2021-01-29T05:30:32-06:00 2020-06-30 310800053 CLARK SCHAEFER HACKETT & CO 14 EAST MAIN ST SUITE 500 SPRINGFIELD OH 45502 990 2019-07-01 310787073 MENTAL HEALTH SERVICES FOR CLARK CO INC MENT 9373999500 474 N YELLOW SPRINGS ST SPRINGFIELD OH 45504 MARY BETH TAYLOR CFO 9373999500 2021-01-28 1 DEVESH KAMAL CPA P00201226 9373992000 2021-01-28 2019 2022-09-23 18:48:47Z MENTAL HEALTH SERVICES FOR CLARK AND MADISON COS INC KELLY RIGGER 474 N YELLOW SPRINGS ST SPRINGFIELD OH 45504 13256562 0 X WWW.MHSCC.ORG X 1969 OH PROVIDES MENTAL AND BEHAVIORAL HEALTH SERVICES TO RESIDENTS OF CLARK AND MADISON COUNTIES OHIO. 13 13 259 13 0 0 4676810 5741122 7416374 7226981 248861 264241 130651 24218 12472696 13256562 0 0 0 0 9182760 9261618 0 0 0 3048865 2770416 12231625 12032034 241071 1224528 20786313 22883008 5216012 6104425 15570301 16778583 TO IMPROVE THE SAFETY AND QUALITY OF LIFE OF THOSE WE SERVE 0 0 5835207 3194775 OUTPATIENT PSYCHIATRIC SERVICES SERVED APPROXIMATELY 5,500 CLIENTS DURING THE FISCAL YEAR FOR YOUTH, ADULT AND GERIATRIC POPULATIONS. 3096387 3109229 INPATIENT PSYCHIATRIC SERVICES OFFERING SHORT TERM, MULTIDISCIPLINARY CARE TO TREAT ACUTE EPISODES OF PSYCHOSIS AND DEPRESSIVE DISORDERS. 836 CLIENTS WERE ADMITTED TO INPATIENT FOR ACUTE PSYCHIATRIC CARE DURING THE FISCAL YEAR. 847824 947195 HOUSING ASSISTANCE SERVICES FOR CLIENTS WITH SEVERE MENTAL DISABILITIES WERE PROVIDED FOR 105 CLIENTS DURING THE FISCAL YEAR. 9779418 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 32 0 1 259 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARY BETH TAYLOR 9373999500 474 N YELLOW SPRINGS ST SPRINGFIELD OH 45504 RICK BRODERICK CHAIR 3.00 X X 0 0 0 BRIAN SMITH VICE CHAIR 3.00 X X 0 0 0 LYNN ROWLAND TRUSTEE 3.00 X 0 0 0 MARILYN KREIDER TRUSTEE 3.00 X 0 0 0 DOUG SCHANTZ TRUSTEE 3.00 X 0 0 0 HORTON HOBBS TRUSTEE 3.00 X 0 0 0 JEFF HUGHES TRUSTEE 3.00 X 0 0 0 CHRISTINE ZECHMAN TRUSTEE 3.00 X 0 0 0 MARY TAYLOR TRUSTEE 3.00 X 0 0 0 TIM DOTSON TRUSTEE 3.00 X 0 0 0 ROD BENINGHAUS TRUSTEE 3.00 X 0 0 0 ALEXIS EVANS COMER TRUSTEE 3.00 X 0 0 0 NANCY SHANAHAN WOEHRLE TRUSTEE 3.00 X 0 0 0 KELLY RIGGER CEO 40.00 X 73995 0 4591 MARY BETH TAYLOR CHIEF FINANCIAL OFFICER 40.00 X 77230 0 13651 SUE FRALICK VP OF ADULT AND YOUTH OUTP 40.00 X 110827 0 5990 DR KALPANA VISHNUPAD PHYSICIAN 40.00 X 254364 0 16701 DR FAWZIA TOOR PHYSICIAN 40.00 X 251680 0 9665 768096 0 50598 3 0 1 0 0 2658 4423002 1315462 480000 5741122 TITLE XIX MEDICAID 900099 4853890 4853890 PATIENT SERVICE REVENUES 621300 1679710 1679710 UPL PAYMENTS 900099 452889 452889 RENTAL REVENUE FROM CLIENT SUPPOR 623990 124559 124559 TITLE XX 900099 115933 115933 7226981 173747 173747 90494 0 90494 90494 90494 OTHER SERVICE REVENUE 621300 24218 