TY 2021 Form 990

- TIN:

SCHEDULE A
(Form 990)

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

CHILD MIND MEDICAL PRACTICE PLLC

Employer identification number

27-3037790

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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
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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
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

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

First 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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)		(d) 2020	(e) 2021	(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	2,819,692	23,324,192	26,143,884
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	2,819,692	23,324,192	26,143,884
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons			0
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.			0
c	Add lines 7a and 7b..			0
8	Public support. (Subtract line 7c from line 6.)			26,143,884

Section B. Total Support

Calendar year (or fiscal year beginning in)		(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...	2,819,692	23,324,192	26,143,884
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 on 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.) ..	177,465	1,082,098	1,259,563
13	Total support. (Add lines 9, 10c, 11, and 12.)..	2,997,157	24,406,290	27,403,447

First 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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, PART III, LINE 12, EXPLANATION OF OTHER INCOME:	ADMINISTRATIVE SERVICES - 2020 AMOUNT: $ 157,573. 2021 AMOUNT: $ 926,005. OTHER REVENUE - 2020 AMOUNT: $ 19,892. 2021 AMOUNT: $ 44,236. GAIN ON LEASE EXIT ACTIVITY - 2021 AMOUNT: $ 111,857.
PART III SECTION B LINE 14	CHILD MIND MEDICAL PRACTICE, PLLC RECEIVED A FAVORABLE DETERMINATION LETTER FOR TAX EXEMPT STATUS UNDER SECTION 501 (C) (3) OF THE INTERNAL REVENUE CODE IN MARCH 2022, EFFECTIVE JULY 31, 2021.

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILD MIND MEDICAL PRACTICE PLLC

Employer identification number

27-3037790

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....	182,627	174,113	8,514
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				8,514

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)DUE FROM AFFILIATED ORGANIZATIONS				548,447
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				548,447

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,728,763
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1	24,406,290
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e	0
3	Subtract line 2e from line 1..................		3	24,406,290
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5	24,406,290

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1	24,251,298
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e	0
3	Subtract line 2e from line 1...................		3	24,251,298
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5	24,251,298

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	CHILD MIND MEDICAL PRACTICE, PLLC (THE "NEW YORK PRACTICE") IS SUBJECT TO THE PROVISIONS OF THE FASB ASC TOPIC 740, INCOME TAXES, AS IT RELATES TO ACCOUNTING AND REPORTING FOR UNCERTAINTY IN INCOME TAXES. BECAUSE OF THE NEW YORK PRACTICE'S GENERAL TAX-EXEMPT STATUS, ASC TOPIC 740 HAS NOT HAD, AND IS NOT ANTICIPATED TO HAVE, A MATERIAL IMPACT ON THE NEW YORK PRACTICE'S FINANCIAL STATEMENTS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILD MIND MEDICAL PRACTICE PLLC

Employer identification number

27-3037790

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1HAROLD KOPLEWICZ MD CEO, MEDICAL DIRECTOR, PSY	(i) (ii)	645,047 ------------- 573,403	333,334 ------------- 0	0 ------------- 104,068	0 ------------- 10,000	0 ------------- 31,835	978,381 ------------- 719,306	0 ------------- 0
2ROY BOORADY MD PSYCHIATRIST	(i) (ii)	1,273,662 ------------- 0	0 ------------- 0	0 ------------- 0	13,548 ------------- 0	7,692 ------------- 0	1,294,902 ------------- 0	0 ------------- 0
3ALI SARPER TASKIRAN MD PSYCHIATRIST	(i) (ii)	653,253 ------------- 233,333	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	653,253 ------------- 233,333	0 ------------- 0
4NATALIE WEDER MD PSYCHIATRIST	(i) (ii)	781,034 ------------- 0	0 ------------- 0	0 ------------- 0	10,000 ------------- 0	0 ------------- 0	791,034 ------------- 0	0 ------------- 0
5PAUL MITRANI MD PHD CLINICAL DIRECTOR, PSYCHIA	(i) (ii)	694,593 ------------- 0	0 ------------- 0	0 ------------- 0	10,000 ------------- 0	15,566 ------------- 0	720,159 ------------- 0	0 ------------- 0
6JEROME BUBRICK PHD SR CLINICAL PSYCHOLOGIST	(i) (ii)	532,243 ------------- 0	0 ------------- 0	0 ------------- 0	10,000 ------------- 0	13,212 ------------- 0	555,455 ------------- 0	0 ------------- 0
7MARY CORCORAN EXECUTIVE DIRECTOR	(i) (ii)	0 ------------- 391,322	0 ------------- 0	0 ------------- 0	0 ------------- 10,000	0 ------------- 21,094	0 ------------- 422,416	0 ------------- 0
8BRETT DAKIN THRU 82022 SECRETARY	(i) (ii)	0 ------------- 281,550	0 ------------- 0	0 ------------- 0	0 ------------- 10,000	0 ------------- 13,825	0 ------------- 305,375	0 ------------- 0
9AMIE CLANCY CHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 284,101	0 ------------- 0	0 ------------- 0	0 ------------- 10,000	0 ------------- 5,825	0 ------------- 299,926	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	THE NEW YORK PRACTICE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION REVIEW POLICY, WHICH IT FOLLOWS WHEN APPROVING THE COMPENSATION AND BENEFITS OF THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS REVIEWED EVERY TWO TO THREE YEARS BY AN INDEPENDENT CONSULTANT, QUALIFIED TO REVIEW SIMILAR POSITIONS IN COMPARABLE NON-PROFIT ORGANIZATIONS. THE NEW YORK PRACTICE HAS ALSO ENGAGED A COMPENSATION CONSULTANT TO ASSESS THE REASONABLENESS OF THE COMPENSATION PROVIDED TO THE NEW YORK PRACTICE'S HIGHEST PAID EMPLOYEES, INCLUDING ALL PSYCHIATRISTS.
PART I, LINE 7	CERTAIN CLINICIANS PROVIDING SERVICES TO PATIENTS OF THE NY PRACTICE ARE ELIGIBLE TO RECEIVE VARIABLE PAY OR INCENTIVES. PAYMENT OF SUCH REWARDS IS CONDITIONED ON THE ACHIEVEMENT OF FINANCIAL TARGETS RELATING TO COLLECTIONS FOR SERVICES. THE AMOUNTS PAID REPRESENT ONLY A LIMITED PORTION OF THE TOTAL COLLECTED; THE REMAINDER ENSURES THAT THE NY PRACTICE ACHIEVES A LEVEL OF REVENUE THAT WILL SUPPORT ITS OPERATIONS AND INVEST IN ENHANCING ITS OPERATIONS AND MEASURING PATIENT OUTCOMES.

