2018-11-14T13:21:46-06:00 2017-12-31 EISNERAMPER LLP 111 WOOD AVE SO STE 600 ISELIN NJ 088302700 990 2017-01-01 221714106 CARRIER CLINIC INC % DONALD PARKER CARR 9082811000 PO BOX 147 BELLE MEAD NJ 085020147 DONALD PARKER PRESIDENT/CEO 9082811560 2018-11-15 true MICHAEL SOMER P00094591 7322437000 2018-11-15 64.238.150.4 20870020183185000003 2018-11-14 P 59644ADEE67D9146A0AFE4941C01EA07CEB282B5 2102CBB05B20C6FB34C254804D7CCA8536BCBA76 2017 2019-02-21 02:37:17Z DONALD PARKER PO BOX 147 BELLE MEAD NJ 08502 98856202 false X WWW.CARRIERCLINIC.ORG X 1910 NJ CARRIER CLINIC'S PRIMARY ACTIVITIES ARE INPATIENT PSYCHIATRIC AND ADDICTION, ADOLESCENT RESIDENTIAL AND SPECIAL EDUCATION FOR ADOLESCENTS. 16 13 1137 0 311513 428291 71572957 75888284 1249933 1600537 1242606 1688232 74377009 79605344 1500 1000 0 0 55530627 56727382 0 0 272014 19524730 21960994 75056857 78689376 -679848 915968 74596238 77132105 34221438 35064333 40374800 42067772 X REFER TO SCHEDULE O FOR MISSION STATEMENT. false false 47022774 1000 49252945 PSYCHIATRIC HOSPITAL WHICH CARED FOR 5,211 INPATIENTS AND HAD A TOTAL OF 52,431 PATIENT DAYS. 6563727 6497277 EAST MOUNTAIN SCHOOL WHICH PROVIDED QUALITY SPECIAL EDUCATION AND THERAPEUTIC SERVICES FOR 198 ADOLESCENTS AFFECTED BY BEHAVIORAL AND PSYCHIATRIC DISORDERS. 6605430 6613450 BLAKE RECOVERY CENTER WHICH CARED FOR 1,389 INPATIENTS AND HAD A TOTAL OF 10,329 PATIENT DAYS. 13228757 13524612 73420688 true true false true false false false false false true true false false false true true true false false false false false false false true false true true false false true false false false false false false false false false false false false false false false false false true 45 0 true 1137 true false false false false false true true false false false false X 16 13 false false false false false false false true true false false true true true true true true true true false NJ X X DONALD PARKER 9082811560 252 RT 601 BLAWENBERG RD BELLE MEAD NJ 085020147 X NICK HILTON TRUSTEE 0.0 0.0 X 0 0 0 THOMAS G AMATO CHAIRMAN 0.0 0.0 X 0 0 0 CAROL HOLZER TRUSTEE 0.0 0.0 X 0 0 0 GORDON PINGICER TRUSTEE 0.0 0.0 X 0 0 0 ANN DAMSGAARD TRUSTEE 0.0 0.0 X 0 0 0 JOHN KOLLIGIAN JR PHD VICE CHAIR 0.0 0.0 X 0 0 0 MATTHEW LOMBARDI TRUSTEE 0.0 0.0 X 0 0 0 MARGARET HELMS TRUSTEE 0.0 0.0 X 0 0 0 CHRISTIAN BORMANN TRUSTEE 0.0 0.0 X 0 0 0 JAIME ROBERTSON-LAVALLE TRUSTEE 0.0 0.0 X 0 0 0 MARILOUISE VENDITTI MD TRUSTEE 0.0 0.0 X 0 0 0 TIMOTHY HOWES TRUSTEE 0.0 0.0 X 0 0 0 DONNA SIMON TRUSTEE 0.0 0.0 X 0 0 0 ANTHONY MARINO MD MEDICAL STAFF PRESIDENT 40.0 0.0 X 314326 0 20154 UMESH MEHTA MD MEDICAL DIRECTOR 40.0 0.0 X X 554579 0 32411 DONALD PARKER PRESIDENT & CEO 40.0 0.0 X X 429930 0 72705 RANDOLPH JACOBSON VP & CFO 40.0 0.0 X 294419 0 56291 CAROL KOSZTYO VICE PRESIDENT(RETIRED 1/4/17) 0.0 0.0 X 101461 0 134 PATRICIA TOOLE VP & COMPLIANCE OFFICER 40.0 0.0 X 250982 0 41923 SHAUN SWEENEY VICE PRESIDENT 40.0 0.0 X 167414 0 24923 TIN CHIN MD PSYCHIATRIST 40.0 0.0 X 267753 0 22235 ABDUL KAZI MD PSYCHIATRIST 40.0 0.0 X 311320 0 40266 ROBERT SAINT-VIL MD PSYCHIATRIST 40.0 0.0 X 303361 0 29115 JAGWINDER SANDHU MD PSYCHIATRIST 40.0 0.0 X 263526 0 39940 JOSEPH VERRET MD PSYCHIATRIST 40.0 0.0 X 305719 0 40621 3564790 0 420718 60 false true false SODEXO INC AFFILIATES PO BOX 905374 CHARLOTTE NC 282905374 DIETARY & HOUSEKEEP 2612863 DRINKER BIDDLE REATH LLP 500 CAMPUS DRIVE FLORHAM PARK NJ 07932 LEGAL SERVICES 490275 KPMG LLP 150 JOHN F KENNEDY PARKWAY SHORT HILLS NJ 07078 AUDITING SERVICES 183389 NEW ADVANCED MEDICAL SERVICES GROUP 2087 KLOCKNER ROAD HAMILTON NJ 08690 INTERNAL MEDICINE 468400 4 X 164695 263596 24195 428291 NET PATIENT SERVICES 624100 69389821 69389821 EDUCATIONAL PROGRAMS 611710 6498463 6498463 75888284 744482 744482 0 0 237774 237774 0 0 0 19602466 18746411 856055 856055 856055 64857 164695 64857 0 0 0 276063 201816 74247 74247 SERVICES AGREEMENT 900099 939892 939892 INS SETTLEMENT 900099 290324 290324 PRESCRIPTION REBATES/PURCHASING DISCOUNTS 900099 315469 315469 68300 68300 1613985 79605344 76828176 2348877 X 0 1000 1000 0 0 1689545 429663 1259882 0 44470907 38726122 5562395 182390 2470900 2095950 365187 9763 4371300 3707972 646056 17272 3724730 3159517 550496 14717 638611 638611 715524 715524 219427 49306 170121 0 0 86000 86000 1674784 1067330 604327 3127 800672 800672 1207258 627178 558544 21536 498325 60408 437917 0 1112453 1112453 142928 134176 8752 0 55399 23191 29704 2504 875035 875035 0 2843600 316120 2527480 774710 774710 DIETARY/ENVIRONMENTAL SVCS 2967209 2967209 PATIENT-RELATED 1894380 1894380 BAD DEBTS 3358087 3358087 MAINTENANCE/MISC 2096592 511882 1568268 16442 78689376 73420688 4996674 272014 X 3349187 5331156 4385048 2121275 84600 71747 6546382 5781487 0 0 0 0 0 0 217724 209628 670024 636682 67288205 35477300 32988013 31810905 21974827 27349614 0 0 0 0 0 0 4380433 3819611 74596238 77132105 9809704 11417660 0 0 0 0 0 0 0 0 0 0 18616257 18153407 0 0 5795477 5493266 34221438 35064333 X 40005084 41616567 369716 451205 0 0 40374800 42067772 74596238 77132105 X 915968 2205956 -1428952 X X false true X true true true X false false false false false false true 4114 false false 4114 false PART II-B, LINE 1 (G), OTHER LOBBYING ACTIVITIES: THIS EXPENSE REPRESENTS a portion of Carrier Clinic's membership dues paid to the American Hospital Association (AHA) and