24218 24218 13256562 7251199 0 264241 286284 247031 39253 7798712 6729409 1069303 655757 533441 122316 520865 440337 80528 610000 308383 301617 126140 51395 74745 590803 505418 85385 60273 51616 8657 106803 56286 50517 334686 185797 148889 OPERATING EXPENSES 536204 318881 217323 OPERATING SUPPLIES 348364 324466 23898 EQUIPMENT EXPENSES 57143 26958 30185 12032034 9779418 2252616 0 3054377 4267040 903931 1221990 1161706 1067593 6920 7792 176102 183869 14935692 5476132 9032412 9459560 6449865 6674164 1000 1000 20786313 22883008 2614000 2220720 2602012 2399055 0 1484650 5216012 6104425 X 15570301 16778583 15570301 16778583 20786313 22883008 1224528 -16246 0 X X 0 1 X 1 0 X 4476261 4365278 4825401 4676810 5213183 23556933 4476261 4365278 4825401 4676810 5213183 23556933 23556933 8066 11684 9195 111015 173747 313707 33768 105493 90456 97865 24218 351800 24222440 38547371 0.97250 0.97430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3139122 95201 20953 3213370 2969311 188973 19162 3139122 2776622 75 210551 17937 2969311 2510601 250 282931 17160 2776622 2500000 14933 4332 2510601 1.00000 1 0 2071230 2071230 9841771 2654441 7187330 564474 548429 16045 2241156 2058996 182160 217061 214266 2795 9459560 OTHER INVESTMENTS 3460794 F INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION 3213370 F 6674164 REFUNDABLE ADVANCE 1484650 1484650 X 13240316 -16246 -16246 13256562 0 13256562 12032034 0 12032034 0 12032034 PART X, LINE 2: THE AGENCY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE AGENCY'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE AGENCY'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 2059632 742295 1317337 0.10950 2059632 742295 1317337 0.10950 2059632 742295 1317337 0.10950 1 8185 0 255380 209165 46215 X 1 1 1 1 MENTAL HEALTH SERVICES 474 NORTH YELLOW SPRINGS STREET SPRINGFIELD OH 45504 X 16 BED PSYCHIATRIC HOSPITAL MENTAL HEALTH SERVICES 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.MHSCC.ORG X 1 18 1 WWW.MHSCC.ORG 0 1 X 250.000000000000 400.000000000000 X X 1 1 X X X 1 X WWW.MHSCC.ORG X X 1 X 0 X X X 1 X 0 0 MENTAL HEALTH SERVICES PART V, SECTION B, LINE 5: MENTAL HEALTH SERVICES MANAGEMENT STAFF PARTICIPATES IN THE COMMUNITY HEALTH ASSESSMENT PROCESS PERFORMED BY THE CLARK COUNTY COMBINED HEALTH DISTRICT WITH OTHER COMMUNITY MEMBERS INCLUDING THE LOCAL HOSPITAL SYSTEM, OUR LOCAL ALCOHOL/DRUG TREATMENT PROGRAM, POLICE, FIRE AND ADMHS BOARD STAFF. IN ADDITION, MENTAL HEALTH SERVICES PERFORMS COMMUNITY FOCUS GROUP SESSIONS TO OBTAIN FEEDBACK AND INFORMATION FROM PATIENTS, FAMILY MEMBERS AND CONSUMER ADVOCATES TO ASSIST US IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. MENTAL HEALTH SERVICES PART V, SECTION B, LINE 11: BASED