES FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. CENTERSTONE DELIVERS CARE THROUGH ITS AFFILIATED COMPANIES CENTERSTONE OF FLORIDA, CENTERSTONE OF ILLINOIS, CENTERSTONE OF INDIANA, CENTERSTONE OF TENNESSEE, JOHNSON NICHOLS HEALTH CLINIC, AND CENTERSTONE MILITARY SERVICES. ON NOVEMBER 1ST, 2016, SEVEN COUNTIES SERVICES, INC., HEADQUARTERED IN LOUISVILLE, KY, JOINED CENTERSTONE BECOMING CENTERSTONE OF KENTUCKY. WITH THE ADDITION OF CENTERSTONE OF KENTUCKY, AT THE TIME OF THIS FILING, CENTERSTONE, THROUGH ITS AFFILIATED COMPANIES HAS ANNUAL REVENUES EXCEEDING 320 MILLION, EMPLOYEES OVER 5,200 STAFF, OPERATES OUT OF 206 FACILITIES, AND SERVES OVER 180,000 CHILDREN, ADULTS, AND FAMILIES EACH YEAR. CENTERSTONES SERVICE ARMS ARE SUPPORTED BY AFFILIATED COMPANIES CENTERSTONE FOUNDATION, CENTERSTONE RESEARCH INSTITUTE, AS WELL AS CENTERSTONE OF AMERICA. IN BECOMING ONE OF THE LARGEST HEALTHCARE ORGANIZATIONS OF ITS KIND IN THE NATION, CENTERSTONES GROWTH HAS BENEFITED ITS CLIENTS AND COMMUNITIES THOUGH THE IDENTIFICATION AND SUPPORT OF MORE EFFECTIVE TREATMENT APPROACHES, STRATEGIC TECHNOLOGY INNOVATION, ENHANCED OPERATIONAL EFFICIENCIES, AND VASTLY INCREASED ACCESS TO PHILANTHROPIC AND GOVERNMENT SUPPORT FOR SERVICES TO THOSE WITH LIMITED RESOURCES. CENTERSTONE OFFERS WARM HOSPITALITY TO INDIVIDUALS AND FAMILIES IN OUR CARE. WE INCLUDE LOVED ONES IN THE HEALING PROCESS AND WORK TO UPLIFT THE HUMAN SPIRIT AND OVERALL HEALTH AND WELLBEING. CENTERSTONE KNOWS THAT OUR CARE ALLOWS FAMILIES AND INDIVIDUALS TO CONTINUE CAREERS, HEAL MARRIAGES, RAISE CHILDREN, COMPLETE EDUCATION, MAINTAIN HEALTH AND SUCCEED IN LIFE. WE ACCEPT MOST INSURANCE AND PRIVATE PAY FOR SERVICES, AND ARE ABLE TO OFFER THIS EXTRAORDINARY LEVEL OF CARE THROUGH ADDITIONAL CONTRACTS AND GRANTS FROM FEDERAL, STATE AND LOCAL GOVERNMENT AS WELL AS PHILANTHROPIC DONATIONS FROM FOUNDATIONS, CORPORATIONS AND INDIVIDUALS. CENTERSTONE OF FLORIDA IS THE LEADING COMMUNITY BEHAVIORAL HEALTH HOSPITAL AND OUTPATIENT PRACTICE IN SOUTH TAMPA BAY. WITH A 60-YEAR HISTORY, WE ARE WORKING TO CHANGE THE LIVES OF CHILDREN, TEENS, ADULTS AND SENIORS WHO FACE TRAUMA, ADDICTIONS, PSYCHIATRIC ILLNESSES AND EMOTIONAL DISORDERS. EACH YEAR, CENTERSTONE OF FLORIDA SERVES MORE THAN 16,000 PEOPLE OF ALL AGES. WE