2019-08-13T13:58:15-05:00 2018-09-30 341884125 CBIZ MHM LLC 4722 N 24TH ST STE 300 PHOENIX AZ 85016 990 2017-10-01 860214457 MOHAVE MENTAL HEALTH CLINIC INC MOHA 9287574250 3707 N STOCKTON HILL RD STE B KINGMAN AZ 86409 DAWN ABBOTT CEO 9287574250 2019-08-08 1 AMY A O'LOUGHLIN P00869687 6022646835 12.221.96.220 2019-08-08 15:08:14 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1212D86953DF9911D4E957E54162B84DD93DFAA7 2017 2019-02-21 02:37:17Z X DAWN ABBOTT 3707 N STOCKTON HILL RD STE B KINGMAN AZ 86409 46230812 0 X MMHC-INC.ORG X 1968 AZ TO IMPROVE, ENHANCE AND PROMOTE THE EMOTIONAL WELL-BEING OF MOHAVE COUNTY RESIDENTS WHO EXPERIENCE LIFE-DISRUPTING PROBLEMS AND TO STRENGTHEN THE QUALITY OF PERSONAL, FAMILY AND COMMUNITY LIFE. 7 7 390 7 71428 -18319 43278754 40526922 1490941 2010595 128684 85263 1058 21633 44899437 42644413 53069 58339 0 0 16963762 17786941 0 0 0 25867660 25503694 42884491 43348974 2014946 -704561 30371798 28667891 6909123 6213210 23462675 22454681 X TO IMPROVE, ENHANCE AND PROMOTE THE EMOTIONAL WELL-BEING OF MOHAVE COUNTY RESIDENTS WHO EXPERIENCE LIFE-DISRUPTING PROBLEMS AND TO STRENGTHEN THE QUALITY OF PERSONAL, FAMILY AND COMMUNITY LIFE. 0 0 16246940 33935 386416 SERIOUSLY MENTALLY ILL - THIS PROGRAM PROVIDES PSYCHAITRIC SERVICES, MEDICATION MANAGEMENT, CASE MANAGEMENT, CRISIS SERVICES, INDIVIDUAL & GROUP THERAPY, PEER SUPPORT, LIVING AND VOCATIONAL SKILLS TRAINING, SUPERVISED RESIDENTIAL LIVING AND SEMISUPERVISED RESIDENTIAL LIVING HOMES. THIS PROGRAM CONTINUES ITS HEALTH COACHING PROGRAM TO PROVIDE INTEGRATED HEALTHCARE SERVICES TO THESE INDIVIDUALS WITH MULTIPLE SERIOUS CONDITIONS. CURRENTLY SERVING 1,951 12758760 18094 244541 CHILDREN'S PROGRAM - THIS PROGRAM PROVIDES PSYCHIATRIC SERVICES, MEDICATION MANAGEMENT, CASE MANAGEMENT, CRISIS SERVICES, INDIVIDUAL, FAMILY & GROUP THREAPY, BEHAVIOR MANAGEMENT, INHOME SERVICES, FAMILY SUPPORT SERVICES, LIVING SKILLS TRAINING AND SUMMER PROGRAMS. THIS PROGRAM CONTINUES ITS INFANT & TODDLER INTERVENTIONS ACROSS THE CHILDREN'S PROGRAM, RESULTING IN IMPROVED CARE TO VERY YOUNG BEHAVIORAL HEALTH RECIPIENTS. CURRENTLY SERVING 1,495 8681359 6310 340266 GENERAL MENTAL HEALTH SUBSTANCE ABUSE - THIS PROGRAM PROVIDES PSYCHIATRIC SERVICES, MEDICATION MANAGEMENT, CASE MANAGEMENT, CRISIS SERVICES, INDIVIDUAL & GROUP THERAPY, AND INTENSIVE OUTPATIENT PROGRAMS FOR SUBSTANCE ABUSE TREATMENT. CURRENTLY SERVING 2,268 5061408 967944 PATHWAYS, LEVEL I SUBACUTE FACILITY PROVIDES A STRUCTURED TREATMENT SETTING WITH 24 HOUR RN SUPERVISION AS WELL AS LICENSED MEDICAL PROVIDERS TO SERVE INDIVIDUALS SUFFERING FROM MENTAL ILLNESS WHO REQUIRE INPATIENT STABLIZATION, COURT ORDERED EVALUATION/TREATMENT AND/OR DETOXIFICATION SERVICES IN A LOCKED UNIT. INCLUDES DELIVERY OF TREATMENT RELATED