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
Grand Lake Mental Health Center Inc
 
Employer identification number

73-1039733
Return Reference Explanation
Form 990, Part VI, Section A, line 8b No committees are able to act on behalf of the board
Form 990, Part VI, Section B, line 11b The 990 will be reviewed by the Board at the next meeting after it is prepared and filed.
Form 990, Part VI, Section B, line 12c Any activity in the course of agency business, marketing, and/or service delivery that would create a conflict of interest between an employee and client, resulting in actual, apparent, or perceived use of the employee's position for private gain or complete loss of impartiality, is prohibited. The conflict of interest policy if reviewed annually at board meeting. No conflicts of interest have been discovered since the inception of the conflict of interest policy.
Form 990, Part VI, Section B, line 15 Annual review of compensation in compliance with the IRS rebuttable presumption rule.
Form 990, Part VI, Section C, line 19 Upon written request.
FORM 990, PART VIII, LINE 2C ON 7/1/22, THE NONPROFIT ORGANIZATION 12&12 MERGED IN WITH GRAND LAKE MENTAL HEALTH CENTER, INC. DURING FISCAL YEAR 6/30/2022 GLMHC CHARGED A MANAGEMENT FEE FOR 12&12'S USE OF GLMHC'S CEO, COO, AND CERTAIN STAFF TO ASSIST WITH 12&12 OPERATIONS PRIOR TO THE MERGER.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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