RECENTLY EARNED PRESTIGIOUS UNITED/OPTUM HEALTH PLAN HOSPITAL STATUS. CENTERSTONE OF FLORIDA IS ACCREDITED BY THE JOINT COMMISSION. CENTERSTONE OF INDIANA PROVIDES AN ARRAY OF MENTAL HEALTH, SUBSTANCE ABUSE TREATMENT, INTEGRATED PRIMARY CARE, AND SUPPORTIVE SERVICES TO APPROXIMATELY 31,000 PEOPLE OF ALL AGES ACROSS SOUTHERN AND CENTRAL INDIANA EACH YEAR. CENTERSTONE HAS BEEN RECOGNIZED BY THE STATE OF INDIANA FOR ITS INNOVATIVE SERVICES IN ADDICTIONS CARE AND RE-ENTRY SERVICES. WE ARE ACCREDITED BY CARF INTERNATIONAL AND HAVE RECEIVED HEALTH HOME STATUS. CENTERSTONE OF INDIANAS SUBSIDIARIES INCLUDE THE CENTERSTONE FOUNDATION, INC., CENTERSTONE SUPPORTIVE HOUSING, LLC AND INDEPENDENT LIVING. CENTERSTONE OF ILLINOIS HAS A 50-YEAR HISTORY OF SERVING CHILDREN, YOUTH, ADULTS AND FAMILIES THROUGH MENTAL HEALTH COUNSELING, SUBSTANCE ABUSE TREATMENT, LIFE SKILLS ENRICHMENT PROGRAMS AND SPECIALIZED SERVICES FOR ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. EACH YEAR, CENTERSTONE OF ILLINOIS SERVES MORE THAN 13,000 PEOPLE OF ALL AGES IN SOUTH CENTRAL ILLINOIS AND THE METRO EAST ST. LOUIS AREA. WE ARE ACCREDITED BY CARF INTERNATIONAL. CENTERSTONE OF ILLINOIS IS THE SOLE CORPORATE MEMBER OF WELLSPRING RESOURCES, INC. THE CENTERSTONE RESEARCH INSTITUTE IS DEDICATED TO IMPROVING BEHAVIORAL HEALTHCARE THROUGH RESEARCH AND EVALUATION STUDIES TO DEFINE BEST PRACTICE AND ADVANCE THE TREATMENT AND PREVENTION OF MENTAL HEALTH AND ADDICTION DISORDERS. WE WORK TO CREATE A BRIGHTER FUTURE FOR INDIVIDUALS AND FAMILIES BY BRIDGING THE GAP BETWEEN SCIENCE AND CARE. WE ALSO WORK CLOSELY WITH OUR CENTERSTONE AFFILIATES TO DELIVER CLINICALLY EXCELLENT, EVIDENCE-BASED AND VALUE-CARE MODELS. CENTERSTONE RESEARCH INSTITUTE EMBRACES TRANSPARENCY AND MEASUREMENT AS A MEANS TO ENHANCING PATIENT CARE. CENTERSTONE MILITARY SERVICES WORKS TO ENSURE THAT SERVICE MEMBERS, VETERANS AND THEIR FAMILIES HAVE THE RESOURCES AND SUPPORT THEY NEED TO LEAD HEALTHY AND FULFILLING LIVES BEYOND MILITARY SERVICE. WE OFFER A VARIETY OF SERVICES TO ADDRESS MANY ISSUES INCLUDING COMBAT STRESS, TRAUMA, HOMELESSNESS, DEPRESSION, ADDICTION, MARRIAGE ISSUES, PARENT-CHILD RELATIONSHIP REPAIR, AND OTHER INVISIBLE WOUNDS OF WAR. THIS INCLUDES THOSE WHO ARE CURRENT SERVING OR HAVE SERVED IN