Return Reference

Explanation

PART I, LINE 3

THE NEW YORK PRACTICE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION REVIEW POLICY, WHICH IT FOLLOWS WHEN APPROVING THE COMPENSATION AND BENEFITS OF THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS REVIEWED EVERY TWO TO THREE YEARS BY AN INDEPENDENT CONSULTANT, QUALIFIED TO REVIEW SIMILAR POSITIONS IN COMPARABLE NON-PROFIT ORGANIZATIONS. THE NEW YORK PRACTICE HAS ALSO ENGAGED A COMPENSATION CONSULTANT TO ASSESS THE REASONABLENESS OF THE COMPENSATION PROVIDED TO THE NEW YORK PRACTICE'S HIGHEST PAID EMPLOYEES, INCLUDING ALL PSYCHIATRISTS.

PART I, LINE 7

CERTAIN CLINICIANS PROVIDING SERVICES TO PATIENTS OF THE NY PRACTICE ARE ELIGIBLE TO RECEIVE VARIABLE PAY OR INCENTIVES. PAYMENT OF SUCH REWARDS IS CONDITIONED ON THE ACHIEVEMENT OF FINANCIAL TARGETS RELATING TO COLLECTIONS FOR SERVICES. THE AMOUNTS PAID REPRESENT ONLY A LIMITED PORTION OF THE TOTAL COLLECTED; THE REMAINDER ENSURES THAT THE NY PRACTICE ACHIEVES A LEVEL OF REVENUE THAT WILL SUPPORT ITS OPERATIONS AND INVEST IN ENHANCING ITS OPERATIONS AND MEASURING PATIENT OUTCOMES.

Schedule J (Form 990) 2021

Additional Data

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Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILD MIND MEDICAL PRACTICE PLLC

Employer identification number

27-3037790

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) CHILD MIND MEDICAL PRACTICE PC	SEE PART V		SEE PART V		No
(2) HAROLD KOPLEWICZ MD	SEE PART V		SEE PART V		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS

(A) INTERESTED PERSON: HAROLD KOPLEWICZ, MD(B) ENTITIES: CHILD MIND MEDICAL PRACTICE, PC (THE "CA PRACTICE")(C) RELATIONSHIP: HAROLD KOPLEWICZ, MD , THE SOLE MEMBER OF CHILD MIND MEDICAL PRACTICE, PLLC (THE "NY PRACTICE"), IS ALSO THE SOLE SHAREHOLDER OF THE CA PRACTICE. THE CA PRACTICE WAS FORMED TO PROVIDE CLINICAL CARE AND TREATMENT TO CHILDREN AND ADOLESCENTS AND TO PERFORM CERTAIN ACTIVITIES RELATED TO CMI'S RESEARCH, WHICH UNDER APPLICABLE STATE LAW CMI IS NOT PERMITTED TO PERFORM AND WHICH ARE CRITICAL TO CMI'S MISSION TO TRANSFORM THE LIVES OF CHILDREN AND FAMILIES STRUGGLING WITH MENTAL HEALTH AND LEARNING DISORDERS.(D) TRANSACTIONS:(1) SERVICES AGREEMENT. PURSUANT TO A MUTUAL SERVICES AGREEMENT BETWEEN THE NY PRACTICE AND THE CA PRACTICE, THE NY PRACTICE PROVIDES CERTAIN SERVICES TO THE CA PRACTICE FOR WHICH THE CA PRACTICE COMPENSATES THE NY PRACTICE. CONSISTENT WITH THE NY PRACTICE'S INTERNAL POLICIES AND PROCEDURES, THIS COMPENSATION IS BASED ON THE ACTUAL COST OF PROVIDING THE SERVICES. THE CA PRACTICE'S PAYMENT OBLIGATIONS TO THE NY PRACTICE FOR SERVICES PROVIDED UNDER THIS SERVICE AGREEMENT IS CURRENTLY REFLECTED AS A RECEIVABLE ON THE NY PRACTICE'S FINANCIAL STATEMENTS IN THE AMOUNT OF $230,859 AS INCLUDED IN PART X OF THIS FORM 990.(2) BOARD OVERSIGHT OF RELATIONSHIP AND TRANSACTIONS:AS NOTED ABOVE, DR. KOPLEWICZ IS THE SOLE MEMBER OF THE NY PRACTICE AND THE SOLE SHAREHOLDER OF THE CA PRACTICE. ACCORDINGLY, THE TRANSACTIONS AMONG THE NY PRACTICE AND THE CA PRACTICE, INCLUDING THE AGREEMENT DESCRIBED ABOVE, WERE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS OF CMI. FURTHERMORE, THE AUDIT & FINANCE COMMITTEE OF THE BOARD OF DIRECTORS OF CMI OVERSEES THE ONGOING RELATIONSHIP AMONG CMI, THE NY PRACTICE AND THE CA PRACTICE IN ACCORDANCE WITH CMI'S CONFLICT OF INTEREST AND DISCLOSURE POLICY.