GROUPS, ARTS AND CRAFTS, EXERCISES, 1:1 INTERACTIONS, EDUCATION PROTOCOLS AND RECREATIONAL ACTIVITIES. CURRENTLY SERVING 530 5061408 967944 42748467 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 12 0 1 390 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 AZ X JANET RETTMANN CFO 9287578111 3707 N STOCKTON HILL RD STE B KINGMAN AZ 86409 CAROLYN STEWART PRESIDENT 1.00 X X 0 0 0 AMY SUGAMELE VICE PRESIDENT 1.00 X X 0 0 0 LORI A HOWELL SECRETARY/TREASURER 1.00 X X 0 0 0 STEVE CARSPECKEN DIRECTOR 1.00 X 0 0 0 MARISUSAN CASSON DIRECTOR 1.00 X 0 0 0 CHUCK PROBST DIRECTOR 1.00 X 0 0 0 SALLY WALKER DIRECTOR 1.00 X 0 0 0 DAWN D ABBOTT CEO 40.00 X 285412 0 40100 JANET M RETTMANN CFO 40.00 X 115127 0 14156 MOHAMED RAMADAN MEDICAL DIRECTOR 40.00 X 278452 0 49168 CAROLINE KOCH ASSOCIATE MEDICAL DIRECTOR 40.00 X 252461 0 38610 LAURENCE SELTZER PSYCHIATRIST 40.00 X 259383 0 29953 MARY TULINNYE PSYCHIATRIC NURSE PRACTITIONER 40.00 X 165987 0 26387 CAROLYN MICHELE NORTON PSYCHIATRIC NURSE PRACTITIONER 40.00 X 168653 0 15017 STEVEN KORONA MEDICAL PRACTICE MANAGER 40.00 X 159859 0 20737 TORRY ZUPKE PSYCHIATRIC NURSE PRACTITIONER 40.00 X 154243 0 17706 1839577 0 251834 16 0 1 0 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 LOCUM TENEMS 421156 WORKWIDE TRAVEL STAFFING LTD 2829 SHERIDAN DR TONAWANDA NY 14150 TEMPORARY LABOR 249144 AUSTIN MAJOR GROUP LLC 545 E JOHN CARPENTER FWY STE 975 IRVING TX 75062 LOCUM TENEMS 194883 INSIGHT TELEPSYCH LLC 2218 CHINOOK KINGMAN AZ 86401 LOCUM TENEMS 151826 4 40341922 185000 40526922 CLIENT FEES 624100 837172 837172 FEES - GOVT AGENCIES 624100 811936 811936 RENTAL FEES 531110 137782 66354 71428 RECORDS FEES 900099 118500 118500 MEDICARE/MEDICAID PMTS 624100 105205 105205 2010595 74050 74050 5040 0 5040 5040 5040 3586399 11213 3586399 0 0 11213 11213 11213 MISC INCOME 900099 16593 16593 16593 42644413 1939167 71428 106896 X 58339 58339 1121074 672056 449018 12056611 12056611 602728 602728 3081341 3070685 10656 925187 897431 27756 2636 2636 4986 4986 42850 42850 13160766 13160766 16961 16622 339 759065 753884 5181 550935 549917 1018 278341 274570 3771 165367 160718 4649 82110 73829 8281 150260 147678 2582 799676 781422 18254 89787 87991 1796 CLIENT MEDICATION COSTS 7293375 7293375 RENTAL/REPAIRS/MAINT 465705 456390 9315 CLIENT LABORATORIES EXP 411675 411675 TELEPHONE 244071 239190 4881 985128 979954 5174 43348974 42748467 600507 0 7992868 4954939 5565876 5067195 2025855 2610070 389486 380348 24042970 8436268 14374872 15606702 22841 48637 30371798 28667891 2297282 2005494 1164506 1134732 3447335 3072984 6909123 6213210 X 23462675 22269681 0 185000 23462675 22454681 30371798 28667891 X -704561 -303433 X 0 1 X 0 1 1 X 30835896 38854265 37288195 43278754 40526922 190784032 30835896 38854265 37288195 43278754 40526922 190784032 190784032 11929 17002 26206 50763 79090 184990 1218 1218 4920 4502 1074 1058 16593 28147 190998387 7162063 0.99890 0.99920 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2013 AMOUNT: $ 4,920. 