ANY BRANCH OF THE MILITARY REGARDLESS OF DISCHARGE STATUS OR CONFLICT IN WHICH THEY SERVED. THE CENTERSTONE FOUNDATION, INC. SECURES PHILANTHROPIC RESOURCES TO SUPPORT CENTERSTONES MISSION OF DELIVERING CARE THAT CHANGES PEOPLES LIVES BOTH NOW AND IN THE FUTURE. IN ADDITION TO SECURING PHILANTHROPIC RESOURCES FOR ITS AFFILIATES AND THE PEOPLE WE SERVE, THE FOUNDATION IS CHARGED WITH PROVIDING EFFECTIVE STEWARDSHIP OF ENDOWMENTS, INCLUDING INVESTMENT AND DISBURSEMENTS. WE ARE DEDICATED TO IMPROVING THE QUALITY OF LIFE OF THE INDIVIDUALS AND FAMILIES WHO COME TO CENTERSTONE FOR CARE. CENTERSTONE OF INDIANA IS THE SOLE CORPORATE MEMBER OF THE CENTERSTONE FOUNDATION. ADVANTAGE BEHAVIORAL HEALTH, A SPECIALTY ORGANIZATION OF CENTERSTONE, CREATES HEALTHCARE MANAGEMENT SOLUTIONS THAT IMPROVE ACCESS TO SERVICES AND ADVANCE PATIENT CARE AND OUTCOMES. WE OPERATE A PROVIDER NETWORK THAT DELIVERS COUNSELING SERVICES FOR CENTERSTONE MILITARY SERVICES REFERRALS, AND PROVIDE EMPLOYEE ASSISTANCE PROGRAMS AND OTHER EMPLOYEE WELLNESS SERVICES TO REGIONAL EMPLOYERS. ADVANTAGE BEHAVIORAL HEALTH IS AN AFFILIATE OF CENTERSTONE OF AMERICA, INC. CENTERSTONE OF TENNESSEE IS THE SOLE CORPORATE MEMBER OF ADVANTAGE BEHAVIORAL HEALTH. VANTAGE POINT IS A PROVIDER OF OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE COUNSELING.
FORM 990, PAGE 6, PART VI, LINE 6	THE GOVERNING BODY OF JOHNSON NICHOLS HEALTH CLINIC, INC. HAS MEMBERS
FORM 990, PAGE 6, PART VI, LINE 7A	THE ORGANIZATION HAS MEMBERS, STOCKHOLDERS, OR OTHER PERSONS WHO HAVE THE POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 7B	GOVERNANCE DECISIONS OF THE ORGANIZATION ARE RESERVED TO (OR SUBJECT TO APPROVAL BY) MEMBERS, STOCKHOLDERS, OR PERSONS OTHER THAN THE GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 9	DR STEVE KISSEL 712 TODDSON DRIVE GREENCASTLE, IN 46135 RICHARD SMOCK 3494 S CO RD 300 W GREENCASTLE, IN 46135 BOB SIEGMANN 720 N MARR RD COLUMBUS, IN 47201 DR. GREG SIDELL 645 S ROGERS ST BLOOMINGTON, IN 47403
FORM 990, PAGE 6, PART VI, LINE 11B	FILING COPY PROVIDED TO ORGANIZATION THAT REQUIRES REVIEW OF THE BOARD OF DIRECTORS PRIOR TO SIGNATURE/SUBMISSION/E-FILING/MAILING.
FORM 990, PAGE 6, PART VI, LINE 19	UPON REQUEST
FORM 990, PART XI, LINE 9	WRITE-OFF OF UNCOLLECTIBLE ACCOUNTS 15,249