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

CHILD MIND MEDICAL PRACTICE PLLC

Employer identification number

27-3037790

Return Reference	Explanation
FORM 990 PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:	CHILD MIND MEDICAL PRACTICE, PLLC (THE "NY PRACTICE") IS A PHYSICIAN PRACTICE ENTITY AFFILIATED WITH CHILD MIND INSTITUTE, INC. ("CMI"), A SECTION 501(C)(3) ORGANIZATION. BOTH THE NY PRACTICE AND CMI ARE LOCATED IN NEW YORK, NEW YORK. CMI'S CHARITABLE PURPOSE IS TO (I) PROVIDE PHYSICIANS, EDUCATORS, MENTAL HEALTH PROFESSIONALS, AND PARENTS WITH THE PROGRAMS, TOOLS, AND KNOWLEDGE NEEDED TO PROMOTE THE MENTAL HEALTH OF THE CHILDREN AND ADOLESCENTS THAT THEY SERVE, AND (II) CONDUCT AND SUPPORT RESEARCH PROGRAMS THAT ADVANCE THE SCIENTIFIC KNOWLEDGE, PREVENTION, AND TREATMENT OF CRITICAL MENTAL HEALTH PROBLEMS FACING CHILDREN AND ADOLESCENTS. A FUNDAMENTAL COMPONENT OF CMI'S CHARITABLE PURPOSES IS TO PROVIDE CHILDREN, ADOLESCENTS, AND THEIR FAMILIES WITH ACCESS TO CLINICAL SERVICES AND TO CONDUCT RESEARCH IN FURTHERANCE OF ADVANCING BRAIN SCIENCE, PRIMARILY AIMED AT DEVELOPING INNOVATIVE EFFECTIVE EVIDENCE-BASED TREATMENTS AND EXPERT DIAGNOSIS TO IMPROVE THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS. IN SUPPORT OF CMI'S CHARITABLE PURPOSES, THE NY PRACTICE EMPLOYS LICENSED THERAPISTS AND CLINICIANS AND BOARD CERTIFIED PSYCHIATRISTS AND (I) PROVIDES CLINICAL SERVICES TO CHILDREN AND ADOLESCENTS WITH PSYCHIATRIC, PSYCHOLOGICAL, LEARNING, EMOTIONAL, AND BEHAVIORAL (COLLECTIVELY, "MENTAL HEALTH") CONDITIONS AND DISORDERS AND THEIR FAMILIES, (II) CONDUCTS EDUCATIONAL PROGRAMMING TO EDUCATE THE PUBLIC, INCLUDING TEACHERS, HEALTHCARE PROVIDERS, AND OTHERS, ABOUT MENTAL HEALTH CONDITIONS AND DISORDERS, (III) CONDUCTS MEDICAL AND SCIENTIFIC RESEARCH RELATING TO MENTAL HEALTH CONDITIONS AND DISORDERS AND FREELY SHARES THE RESULTS WITH THE GLOBAL SCIENTIFIC AND MEDICAL COMMUNITY, AND (IV) OTHERWISE SUPPORTS CMI'S CHARITABLE PURPOSES, INCLUDING THROUGH MEDIA APPEARANCES AND OTHER PUBLIC OUTREACH.
FORM 990 PART V, LINE 15	THE COMPENSATION NOTED ON PART VII TO PSYCHIATRISTS IS PAID FOR THE PERFORMANCE OF MEDICAL SERVICES BY LICENSED MEDICAL PROFESSIONALS AND IS NOT SUBJECT TO SECTION 4960 TAX ON PAYMENT OF MORE THAN $1,000,000 IN REMUNERATION OR EXCESS PARACHUTE PAYMENTS IN ACCORDANCE WITH SECTIONS 4960(C) (3) (B) AND (C) (5) (C) (III).
FORM 990, PART VII LINE 1 AND PART V, LINE 15	ALTHOUGH HAROLD KOPLEWICZ, MD RECEIVED COMPENSATION ON HIS W-2 IN EXCESS OF $1,000,000, INCLUDING COMPENSATION FROM A RELATED ORGANIZATION, THIS COMPENSATION IS NOT SUBJECT TO THE TAX UNDER SECTION 4960, BECAUSE (I) PART OF THE COMPENSATION WAS PAID BY ANOTHER ORGANIZATION BEFORE IT BECAME A RELATED ORGANIZATION AND (II) PART OF THE COMPENSATION IS COMPENSATION PAID TO A LICENSED MEDICAL PROFESSIONAL FOR THE PERFORMANCE OF MEDICAL SERVICES. CMI AND THE NY PRACTICE BECAME RELATED ENTITIES PURSUANT TO AN AFFILIATION AGREEMENT IN RELATION TO THE NY PRACTICE'S APPLICATION FOR EXEMPT STATUS ON JULY 30, 2021, AND THE NON-MEDICAL SERVICE COMPENSATION FROM THE NY PRACTICE FROM AUGUST 2021 TO DECEMBER 2021 FOR HAROLD KOPLEWICZ, MD WAS $135,417. THEREFORE, THE TOTAL REMUNERATION TO HAROLD KOPLEWICZ, MD FOR PURPOSES OF SECTION 4960 WAS $812,888, WHICH IS BELOW THE $1,000,000 THRESHOLD.
FORM 990, PART VI, SECTION A, LINE 2	ALL OFFICERS ARE ALSO EMPLOYEES OF CHILD MIND INSTITUTE, INC. ("CMI").
FORM 990, PART VI, SECTION A, LINE 6	DR. HAROLD KOPLEWICZ IS THE SOLE MEMBER OF CHILD MIND MEDICAL PRACTICE, PLLC.
FORM 990, PART VI, SECTION A, LINE 8B	THE NY PRACTICE DOES NOT HAVE A BOARD OF DIRECTORS OR ANY COMMITTEES.
FORM 990, PART VI, SECTION B, LINE 11B	THE NY PRACTICE'S FORM 990 IS PREPARED BY AN OUTSIDE TAX PREPARER BASED ON INFORMATION PROVIDED BY THE ORGANIZATION'S FINANCE STAFF. THE DRAFT FORM 990 IS THEN REVIEWED BY THE NY PRACTICE'S GENERAL COUNSEL AND OUTSIDE COUNSEL. PRIOR TO FILING THE FORM 990 WITH THE IRS, A COPY IS SHARED WITH THE SOLE MEMBER AND ALL MEMBERS OF CMI'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C	THE NEW YORK PRACTICE'S CONFLICT OF INTEREST AND DISCLOSURE POLICY REQUIRES MEMBERS AND OFFICERS TO DISCLOSE POTENTIAL AND ACTUAL CONFLICTS AND TO RECUSE THEMSELVES FROM DELIBERATIONS AND VOTES ON MATTERS THAT INVOLVE A CONFLICT. THE NEW YORK PRACTICE OBTAINS A SIGNED CONFLICT OF INTEREST DISCLOSURE FORM FROM EACH MEMBER, OFFICER, AND KEY EMPLOYEE ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION B, LINE 15	THE NY PRACTICE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION REVIEW POLICY, WHICH CMI'S BOARD OF DIRECTORS FOLLOWS WHEN APPROVING THE COMPENSATION AND BENEFITS OF THE CEO. THE CEO'S COMPENSATION IS REVIEWED EVERY TWO TO THREE YEARS BY AN INDEPENDENT CONSULTANT, QUALIFIED TO REVIEW SIMILAR POSITIONS IN COMPARABLE NON-PROFIT ORGANIZATIONS. EACH YEAR, THE COMPENSATION COMMITTEE OF CMI'S BOARD OF DIRECTORS, WHICH IS COMPOSED OF NON-INTERESTED MEMBERS, REVIEWS THE INDEPENDENT CONSULTANT'S REPORT, INCLUDING APPROPRIATE COMPARABILITY DATA, AND MAKES A DETERMINATION ABOUT THE CEO'S ANNUAL COMPENSATION BASED ON ALL RELEVANT FACTORS, ENSURING THAT THE COMPENSATION IS REASONABLE. THE COMMITTEE REVIEWS THE CEO'S TOTAL COMPENSATION, WHICH INCLUDES BOTH CURRENT COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S DELIBERATIONS AND DECISIONS ARE DOCUMENTED CONTEMPORANEOUSLY IN THE COMMITTEE'S MINUTES AND RETAINED IN THE ORGANIZATION'S RECORDS.
FORM 990, PART VI, SECTION C, LINE 19	AVAILABILITY OF ORGANIZATIONAL DOCUMENTS: THE NY PRACTICE'S FORMS 990, AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST AND DISCLOSURE POLICY ARE AVAILABLE UPON REQUEST.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