ON KEY ASSESSMENT DATA FROM THE CLARK COUNTY COMBINED HEALTH DISTRICT, MENTAL HEALTH SERVICES PROVIDES AN ONLINE DEPRESSION SCREENING FOR ADOLESCENTS AND ADULTS TO IDENTIFY DEPRESSION AND RISK OF SUICIDE. MENTAL HEALTH SERVICES PROVIDES WALK IN COUNSELING AS A PART OF OUR MENTAL HEALTH RECOVERY BOARD CONTRACT. IN ADDITION, MENTAL HEALTH SERVICES IS IMPLEMENTING EVIDENCE BASED PROGRAMMING IN THE LOCAL SCHOOLS TO REDUCE THE INCIDENCE OF SUICIDAL IDEATION AMONG MIDDLE SCHOOL AGE CHILDREN IN CLARK COUNTY. WE PARTICIPATE IN THE UPCOMING CLARK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE COMBINED HEALTH DISTRICT AND OTHER COMMUNITY ORGANIZATIONS TO EVALUATE THE COMMUNITY NEEDS. MENTAL HEALTH SERVICES PART V, SECTION B, LINE 13B: THE BILLING CLERK PROVIDES INFORMATION TO PATIENTS ON OUR CHARITY CARE PROGRAM. WE HAVE INFORMATION POSTED ON THE INPATIENT UNIT BULLETIN AREA AND ALSO HAVE A NOTICE ON THE PATIENT STATEMENT ALONG WITH THE BILLING CLERK PHONE NUMBER. OUR FINANCIAL ASSISTANCE COLLECTION POLICY IS POSTED ON OUR WEBSITE. FOR RESIDENTS OF CLARK AND MADISON COUNTIES WITHOUT INSURANCE, WE PROVIDE FREE INPATIENT CARE. WE OFFER A 30% DISCOUNT FOR UNINSURED OUT OF COUNTY CLIENTS AS WELL AS CLIENTS WHO HAVE OUTSTANDING MEDICAL EXPENSES EXCEEDING $5,000. PART I, LINE 3C: MENTAL HEALTH SERVICES SCREENED ALL ADMISSIONS AND, FOR 2019, PROVIDED FINANCIAL ASSISTANCE TO 50% OF ALL INPATIENT ADMISSIONS. PART VI, LINE 2: MENTAL HEALTH SERVICES MANAGEMENT STAFF PARTICIPATES IN THE CLARK COUNTY COMBINED HEALTH DISTRICT COMMUNITY HEALTH ASSESSMENT ALONG WITH OTHER COMMUNITY MEMBERS INCLUDING THE LOCAL HOSPITAL SYSTEM, OUR LOCAL ALCOHOL/DRUG TREATENT PROVIDER, POLICE, FIRE, AND LOCAL ALCOHOL/DRUG MENTAL HEALTH RECOVERY BOARD STAFF. IN ADDITION, MENTAL HEALTH SERVICES PERFORMS COMMUNITY FOCUS GROUP SESSIONS TO OBTAIN FEEDBACK ON SERVICE NEEDS. PART VI, LINE 3: THE INPATIENT BILLING CLERK MEETS WITH THE PATIENT, THE PATIENTS FAMILY OR ANOTHER AUTHORIZED GUARDIAN OR REPRESENTATIVE TO DISCUSS CLIENT CARE PROGRAMS. IN ADDITION, WE HAVE A PHARMACY PROGRAM THAT PROVIDES PATIENTS THEIR MEDICATION AT NO COST FOR PATIENTS WITHOUT INSURANCE. FOR THOSE PATIENTS OF CLARK OR MADISON COUNTY WITHOUT HEALTH INSURANCE, WE OFFER A 100% CHARITY CARE PROGRAM. IN FY 2020 WE WERE ABLE TO PROVIDE FINANCIAL ASSISTANCE TO 50% OF ALL ADMISSIONS. PART VI, LINE 4: CLARK AND MADISON COUNTIES ARE LOCATED IN SOUTHWEST OHIO WITH AN AREA POPULATION OF APPROXIMATELY 179,000. THE PERCENTAGE OF HOUSEHOLDS UNDER THE FEDERAL POVERTY GUIDELINES IS 15%. THE CLIENTS THAT WE SERVE ARE TYPICALLY ELIGIBLE FOR MEDICAID, MEDICARE OR OTHER FEDERAL ASSISTANCE PROGRAMS. THIS ELIGIBILITY IS USUALLY A FUNCTION OF OUR CLIENTS PSYCHIATRIC