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

JOHNSON NICHOLS HEALTH CLINIC INC

Employer identification number

35-1270418

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ADVANTAGE BEHAVIORAL HEALTH 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 20-1590169	BILLING	TN	501C4		N/A		No
(2)AMY'S CROSSING INC 44 VANAGE WAY SUITE 400 NASHVILLE,TN37228 45-4926717	HOUSING	IL	501C3	10	N/A		No
(3)ASPEN HOUSE INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1925610	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(4)BEHAVIORIAL HEALTH ORGAN OF IN 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1985649	GROUP HOME	IN	501C3		NA		No
(5)CEDAR VIEW INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1943874	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(6)CENTERSTONE OF TN 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 62-1674308	MENTAL HEA	TN	501C3	3	NA		No
(7)CENTERSTONE FOUNDATION FORMERLY CBH FOUNDATION44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 26-1186476	FUNDRAISIN	IN	501C3	12A	CENTERSTON CENTERSTONE OF INDIANA		No
(8)CENTERSTONE HOUSING RESOURCES 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 30-0181963	GROUP HOME	TN	501C3	12C	N/A		No
(9)CENTERSTONE LEARNING 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 27-4417281	MENTAL HEA	KY	501C3	7	N/A		No
(10)CENTERSTONE MILITARY SERVICES INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 27-1934061	MENTAL HEA	TN	501C3	7	CENTERSTON CENTERSTONE OF AMERICA		No
(11)CENTERSTONE OF AMERICA 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 20-0072992	HOLDING CO	IN	501C3	10	N/A		No
(12)CENTERSTONE OF FLORIDA 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 59-1009537	MENTAL HEA	FL	501C3	7	CENTERSTON CENTERSTONE OF FLORIDA		No
(13)CENTERSTONE OF ILLINOIS INC FORMERLY THE H GROUP BBT INC44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 37-0916475	MENTAL HEA	IL	501C3	7	CENTERSTON CENTERSTONE OF AMERICA		No
(14)CENTERSTONE OF INDIANA 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1147323	MENTAL HEA	IN	501C3	7	CENTERSTON CENTERSTONE OF AMERICA		No
(15)CENTERSTONE OF KENTUCKY INC FORMERLY THE H GROUP OF KENTUCKY BB44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228	MENTAL HEA	KY	501C3	7	CENTERSTON CENTERSTONE OF AMERICA		No
(16)CENTERSTONE RESEARCH INSTITUTE 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 26-2505456	RESEARCH	IN	501C3	7	CENTERSTON CENTERSTONE OF AMERICA		No
(17)CUMBERLAND HOLDING CORP 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 62-1234354	HOUSING	TN	501C3	10	N/A		No
(18)DOGWOOD PLACE INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 20-1926260	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(19)F - W RESIDENTIAL PROPERTIES INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 37-1398964	HOUSING	IL	501C3	10	CENTERSTON CENTERSTONE OF AMERICA		No
(20)FRANKLIN-WILLIAMSON PROPERTIES INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 37-1275096	HOUSING	IL	501C2	7	CENTERSTON CENTERSTONE OF AMERICA		No
(21)HEMPEL HOUSE INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 37-1365765	HOUSING	IL	501C3	10	N/A		No
(22)INDIANA HOUSE INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1942793	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(23)JOHNSON NICHOLS HEALTH CLINIC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1270418	HEALTHCARE	IN	501C3	7	CENTERSTON CENTERSTONE OF AMERICA		No
(24)MAPLEVIEW INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1876232	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(25)MCCC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 27-0333241	RESOURCES	IL	501C3	12B	CENTERSTON CENTERSTONE OF ILLINOIS		No
(26)MHC DEVELOPMENT COMPANY INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 37-1120291	HOUSING	IL	501C3	10	N/A		No
(27)OAKVIEW INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-1942794	PRIV FOUND	IN	501C3	PF	CENTERSTON CENTERSTONE OF INDIANA		No
(28)PINEVIEW INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-2129307	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(29)RED OAK INDUSTRIES INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 20-4805937	CLEANING S	IN	501C3	10	NA		No
(30)THEODORO PLACE 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 20-1885830	HOUSING	IL	501C3	10	CENTERSTON CENTERSTONE OF ILLINOIS		No
(31)WELLSPRING RESOURCES 44 VANTAGE WAY SUITE 40 NASHVILLE,TN37228 37-0798015	MENTAL HEA	IL	501C3	7	CENTERSTON CENTERSTONE OF ILLINOIS		No
(32)WILLOWVIEW INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 35-2129471	HOUSING	IN	501C3	10	CENTERSTON CENTERSTONE OF INDIANA		No
(33)YAKUBIAN HOMES INC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 37-1393454	HOUSING	IL	501C3	10	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) PRIZAM HEALTHCARE TECHNOLOGIES LLC 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 38-3935772	HEALTHCARE	TN	CENTERSTON				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) CENTERSTONE HEALTHCARE PARTNERS IN 44 VANTAGE WAY SUITE 400 NASHVILLE,TN37228 46-2383025	MGT CO	TN	CENTERSTON	C CORP				No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(d) Method of determining amount involved
(1) CENTERSTONE OF TN	L	COST
(2) CENTERSTONE OF IN	L	COST
(3) CENTERSTONE OF IL	L	COST
(4) CENTERSTONE OF KY	L	COST
(5) CENTERSTONE OF FL	L	COST
(6) CENTERSTONE RESEARCH INSTITUTE	L	COST
(7) ADVANTAGE BEHAVIORAL HEALTH	L	COST
(8) CENTERSTONE MILITARY SERVICES	L	COST