NJ Hospital Association (NJHA) that both associations identified to pertain to their lobbying activities on behalf of their members. OTHER DUES ARE PAID TO THE NEW JERSEY ALLIANCE FOR CHILDREN, NATIONAL ASSOCIATION OF PSYCHIATRIC HEALTH SYSTEM (NAPHS) AND NEW JERSEY ASSOCIATION OF MENTAL HEALTH AND ADDICTION AGENCIES (NJAMHAA). LOBBYING ACTIVITIES ARE PERFORMED BY THESE ASSOCIATIONS ON BEHALF OF THEIR MEMBERS. THE SPECIFIC LOBBYING ALLOCATION IS NOT AVAILABLE. 369716 413410 331921 451205 561426 250292 442002 369716 552563 356664 347801 561426 505721 829629 782787 552563 423297 1474449 1392025 505721 1.00000 false false 278290 278290 43683462 21184567 22498895 8986738 6783809 2202929 14339715 7508924 6830791 31810905 0 DEFERRED COMPENSATION 1308460 DUE TO THIRD-PARTY PAYORS 215391 ACCRUED PENSION AND BENEFITS 3969415 5493266 X 74705885 399862 399862 74306023 5299321 5299321 79605344 75731151 399862 399862 75331289 3358087 3358087 78689376 PART X, LINE 2 THE CLINIC IS AN ORGANIZATION DESCRIBED IN SECTION 501(c)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND, THEREFORE, IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(a) OF THE CODE. THE CLINIC IS ALSO EXEMPT FROM STATE INCOME TAXES. THE CLINIC RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 162,088 RENTAL EXPENSE 237,774 TOTAL PART XII, LINE 2D 399,862 PART XI, LINE 4B - OTHER ADJUSTMENTS: PATIENT BAD DEBTS 3,358,087 ACTUAL DONATIONS VS. INCOME STATEMENT 92,341 INVESTMENT INCOME 1,600,537 NET ASSETS RELEASED-CAPITAL 248,356 TOTAL PART XI, LINE 4B 5,299,321 PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 162,088 RENTAL EXPENSE 237,774 TOTAL PART XII, LINE 2D 399,862 PART XII, LINE 4B - OTHER ADJUSTMENTS: PATIENT BAD DEBTS 3,358,087 TOTAL PART XII, LINE 4B 3,358,087 PART V, LINE 4 ENDOWMENT FUNDS ARE TO BE USED CONSISTENT WITH THE DONOR'S INTENT AND IN FURTHERANCE OF CARRIER CLINIC'S CHARITABLE TAX-EXEMPT PURPOSES. THE ENDOWMENT FUNDS ARE RESTRICTED FOR CAPITAL IMPROVEMENTS AND VARIOUS PATIENT CARE RELATED ACTIVITIES, AS SPECIFIED BY THE DONORS. GALA 114430 77395 37035 24053 12982 GOLF OUTING 51723 29761 21962 16716 5246 1 63399 57539 5860 5860 229552 164695 64857 40769 24088 64857 true true X true X true X 100 true true true false true true 649840 649840 0.00860 5914728 5141748 772980 0.01030 6564568 5141748 1422820 0.01890 5891 5891 0.00010 12951 12951 0.00020 5892049 3585554 2306495 0.03060 11040 11040 0.00010 5921931 3585554 2336377 0.03100 12486499 8727302 3759197 0.04990 9162 9162 0.00010 9162 9162 0.00010 true 1954382 12755748 11976491 779257 X true false 1 1 CARRIER CLINIC INC PO BOX 147 BELLE MEAD NJ 08502 WWW.CARRIERCLINIC.ORG 51806 X PSYCHIATRIC