CHILD MIND MEDICAL PRACTICE PLLC

Employer identification number

27-3037790

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)CHILD MIND INSTITUTE INC 101 EAST 56TH STREET NEW YORK,NY10022 80-0478843	CHILDREN'S MENTAL HEALTH	NY	501(C)(3)	LINE 7	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

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) ............................

Yes

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) .................

Yes

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

Yes

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

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

Yes

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

Yes

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)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference

Explanation

FORM 990, SCHEDULE R PART V

TRANSACTIONS: (1) FORMATION. UNDER APPLICABLE STATE LAW, ONLY PERSONS WHO ARE LICENSED TO PRACTICE MEDICINE MAY HOLD AN OWNERSHIP INTEREST IN AN ENTITY FORMED TO PROVIDE CLINICAL CARE AND TREATMENT. CMI, AS A NEW YORK NOT-FOR-PROFIT CORPORATION, IS THEREFORE NOT PERMITTED TO HOLD AN OWNERSHIP INTEREST IN THE CHILD MIND MEDICAL PRACTICE, PLLC (THE "NY PRACTICE"). IN FURTHERANCE OF CMI'S MISSION, TO PROTECT CMI'S INTERESTS, TO SUPPORT CLINICAL AND RESEARCH ACTIVITIES CONDUCTED BY THE PRACTICE, AND TO COMPLY WITH THE FOREGOING OWNERSHIP REQUIREMENT, DR. KOPLEWICZ, A PHYSICIAN LICENSED IN NEW YORK AND CALIFORNIA, IS THE SOLE MEMBER OF THE NY PRACTICE. (2) THE MEMBERSHIP INTERESTS IN THE NY PRACTICE HAVE BEEN STRUCTURED SO THAT NO MEMBER CAN RECEIVE, OR OTHERWISE REALIZE, ANY ECONOMIC BENEFIT FROM HOLDING THESE MEMBERSHIP INTERESTS OR FROM THE SALE OR OTHER DISPOSITION THEREOF. THE MEMBER HAS ENTERED INTO A BUY-SELL AGREEMENT WITH THE NY PRACTICE PURSUANT TO WHICH HE HAS AGREED NOT TO SELL HIS INTERESTS TO ANY PARTY OTHER THAN THE NY PRACTICE, WHICH MAY RE-PURCHASE HIS INTERESTS FOR AN AMOUNT NOT TO EXCEED THE NOMINAL AMOUNT THAT THE MEMBER PAID TO ACQUIRE THEM. FURTHER, THE NY PRACTICE'S ARTICLES OF ORGANIZATION PROVIDE THAT THE NY PRACTICE IS TO BE OPERATED SOLELY FOR CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES IN FURTHERANCE AND SUPPORT OF CMI'S MISSION TO THE EXTENT NOT INCONSISTENT WITH RELEVANT NEW YORK LAW. NONE OF THE NY PRACTICE'S ASSETS, NET EARNINGS, INCOME OR PROFIT MAY BE DISTRIBUTED TO ANY MEMBER, MANAGER, OFFICER OR EMPLOYEE OF THE NY PRACTICE OR OTHER PRIVATE PERSON, AND IF THE NY PRACTICE IS EVER DISSOLVED, ITS ASSETS AND PROPERTY MUST BE DISTRIBUTED TO A CHARITABLE ORGANIZATION QUALIFYING FOR EXEMPTION FROMTAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CMI, THE NY PRACTICE, AND ITS MEMBER HAVE ALSO ENTERED INTO AN AFFILIATION AGREEMENT PROVIDING THAT THE MEMBER HOLDS HIS INTERESTS IN THE NY PRACTICE SOLELY FOR THE BENEFIT OF CMI AND CMI HAS THE RIGHT, IN ITS SOLE DISCRETION, TO FORCE THE TRANSFER OF A MEMBER'S INTERESTS IN THE NY PRACTICE TO ANOTHER LICENSED PHYSICIAN. (3) RESTRICTED GRANT AGREEMENT. TO FACILITATE THE FORMATION OF THE NY PRACTICE, THE CONDUCT BY THE PRACTICE OF CLINICAL AND RESEARCH ACTIVITIES THAT FURTHER CMI'S MISSION, CMI ENTERED INTO A RESTRICTED GRANT AGREEMENT WITH THE NY PRACTICE PURSUANT TO WHICH CMI AGREED TO MAKE SPECIAL PURPOSE RESTRICTED GRANTS TO THE AGGREGATE AMOUNT OF $1,750,000. THE RESTRICTED GRANT AGREEMENT PROVIDES, AMONG OTHER THINGS, THAT: (X) THE NY PRACTICE IS REQUIRED TO OPERATE IN A MANNER THAT IS, AND LIMITS ITS ACTIVITIES TO THOSE THAT ARE, CONSISTENT WITH AND FURTHER THE MISSION OF CMI; (Y) THE GRANTS MUST BE USED BY THE NY PRACTICE EXCLUSIVELY IN CONNECTION WITH THE CONDUCT OF ACTIVITIES THAT FURTHER AND SUPPORT CMI'S MISSION; AND (Z) THE NY PRACTICE MUST OBSERVE VARIOUS REPORTING, BUDGETARY AND OTHER FINANCIAL REQUIREMENTS AND ENGAGE AUDITORS ACCEPTABLE TO CMI. IF THE NY PRACTICE FAILS TO OBSERVE THE REQUIREMENTS OF THE RESTRICTED GRANT AGREEMENT, THE AGREEMENT MAY BE TERMINATED, IN WHICH CASE UNSPENT FUNDS MUST BE RETURNED TO CMI AND DAMAGES MAY BE DUE. (4) SERVICES AGREEMENT. PURSUANT TO AN ADMINISTRATIVE SERVICES AGREEMENT BETWEEN CMI AND THE NY PRACTICE, CMI PROVIDES CERTAIN SERVICES TO THE NY PRACTICE FOR WHICH THE NY PRACTICE COMPENSATES CMI. CONSISTENT WITH CMI'S INTERNAL POLICIES AND PROCEDURES, THIS COMPENSATION IS BASED ON THE ACTUAL COST OF PROVIDING THE SERVICES. THE PRACTICE'S PAYMENT OBLIGATIONS TO CMI FOR SERVICES PROVIDED UNDER THIS SERVICES AGREEMENT IS CURRENTLY REFLECTED AS A PAYABLE ON THE NY PRACTICE'S FINANCIAL STATEMENTS IN THE AMOUNT OF $1,660,802 AS REFLECTED IN PART X OF THIS FORM 990. (5) LICENSE AGREEMENT. PURSUANT TO A LICENSE AGREEMENT BETWEEN CMI AND THE NY PRACTICE, CMI GRANTED A ROYALTY-FREE LICENSE TO USE CERTAIN OF ITS TRADEMARKS AND DOMAIN NAMES TO THE NY PRACTICE SUBJECT TO CERTAIN TERMS AND CONDITIONS, INCLUDING CMI'S RIGHT TO TERMINATE THE LICENSE AGREEMENT IN THE EVENT OF THE BREACH OF THE TERMS AND CONDITIONS OF THE RESTRICTED GRANT AGREEMENT. (6) GRANT SERVICES AGREEMENT. PURSUANT TO A GRANT SERVICES AGREEMENT BETWEEN CMI AND THE NY PRACTICE, CMI ENGAGES THE NY PRACTICE TO PROVIDE CERTAIN SERVICES REQUIRED BY CONTRIBUTIONS OR GRANTS THAT CMI HAS RECEIVED AND WHICH CMI IS UNABLE TO PROVIDE. CMI DISCLOSES TO ITS DONORS AND GRANTORS THAT SERVICES WILL BE SUB-CONTRACTED TO THE NY PRACTICES TO SATISTY THE REQUIREMENTS OF THE DONATION OR GRANT. DURING FY 2022, AMOUNTS PAID BY THE NY PRACTICE PURSUANT TO THE GRANT SERVICES AGREEMENT IN PERFORMANCE OF THESE REQUIREMENTS AMOUNTED TO $3,591,816, INCLUDED UNDER GRANT SUBCONTRACT REVENUE IN PART VIII OF THIS FORM 990. (7) BOARD OVERSIGHT OF RELATIONSHIP AND TRANSACTIONS: AS NOTED ABOVE, DR. KOPLEWICZ IS THE PRESIDENT OF CMI AND THE SOLE MEMBER OF THE NY PRACTICE. ACCORDINGLY, THE TRANSACTIONS BETWEEN CMI AND THE NY PRACTICE, INCLUDING THE AGREEMENTS DESCRIBED ABOVE, WERE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS OF CMI. FURTHERMORE, THE AUDIT & FINANCE COMMITTEE OF THE BOARD OF DIRECTORS OF CMI OVERSEES THE ONGOING RELATIONSHIP BETWEEN CMI AND THE NY PRACTICE IN ACCORDANCE WITH CMI'S CONFLICT OF INTEREST AND DISCLOSURE POLICY.