DISABILTIIES. X X X 0 0 0 0 0 0 0 0 0 DR KALPANA VISHNUPAD PHYSICIAN 254364 0 0 0 0 0 5327 0 11374 0 271065 0 0 0 DR FAWZIA TOOR PHYSICIAN 251680 0 0 0 0 0 5074 0 4591 0 261345 0 0 0 A CLARK COUNTY OHIO 316000132 999999999 2011-12-28 5000000 CONSTRUCTING INPATIENT AND OUTPATIENT FACILITY FOR MENTAL HEALTH SERVICES 0 0 0 A 5000000 50000 4215532 734468 2013 0 0 0 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 PART III, LINE 9; PART IV, LINE 7; AND PART V: MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES, INC. HAS ESTABLISHED WRITTEN PROCEDURES (A) TO ENSURE THAT ALL NON-QUALIFIED BONDS OF AN ISSUE ARE REMEDIATED IN ACCORDANCE WITH REGULATIONS SECTIONS 1.141-12 AND 1.145-2, (B) TO MONITOR THE REQUIREMENTS OF SECTION 148 OF THE INTERNAL REVENUE CODE, AND (C) TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. X 1 480000 APPRAISAL 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS AUDIT COMMITTEE REVIEWS THE FORM 990 AND APPROVES IT BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF DIRECTORS REVIEW THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS AND COMPLETE SURVEY AND STATEMENT OF UNDERSTANDING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REFERENCES VARIOUS INDUSTRY COMPENSATION STUDIES AND SALARY SCHEDULES OF COMPARABLE ORGANIZATIONS. THE HUMAN RESOURCES DIRECTOR REPORTS TO THE BOARD OF DIRECTORS REGARDING MATTERS OF COMPENSATION LEVELS AND RESULTS OF SUCH STUDIES. FORM 990, PART VI, SECTION C, LINE 18 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 FORM 1023 AND FORM 990 ARE MADE AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST OF THE ORGANIZATION. PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS ACCEPTANCE PROCEDURES FOR THE FINANCIAL STATEMENTS FROM THE PRIOR PERIOD METHOD. MANAGEMENT REVIEWS THE AUDITED FINANCIAL STATEMENTS AND PRESENTS THEM TO THE BOARD FOR APPROVAL. CLEANERS EXTRAORDINAIRE INC 128 EAGLE CITY ROAD SPRINGFIELD OH 45502 311110016 JOB TRAINING FOR INDIVIDUALS WITH DISABILITES OH 501(C)(3) 170(B)(1)(A)(VI) MENTAL HEALTH SERVICES 1 RESOURCE CENTER APARTMENTS INC 1086 MOUND ST SPRINGFIELD OH 45505 311307922 AFFORDABLE HOUSING FOR THE DISABLED OH 501(C)(3) 170(B)(1)(A)(VI) MENTAL HEALTH SERVICES 1 RESTAN CORP 1086 MOUND ST SPRINGFIELD OH 45505 311368099 AFFORDABLE HOUSING FOR THE DISABLED OH 501(C)(3) 509(A)(2) MENTAL HEALTH SERVICES 1 JANI-TURF MAINTENENCE SERVICE INC 128 EAGLE CITY ROAD SPRINGFIELD OH 45502 311331268 JANITORIAL AND PROPERTY MAINTENECE SERVICES OH MENTAL HEALTH SERVICES C -3286 139769 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 JANI-TURF MAINTENANCE SERVICES INC M 23814 CLEANERS EXTRAORDINAIRE INC K 16102 RESOURCE CENTER APARTMENTS INC Q 71696 RESTAN CORP L 2131