HOSPITAL CARRIER CLINIC INC 1 false false true X X X X X X X X X 16 true true false true X WWW.CARRIERCLINIC.ORG X true 16 true WWW.CARRIERCLINIC.ORG false true X 100 100 X true true X X X true X WWW.CARRIERCLINIC.ORG X WWW.CARRIERCLINIC.ORG X X X true false true X false false PART V, SECTION B, LINE 5 WHILE CONDUCTING CARRIER CLINIC'S 2017-2019 CHNA, A REPRESENTATIVE OF CARRIER CLINIC INTERVIEWED MENTAL HEALTH ADMINISTRATORS FROM MIDDLESEX AND SOMERSET COUNTIES TO DISCUSS SERVICE GAPS IN THE COMMUNITY. THESE COUNTIES REPRESENT APPROXIMATELY 35% OF CARRIER CLINIC's ADMISSIONS. PART V, SECTION B, LINE 6a IN AN EFFORT TO BE COST-EFFECTIVE, CARRIER CLINIC CONDUCTED ITS CHNA IN CONJUNCTION WITH EAST MOUNTAIN HOSPITAL (EMH). CARRIER CLINIC ALSO PARTNERED WITH SOMERSET MEDICAL CENTER FOR SOMERSET COUNTY'S DATA COLLECTION. THE CHNA WAS FIRST CONDUCTED IN 2013 AND THEN AGAIN IN 2016. PART V, SECTION B, LINE 11 IN CARRIER CLINIC'S IMPLEMENTATION STRATEGY OF THE CHNA THAT WAS CONDUCTED, APPROVED BY ITS BOARD AND PUBLISHED IN 2016, CARRIER IDENTIFIED CERTAIN COMMUNITY NEEDS INCLUDING PUBLIC EDUCATION AND ACCESS TO MENTAL HEALTH CARE. CARRIER ADOPTED A TIMELINE AND STRATEGIES TO ADDRESS THESE NEEDS OVER A THREE-YEAR PERIOD. THE GOALS AND OBJECTIVES SET TO BE COMPLETED BY DECEMBER 31, 2017 HAVE BEEN MET. THE CHNA PROCESS IDENTIFIED OTHER COMMUNITY NEEDS THAT WERE NOT INCLUDED IN THE IMPLEMENTATION STRATEGY DUE TO LIMITATIONS IN EXPERTISE AND RESOURCES. PART V, LINE 22d PATIENTS WHO ARE RESIDENTS OF NEW JERSEY AND DO NOT HAVE INSURANCE ARE BILLED PURSUANT TO NEW JERSEY STATE BILLING REGULATIONS. ALL PATIENTS REGARDLESS OF RESIDENCY ARE ABLE TO APPLY FOR FINANCIAL ASSISTANCE. 6 EAST MOUNTAIN SCHOOL PO BOX 147 BELLE MEAD NJ 08502 PRIVATE SCHOOL FOR THE HANDICAPPED EAST MOUNTAIN YOUTH LODGE PO BOX 147 BELLE MEAD NJ 08502 RESIDENTIAL TREATMENT FACILITY BLAKE RECOVERY CENTER PO BOX 147 BELLE MEAD NJ 08502 RESIDENTIAL SUBSTANCE ABUSE FACILITY SWAN LODGE PO BOX 147 BELLE MEAD NJ 08502 INTENSIVE RESIDENTIAL TREATMENT FACILITY SUNFLOWER LODGE PO BOX 147 BELLE MEAD NJ 08502 PSYCHIATRIC COMMUNITY HOME FOR CHILDREN LOTUS LODGE PO BOX 147 BELLE MEAD NJ 08502 PSYCHIATRIC COMMUNITY HOME FOR CHILDREN Part I, Line 7 COLUMN E BAD DEBT EXPENSE FOR 2016 IS $3,358,087 AND IS EXCLUDED FROM TOTAL EXPENSES FOR CALCULATING THE PERCENTAGE OF TOTAL EXPENSE. PART I, LINE 7 THE COST-TO-CHARGE RATIO USED FOR PART I, LINE 7 IS BASED ON WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART III, LINE 4 In evaluating the collectability of accounts receivable, the Clinic analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third party coverage, the Clinic