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TRANSFORMING THE LIVES OF CHILDREN STRUGGLING WITH MENTAL HEALTH & LEARNING DISORDERS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	1
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	0
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	154
6	Total number of volunteers (estimate if necessary) .............	6	85
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	2,819,692	23,324,192
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	0	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	177,465	1,082,098
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	2,997,157	24,406,290
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	2,719,564	18,962,288
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	868,115	5,289,010
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	3,587,679	24,251,298
19	Revenue less expenses. Subtract line 18 from line 12.......	-590,522	154,992
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,964,544	1,598,542
21	Total liabilities (Part X, line 26).............	3,822,594	3,301,600
22	Net assets or fund balances. Subtract line 21 from line 20.....	-1,858,050	-1,703,058

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,554,612 including grants of $ ) (Revenue $ 1,543,991 )
	EDUCATION AND OUTREACHEDUCATING THE PUBLIC: THE NY PRACTICE CREATES, PUBLISHES, AND OTHERWISE DISSEMINATES FREE EDUCATIONAL RESOURCES ABOUT MENTAL HEALTH AND HOW TO SUPPORT CHILDREN WHO HAVE MENTAL HEALTH DISORDERS AND CONDITIONS. FOR EXAMPLE, THE NY PRACTICE HAS CONTRIBUTED THE CLINICAL EXPERTISE THAT INFORMS DOZENS OF GUIDES ON CMI'S WEBSITE THAT COVER A WIDE VARIETY OF TOPICS RELATING TO MENTAL HEALTH, INCLUDING BASIC INFORMATION AND INFORMATION ABOUT THE PREVALENCE AND IDENTIFYING MARKERS OF CERTAIN DISORDERS AND CONDITIONS, COPING WITH DISTRESSING EVENTS AND TRAUMA, AND HOW TO SUPPORT PEOPLE WHO HAVE CERTAIN DISORDERS AND CONDITIONS. THE NY PRACTICE ALSO CONTRIBUTES THE CLINICAL EXPERTISE THAT INFORMS DOZENS OF ARTICLES ON CMI'S WEBSITE TO HELP FAMILIES AND EDUCATORS LEARN HOW TO SUPPORT PEOPLE WITH MENTAL HEALTH CONDITIONS, IMPROVE THEIR ACADEMIC PERFORMANCE, AND OTHERWISE ADDRESS A MULTITUDE OF CHALLENGES THAT CAN ARISE ON A DAY-TO-DAY BASIS.IN CONJUNCTION WITH THE CMI, THE NY PRACTICE ALSO CONDUCTS ONLINE AND IN-PERSON EDUCATIONAL PROGRAMS, INCLUDING LECTURES, TRAININGS, CLASSES, AND WORKSHOPS, ON TOPICS RELATING TO MENTAL HEALTH FOR PEOPLE WITH MENTAL HEALTH CONDITIONS AND THEIR FAMILIES, EDUCATORS, CAREGIVERS, AND OTHERS WHO WORK WITH PEOPLE WITH MENTAL HEALTH CONDITIONS, PEOPLE WHO HAVE EXPERIENCED TRAUMA, AND STUDENTS IN GENERAL.THE NY PRACTICE CONTRIBUTES EDUCATIONAL SERVICES THAT ARE REQUIRED FOR THE CMI'S SCHOOL AND COMMUNITY PROGRAMS, INCLUDING WORKSHOPS FOR TEACHERS AND PARENTS ON TOPICS LIKE STRESS MANAGEMENT, LEARNING SUPPORTS, BEHAVIOR MANAGEMENT, AND TRAUMA-INFORMED STUDENT SUPPORT, AS WELL AS TRAINING FOR SCHOOL COUNSELORS AND EDUCATORS TO DELIVER THE NY PRACTICE'S INTERVENTIONS INDEPENDENTLY.THE NY PRACTICE ALSO PROVIDES TUTORING AND REMEDIATION ON SCHOOL SUBJECTS AND EDUCATIONAL SKILLSETS, AND SCHOOL PLACEMENT CONSULTATIONS FOR STUDENTS WHO HAVE LEARNING AND DEVELOPMENT DISORDERS AND CONDITIONS.MEDIA AND PUBLIC OUTREACH: THE NY PRACTICE'S LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS CONDUCT MEDIA APPEARANCES AND INTERVIEWS ON BEHALF OF CMI IN PRINT, ONLINE AND ON-AIR MEDIA OUTLETS SUCH AS NBC, ABC, CBS, AND CNN, AND ON TOPICS INCLUDING RESEARCH INTERPRETATION, PARENTING, AND SUICIDE PREVENTION. THE NY PRACTICE SPENDS APPROXIMATELY 5% OF THE NY PRACTICE'S ORGANIZATIONAL TIME AND RESOURCES ON MEDIA AND PUBLIC OUTREACH. THESE APPEARANCES, FOR WHICH THE NY PRACTICE IS NOT COMPENSATED AND WHICH HAVE REACHED MILLIONS OF VIEWERS AROUND THE WORLD, PROVIDE INVALUABLE SUPPORT FOR THE PUBLIC AWARENESS AND EDUCATIONAL COMPONENT OF THE CMI'S CHARITABLE PURPOSES BY HELPING TO DISSEMINATE EVIDENCE-BASED INFORMATION ABOUT CHILD AND ADOLESCENT MENTAL HEALTH CONDITIONS AND DISORDERS TO THE PUBLIC.

4b	(Code: ) (Expenses $ 1,606,542 including grants of $ ) (Revenue $ 1,606,542 )
	RESEARCHTHE NY PRACTICE CONTRIBUTES CLINICAL SERVICES THAT ARE REQUIRED FOR CMI'S SCIENTIFIC RESEARCH RELATING TO MENTAL HEALTH, THE RESULTS OF WHICH ARE FREELY SHARED WITH THE GLOBAL SCIENTIFIC AND MEDICAL COMMUNITY. THIS SCIENTIFIC RESEARCH IS INTENDED TO HELP ACQUIRE A FULL PICTURE OF HOW THE HUMAN BRAIN MATURES AND FUNCTIONS THROUGHOUT LIFE AND TO DEVELOP SCIENTIFIC ADVANCEMENTS THAT FACILITATE THE TREATMENT, PREVENTION AND EARLY DETECTION OF MENTAL HEALTH CONDITIONS AND DISORDERS. FOR EXAMPLE, ONE PROJECT IS TO CREATE A NEUROIMAGING AND DNA DATABASE OF MORE THAN 10,000 CHILDREN AND ADOLESCENTS THAT IS SHARED FREELY WITH THE SCIENTIFIC COMMUNITY. THE PURPOSE OF THE DATABASE IS TO DISCOVER BIOLOGICAL MARKERS OF MENTAL HEALTH DISORDERS IN THE DEVELOPING BRAIN AND THEREBY ADVANCE THE STUDY OF CHILD AND ADOLESCENT MENTAL HEALTH CONDITIONS AND DISORDERS AND ACCELERATE THE DISCOVERY OF SCIENTIFIC BREAKTHROUGHS THAT WILL HELP PEOPLE WITH MENTAL HEALTH CONDITIONS AND DISORDERS. ANOTHER AREA OF RESEARCH INVOLVES BUILDING AND APPLYING TECHNOLOGIES, SUCH AS WEARABLE DEVICES, MOBILE APPS, AND ANALYTICS TOOLS, TO HELP DIAGNOSE, ASSESS, MONITOR, AND IMPROVE MENTAL HEALTH.