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation
SCHEDULE R	PART III, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIP: NAME, ADDRESS, AND EIN OF RELATED ORGANIZATION: PRIZAM HEALTHCARE TECHNOLOGIES, LLC EIN: 38-3935772 44 VANTAGE WAY, SUITE 400 NASHVILLE, TN 37228 PARTIV, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST: NAME OF RELATED ORGANIZATION: CENTERSTONE HEALTHCARE PARTNERS, INC. DIRECT CONTROLLING ENTITY: CENTERSTONE OF AMERICA

Return Reference

Explanation

SCHEDULE R

PART III, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIP: NAME, ADDRESS, AND EIN OF RELATED ORGANIZATION: PRIZAM HEALTHCARE TECHNOLOGIES, LLC EIN: 38-3935772 44 VANTAGE WAY, SUITE 400 NASHVILLE, TN 37228 PARTIV, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST: NAME OF RELATED ORGANIZATION: CENTERSTONE HEALTHCARE PARTNERS, INC. DIRECT CONTROLLING ENTITY: CENTERSTONE OF AMERICA

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HEALTH CARE, NUTRITION, PRENATAL CARE AND COUNSELING, BIRTH CONTROL, VACCINES AND RELATED EDUCATIONAL HEALTH PROGRAMS FOR AT-RISK INDIVIDUALS OF PUTNAM AND OWEN COUNTIES OF WEST-CENTRAL INDIANA.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	4
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	654,444	9,458
9	Program service revenue (Part VIII, line 2g) .........	60,383	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	201	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	25,724	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	740,752	9,458
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	534,492	0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	150,644	8,790
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	685,136	8,790
19	Revenue less expenses. Subtract line 18 from line 12.......	55,616	668
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	135,418	58,175
21	Total liabilities (Part X, line 26).............	114,622	0
22	Net assets or fund balances. Subtract line 21 from line 20.....	20,796	58,175

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 8,790 including grants of $ ) (Revenue $ 9,458 )
	SEE SCHEDULE O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses8,790

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) DR STEVE KISSEL...................................................................... BOARD MEMBER	.................	X		0	0	0
(2) RICHARD SMOCK...................................................................... PRESIDENT	.................	X	X	0	0	0
(3) BOB SIEGMANN...................................................................... VICE PRESIDE	.................	X	X	0	0	0
(4) DR GREG SIDELL...................................................................... BOARD MEMBER	.................	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	9,458

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		9,458

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....

3 Investment income (including dividends, interest, and othersimilar amounts) ......
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			9,458

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)
12	Advertising and promotion ....
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	80	80
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..
23	Insurance ...
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PROGRAM EXPENSES	8,570	8,570
b	BANK CHARGES	140	140
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	8,790	8,790	0	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........		51,528	1	9,858
2	Savings and temporary cash investments .........			2
3	Pledges and grants receivable, net ......		83,890	3	48,317
4	Accounts receivable, net .............			4
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				6
7	Notes and loans receivable, net ...........			7
8	Inventories for sale or use ............			8
9	Prepaid expenses and deferred charges ......			9
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c
11	Investments—publicly traded securities .			11
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 ..			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........			15
16	Total assets. Add lines 1 through 15 (must equal line 33)...		135,418	16	58,175

17	Accounts payable and accrued expenses .....	114,622	17
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D		25
26	Total liabilities. Add lines 17 through 25..	114,622	26	0

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	20,796	32	58,175
33	Total liabilities and net assets/fund balances ........	135,418	33	58,175