2014 AMOUNT: $ 4,502. 2015 AMOUNT: $ 1,074. 2016 AMOUNT: $ 1,058. 2017 AMOUNT: $ 16,593. 1589348 1589348 19394827 6077048 13317779 13181 13181 0 2969984 2346039 623945 75630 75630 15606702 X 42335806 0 42335806 308607 308607 42644413 43343800 0 43343800 5174 5174 43348974 PART X, LINE 2: MMHC QUALIFIES AS A TAX EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND, THEREFORE, THERE IS NO PROVISION FOR INCOME TAXES. IN ADDITION, MMHC QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170 OF THE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. INCOME DETERMINED TO BE UNRELATED BUSINESS TAXABLE INCOME ("UBTI") WOULD BE TAXABLE. MANAGEMENT DOES NOT BELIEVE MMHC HAS ANY UBTI FOR THE YEAR ENDED SEPTEMBER 30, 2018. MMHC EVALUATES ITS UNCERTAIN TAX POSITIONS, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF ITS POLICIES AND PROCEDURES, REVIEW OF ITS REGULAR TAX FILINGS, AND DISCUSSIONS WITH OUTSIDE EXPERTS. MMHC'S FEDERAL RETURN OF ORGANIZATIONS EXEMPT FROM INCOME TAX (FORM 990) FOR FISCAL 2017, 2016, AND 2015 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 303,433. PRIVILEGE AND USE TAX EXPENSE 5,174. PART XII, LINE 4B - OTHER ADJUSTMENTS: PRIVILEGE AND USE TAX EXPENSE 5,174. 1 MOVE-IN ASSISTANCE OR EVICITION PREVENTION 92 58339 PART I, LINE 2: MMHC ASSISTS WITH HOUSING ASSISTANCE (INCLUDES RENTS, UTILITIES AND MOVING EXPENSE) TO QUALIFYING CLIENTS. THE NEED IS DISCUSSED WITH A CLINICAL LIAISON WHICH IS DOCUMENTED IN THE CLIENT'S RECORD ON THE BEHAVIORAL HEALTH SERVICE PLAN. IF THE CLIENT MEETS THE REQUIREMENTS AS SET FORTH IN THE DEPARTMENT OF BEHAVIORAL HEALTH COVERED SERVICE GUIDE, A FINANCIAL REQUEST IS MADE THROUGH A SUPERVISOR AND APPROVED BY THE PROGRAM DIRECTOR, WITH FINAL APPROVAL MADE BY THE CHIEF FINANCIAL OFFICER TO ENSURE AVAILABILITY OF FUNDING. X 0 1 X X X 0 0 0 0 0 0 0 1 0 DAWN D ABBOTT CEO 285412 0 0 0 0 0 28748 0 11352 0 325512 0 0 0 MOHAMED RAMADAN MEDICAL DIRECTOR 278452 0 0 0 0 0 28486 0 20682 0 327620 0 0 0 CAROLINE KOCH ASSOCIATE MEDICAL DIRECTOR 252461 0 0 0 0 0 25490 0 13120 0 291071 0 0 0 LAURENCE SELTZER PSYCHIATRIST 259383 0 0 0 0 0 20780 0 9173 0 289336 0 0 0 MARY TULINNYE PSYCHIATRIC NURSE PRACTITIONER 165987 0 0 0 0 0 8477 0 17910 0 192374 0 0 0 CAROLYN MICHELE NORTON PSYCHIATRIC NURSE PRACTITIONER 158653 0 10000 0 0 0 3665 0 11352 0 183670 0 0 0 STEVEN KORONA MEDICAL PRACTICE MANAGER 159859 0 0 0 0 0 9673 0 11064 0 180596 0 0 0 TORRY ZUPKE PSYCHIATRIC NURSE PRACTITIONER 144243 0 10000 0 0 0 7734 0 9972 0 171949 0 0 0 PART I, LINE 1A BOARD MEMBERS ARE ENCOURAGED TO