4c	(Code: ) (Expenses $ 14,827,465 including grants of $ ) (Revenue $ 19,732,376 )
	CLINICAL SERVICES AND CLINICIAN PROFESSIONAL DEVELOPMENTTHE NY PRACTICE PROVIDES CLINICAL SERVICES TO CHILDREN AND ADOLESCENTS WITH MENTAL HEALTH CONDITIONS AND DISORDERS AND THEIR FAMILIES, INCLUDING PROVIDING DIAGNOSTIC EVALUATIONS, SPECIALTY TREATMENT PROGRAMS FOR A WIDE VARIETY OF CONDITIONS AND DISORDERS (INCLUDING ADHD AND BEHAVIORAL DISORDERS, ANXIETY DISORDERS, AUTISM, LEARNING AND DEVELOPMENT DISORDERS, MOOD DISORDERS, AND TIC AND TOURETTE SYNDROME, AMONG OTHERS), AND PSYCHOPHARMACOLOGY CARE. THE NY PRACTICE SPENDS APPROXIMATELY 70% OF THE NY PRACTICE'S ORGANIZATIONAL TIME AND RESOURCES ON CLINICAL SERVICES. THE NY PRACTICE'S CLINICAL SERVICES FOR PATIENTS AND THEIR FAMILIES INCLUDE THERAPY, BEHAVIORAL AND EMOTIONAL SKILLS TRAINING, IN-SCHOOL SUPPORT SERVICES AND INTERVENTIONS (INCLUDING IN-CLASS OBSERVATIONS AND COACHING, CONSULTATIONS WITH TEACHERS, ESTABLISHING BEHAVIOR PLANS, AND OTHER SERVICES DESIGNED TO IMPROVE ACADEMIC OUTCOMES FOR CHILDREN WITH MENTAL HEALTH CONDITIONS AND DISORDERS), GROUP PROGRAMS (INCLUDING GROUP THERAPY, PEER-BASED TRAINING PROGRAMS, SUPPORT GROUPS, AND OTHER PEER-ORIENTED CLINICAL SERVICES), AND OTHER THERAPEUTIC AND BENEFICIAL SERVICES. THE NY PRACTICE TAILORS EACH PATIENT'S TREATMENT PLAN TO FIT THE PATIENT'S NEEDS AND THE NEEDS OF THE PATIENT'S FAMILY. POSTDOCTORAL FELLOWSHIP PROGRAM: THE NY PRACTICE CONDUCTS ONE-YEAR (PSYCHOLOGISTS) AND TWO-YEAR (NEUROPSYCHOLOGISTS) FULL-TIME POSTDOCTORAL FELLOWSHIPS TO PROVIDE PROFESSIONAL TRAINING AND PREPARE FELLOWS WHO HAVE DEGREES IN CLINICAL PSYCHOLOGY OR CLINICAL CHILD PSYCHOLOGY FOR SUCCESSFUL CAREERS IN CHILD AND ADOLESCENT PSYCHOLOGY. FELLOWS IN THE PROGRAM ARE SUPERVISED BY THE NY PRACTICE LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS AND THEY PARTICIPATE IN A VARIETY OF LEARNING EXPERIENCES, INCLUDING ATTENDING MULTIDISCIPLINARY CASE CONFERENCES, PARTICIPATING IN CLINICAL MEETINGS WITH PATIENTS, SUPPORTING GROUP TREATMENT AND OTHER CLINICAL PROGRAMS, ATTENDING LECTURES AND OTHER EDUCATIONAL PROGRAMMING PROVIDED BY THE NY PRACTICE, GIVING EDUCATIONAL PRESENTATIONS AT SCHOOLS AND OTHER COMMUNITY-BASED ORGANIZATIONS, AUTHORING OR CO- AUTHORING EDUCATIONAL PAPERS, ARTICLES, AND GUIDES, AND OTHERWISE TRAINING UNDER THE NY PRACTICE'S LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS. FELLOWS IN THE PROGRAM FULFILL POSTDOCTORAL CLINICAL HOURS AND RECEIVE THE SUPERVISION NEEDED FOR LICENSURE. ALL FELLOWS ARE PAID A SALARY AND FULL BENEFITS DURING THE PROGRAM.CLINICAL EXTERNSHIP PROGRAM: THE NY PRACTICE CONDUCTS YEAR-LONG, PART-TIME CLINICAL EXTERNSHIP PROGRAMS IN FIVE DIFFERENT SUBJECT AREAS FOR PSYCHOLOGY GRADUATE STUDENTS IN DOCTORAL PROGRAMS. THE SUBJECT AREAS ARE ADHD AND BEHAVIOR DISORDERS, ANXIETY DISORDERS, MOOD DISORDERS, NEUROPSYCHOLOGY, AND CLINICAL RESEARCH. DURING THE PROGRAM, EXTERNS ATTEND CLINICAL DIDACTIC SEMINARS, CLINICAL CASE CONFERENCES, EDUCATIONAL LECTURES, AND EXTERN GROUP MEETINGS THAT ARE CONDUCTED AND LED BY THE NY PRACTICE. EXTERN TRAINING DIFFERS DEPENDING ON THE SUBJECT AREA BUT GENERALLY INCLUDES TRAINING WITH RESPECT TO DIAGNOSTIC ASSESSMENTS, WRITING, TREATMENT STRATEGIES AND RECOMMENDATIONS, AND RESEARCH. EXTERNS IN THE PROGRAMS ARE SUPERVISED BY THE NY PRACTICE'S LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS.INTERNSHIP PROGRAM: THE NY PRACTICE CONDUCTS A SUMMER INTERNSHIP PROGRAM FOR UNDERGRADUATE STUDENTS WHO ARE INTERESTED IN CAREERS IN CHILD MENTAL HEALTH, MEDICINE, EDUCATION AND SPECIAL EDUCATION, PUBLIC HEALTH, NEUROSCIENCE, AND OTHER RELATED AREAS. THE INTERNSHIP PROVIDES STUDENTS WITH EXPERIENCE WORKING IN THE NY PRACTICE'S OUTPATIENT CLINICAL PRACTICE, LEARNING ABOUT EVIDENCE-BASED TREATMENTS FOR ADHD AND BEHAVIOR DISORDERS, ANXIETY DISORDERS, MOOD DISORDERS, LEARNING AND DEVELOPMENT, AND OTHER PSYCHIATRIC DISORDERS. DURING THE INTERNSHIP, INTERNS SHADOW THE NY PRACTICE'S LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS, CONDUCT AND OTHERWISE PARTICIPATE IN RESEARCH PROJECTS, ATTEND EDUCATIONAL LECTURES, WORKSHOPS AND SEMINARS CONDUCTED BY THE NY PRACTICE, AND OTHERWISE SUPPORT THE NY PRACTICE AND ITS STAFF.SOCIAL WORK TRAINING PROGRAM: THE NY PRACTICE PROVIDES SUPERVISION AND TRAINING FOR LICENSED MASTERS SOCIAL WORKERS (LMSW) TO BECOME LICENSED CLINICAL SOCIAL WORKERS (LCSW). SOCIAL WORKERS IN THE PROGRAM ARE SUPERVISED BY THE NY PRACTICE LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS, AND THEY PARTICIPATE IN A VARIETY OF LEARNING EXPERIENCES, INCLUDING ATTENDING MULTIDISCIPLINARY CASE CONFERENCES, PARTICIPATING IN CLINICAL MEETINGS WITH PATIENTS, SUPPORTING GROUP TREATMENT AND OTHER CLINICAL PROGRAMS, ATTENDING LECTURES AND OTHER EDUCATIONAL PROGRAMMING PROVIDED BY THE NY PRACTICE, GIVING EDUCATIONAL PRESENTATIONS AT SCHOOLS AND OTHER COMMUNITY-BASED ORGANIZATIONS, AUTHORING OR CO-AUTHORING EDUCATIONAL PAPERS, ARTICLES, AND GUIDES, AND OTHERWISE TRAINING UNDER THE NY PRACTICE'S LICENSED THERAPISTS AND CLINICIANS AND BOARD-CERTIFIED PSYCHIATRISTS. SOCIAL WORKERS IN THE PROGRAM FULFILL THE REQUIRED CLINICAL HOURS AND RECEIVE THE SUPERVISION NEEDED FOR LICENSURE. ALL SOCIAL WORKERS ARE PAID A SALARY AND FULL BENEFITS DURING THE PROGRAM.VISITING PROFESSOR LECTURE SERIES: THE NY PRACTICE INVITES LEADERS IN THE FIELD OF CHILD AND ADOLESCENT MENTAL HEALTH TO TALK ABOUT THE LATEST RESEARCH AND TREATMENT PROTOCOLS. ALL EVENTS ARE OPEN TO THE PUBLIC AND CONTINUING MEDICAL EDUCATION (CME) CREDITS FOR PSYCHIATRISTS AND CONTINUING EDUCATION (CE) CREDITS FOR PSYCHOLOGISTS ARE AVAILABLE TO REGISTERED COURSE PARTICIPANTS.