ATTEND THE NATIONAL CONFERENCE FOR BEHAVIORAL HEALTH ORGANIZATIONS IN ORDER TO EDUCATE THEMSELVES ON CURRENT TRENDS AND CHANGES IN THE INDUSTRY. IF REQUESTED, MMHC PAYS FOR COMPANION TRAVEL. COMPANION TRAVEL IS NON-TAXABLE TO THE BOARD MEMBERS AS IT IS CONSIDERED TO BE PART OF THE BUSINESS PURPOSE OF THE ORGANIZATION. PART I, LINE 1B NO POLICY HAS BEEN WRITTEN BUT IT IS PRACTICE TO EXTEND THE INVITATION OF THE GUEST TO EACH PERSON ATTENDING NATIONAL CONFERENCES. PART I, LINE 7 ALL BONUSES WERE PAID OUT IN ACCORDANCE WITH THE ORGANIZATION'S PERFORMANCE BASED INCENTIVE COMPENSATION PLAN AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B IF TIME PERMITS, A COPY WILL BE MADE AVAILABLE TO ALL MEMBERS OF THE BOARD FOR REVIEW PRIOR TO FILING. FINAL APPROVAL OF FORM 990 WILL BE MADE BY THE CEO PRIOR TO SUBMISSION OF FORM 990. A COPY OF THE FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT THE FIRST AVAILABLE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C AS PER THE PERSONNEL POLICY SECTION 719, CONFLICT OF INTEREST, ALL STAFF, INCLUDING MEMBERS OF THE BOARD OF DIRECTORS, ARE MADE AWARE OF THE PROCESS OF REPORTING OF POSSIBLE CONFLICTS OF INTEREST. A CONFLICT OF INTEREST DISCLOSURE IS COMPLETED ANNUALLY BY ALL EMPLOYEES AND BOARD MEMBERS. IN ALL INSTANCES IN WHICH A CONFLICT OF INTEREST IS PRESENT OR MAY APPEAR TO BE PRESENT, FULL WRITTEN DISCLOSURE MUST BE MADE TO THE CEO OR THE PRESIDENT OF THE BOARD, AS MAY BE APPLICABLE. FOR INSTANCES NOT EXPRESSLY FORBIDDEN BY THE POLICY, PERMISSION FROM THE CEO OR BOARD MUST BE OBTAINED BEFORE PROCEEDING WITH PARTICIPATING IN THE SITUATION. FORM 990, PART VI, SECTION B, LINE 15A AN ANNUAL EVALUATION IS REQUESTED FROM THE BOARD OF DIRECTORS AND IS SUMMARIZED AND DISCUSSED IN AN EXECUTIVE SESSION OF THE BOARD MEETING IN THE ANNIVERSARY MONTH OF THE CEO. SALARY IS BASED ON REVIEW OF MARKET AND LOCAL COMPENSATION. EVALUATION OF OTHER OFFICERS ARE COMPLETED BY THE CEO AND SALARIES ARE DETERMINED BASED ON MARKET AND LOCAL COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION, BY-LAWS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND AUTHORIZED BY BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G CONTRACTED PSYCHIATRIST: PROGRAM SERVICE EXPENSES 738,891. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 738,891. OUTSIDE BEHAVIORAL HEALTH PROVIDERS: PROGRAM SERVICE EXPENSES 11,719,564. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,719,564. CLIENT TRANSPORTATION AND INTERPRETER SERVICES: PROGRAM SERVICE EXPENSES 412,774. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 412,774. TEMPORARY SERVICES: PROGRAM SERVICE EXPENSES 289,537. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 289,537. FORM 990, PART XI, LINE 9: PROVISION OF UNCOLLECTIBLE ACCOUNTS -303,433.