	(Code: ) (Expenses $ 361,283 including grants of $ ) (Revenue $ 441,283 )
	TRAINING PROGRAMSTHE NY PRACTICE CONTRIBUTES CLINICAL EXPERTISE THAT INFORMS THE CHILD AND ADOLESCENT MENTAL HEALTH INITIATIVE, A PROGRAM TO HELP ENHANCE CHILD AND ADOLESCENT MENTAL HEALTH CARE CAPACITY AND STRENGTHEN THE INFRASTRUCTURE FOR THE PREVENTION, ASSESSMENT, AND TREATMENT OF MENTAL HEALTH STRUGGLES FACED BY CHILDREN AND ADOLESCENTS IN GREECE. THIS IS A NATIONWIDE "TRAIN-THE-TRAINER" PROGRAM THAT WILL BE SUPPLEMENTED BY FREE RESOURCES FOR HEALTHCARE PROFESSIONALS AND THE GENERAL PUBLIC.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 361,283 including grants of $ ) (Revenue $ 441,283 )
4e	Total program service expenses18,349,902

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) HAROLD KOPLEWICZ MD...................................................................... CEO, MEDICAL DIRECTOR, PSY	20.00 ................. 40.00	X	X		978,381	677,471	41,835
(2) BRETT DAKIN THRU 82022...................................................................... SECRETARY	1.00 ................. 40.00		X		0	281,550	23,825
(3) MARY CORCORAN...................................................................... EXECUTIVE DIRECTOR	1.00 ................. 40.00		X		0	391,322	31,094
(4) AMIE CLANCY...................................................................... CHIEF OPERATING OFFICER	1.00 ................. 40.00		X		0	284,101	15,825
(5) MARYANA GELLER...................................................................... CHIEF FINANCIAL OFFICER	1.00 ................. 40.00		X		0	68,328	8,288
(6) ROY BOORADY MD...................................................................... PSYCHIATRIST	60.00 ................. 0.00			X	1,273,662	0	21,240
(7) NATALIE WEDER MD...................................................................... PSYCHIATRIST	40.00 ................. 0.00			X	781,034	0	10,000
(8) JEROME BUBRICK PHD...................................................................... SR CLINICAL PSYCHOLOGIST	40.00 ................. 0.00			X	532,243	0	23,212
(9) PAUL MITRANI MD PHD...................................................................... CLINICAL DIRECTOR, PSYCHIA	40.00 ................. 0.00			X	694,593	0	25,566
(10) ALI SARPER TASKIRAN MD...................................................................... PSYCHIATRIST	34.00 ................. 16.00			X	653,253	233,333	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,913,166	1,936,105	200,885

(A) Name and business address	(B) Description of services	(C) Compensation
ITELAGEN LLC 5901 N HONORE AVENUE SARASOTA,FL34243	HEALTHCARE IT SERVICES	168,854
AXISPOINT TECHNOLOGY SOLUTIONS GROUP IN ONE PENN PLAZA NEW YORK,NY10119	IT SUPPORT AND CONSULTING	135,764



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 2

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

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.......

		Business Code
2a	PATIENT SERVICE REVENUE	621300	19,732,376	19,732,376
b	GRANT SUBCONTRACT	621300	3,591,816	3,591,816
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		23,324,192

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	ADMINISTRATIVE SERVICES		900099	926,005	926,005
b	GAIN ON LEASE EXIT ACTIVITY		900099	111,857			111,857
c	OTHER REVENUE		900099	44,236			44,236
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,082,098
12	Total revenue. See instructions.....			24,406,290	24,250,197	0	156,093

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 ...........	1,039,031	893,566	145,465
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........	15,486,394	13,377,239	2,109,155
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	413,328	342,689	70,639
9	Other employee benefits .......	1,032,242	855,829	176,413
10	Payroll taxes ...........	991,293	821,878	169,415
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	124,117		124,117
c	Accounting ...........	166,887		166,887
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)	2,383,269	115,900	2,267,369
12	Advertising and promotion ....
13	Office expenses .......	76,383	43,991	32,392
14	Information technology ......	505,280	324,505	180,775
15	Royalties ..
16	Occupancy ...........	1,180,271	866,358	313,913
17	Travel ............	55,038	40,921	14,117
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	4,797	4,797
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,670		5,670
23	Insurance ...	116,684	25,405	91,279
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	BANK AND CREDIT CARD FE	478,200	474,880	3,320
b	SUPPLIES	125,575	125,575
c	STAFF DEVELOPMENT	41,240	13,316	27,924
d	MISCELLANEOUS EXPENSE	25,599	23,053	2,546
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	24,251,298	18,349,902	5,901,396	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 ........			408,612	1	552,446
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			279,434	4	384,149
5	Loans and other receivables from 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 ......			212,283	9	104,986
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	182,627
b	Less: accumulated depreciation	10b	174,113	14,184	10c	8,514
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 ...........			1,050,031	15	548,447
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,964,544	16	1,598,542

17	Accounts payable and accrued expenses .....	1,181,839	17	1,334,456
18	Grants payable ...		18
19	Deferred revenue .........	152,236	19	238,381
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	2,488,519	25	1,728,763
26	Total liabilities. Add lines 17 through 25..	3,822,594	26	3,301,600

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-1,858,050	27	-1,703,058
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 ...........	-1,858,050	32	-1,703,058
33	Total liabilities and net assets/fund balances ........	1,964,544	33	1,598,542