analyzes contractually due amounts and provides an allowance for doubtful accounts. For receivables associated with self pay patients, which includes both patients without insurance and patients with deductible and copayment balances due for which third party coverage exists for part of the bill, the Clinic records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. Account balances are written off against the allowance for doubtful accounts after all means of collection has been exhausted. PART VI, SUPPLEMENTAL INFORMATION 2 CARRIER CLINIC COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2017-2019 WHICH REFLECTED THE MENTAL HEALTH AND ADDICTION NEEDS OF ITS SURROUNDING COMMUNITY, AND A CORRESPONDING IMPLEMENTATION STRATEGY TO MEET THESE NEEDS. ADDITIONALLY, CARRIER CLINIC STAFF ATTENDS AN AVERAGE OF 10 COMMUNITY MEETINGS A MONTH THROUGHOUT THE STATE OF NEW JERSEY. DOING SO ENABLES CARRIER CLINIC TO BE EDUCATED ON EACH COUNTY'S MENTAL HEALTH AND ADDICTION NEEDS AND SPECIFIC ISSUES THAT ARE IMPORTANT TO THE COMMUNITY. AS PART OF CARRIER CLINIC'S STRATEGIC PLANNING PROCESS, CARRIER GATHERS AND INCORPORATES NATIONAL, STATE AND CLINICAL INDUSTRY DATA IN THE DEVELOPMENT OF CLINICAL SERVICES AND EDUCATIONAL FORUMS. CARRIER CLINIC IS A PARTICIPATORY MEMBER OF THE NEW JERSEY HOSPITAL ASSOCIATION, NEW JERSEY ASSOCIATION OF MENTAL HEALTH AND ADDICTION AGENCIES, NATIONAL ASSOCIATION FOR BEHAVIORAL HEALTHCARE AND THE AMERICAN HOSPITAL ASSOCIATION. EACH OF THESE ORGANIZATIONS ALSO PROVIDES BEHAVIORAL HEALTH AND ADDICTION INFORMATION RELEVANT TO OUR COMMUNITY'S BEHAVIORAL HEALTH AND ADDICTION NEEDS. READING INDUSTRY JOURNALS, NEWSLETTERS AND COMMUNITY NEWSPAPERS ALSO ALLOWS US TO HELP TAILOR FREE EDUCATIONAL EVENTS TO OUR SURROUNDING COMMUNITY. CARRIER CLINIC RECEIVES MANY TELEPHONE CALLS ON A REGULAR BASIS, IN EXCESS OF 80,000 IN 2017, REQUIRING REFERRALS TO AND INFORMATION REGARDING COMMUNITY RESOURCES, OTHER TREATMENT CENTERS OUTSIDE THE AREA, SUPPORT GROUPS, SELF-HELP GROUPS, ETC. INFORMATION IS PROVIDED WITHOUT CHARGE. CARRIER ALSO MAINTAINS ITS WEBSITE, WHICH IN ADDITION TO PROVIDING INFORMATION ABOUT CARRIER'S PROGRAMS AND SERVICES, PROVIDES THE ABILITY TO REQUEST INFORMATION VIA E-MAIL AND LINKS TO OTHER MENTAL HEALTH RESOURCES. IT IS THROUGH THIS CONTACT WITH OUR COMMUNITY THAT WE ARE ABLE TO UNDERSTAND WHAT SERVICES ARE NEEDED THROUGHOUT OUR GEOGRAPHIC AREA. PART VI, SUPPLEMENTAL INFORMATION 3 PATIENT EDUCATION AT TIME OF ADMISSION OR AS PRACTICAL THEREAFTER: PATIENTS ARE GIVEN A PATIENT HANDBOOK WHICH INCLUDES INFORMATION FOR PATIENTS REGARDING THEIR FINANCIAL RESPONSIBILITY. A PATIENT SERVICE REPRESENTATIVE (PSR) MEETS WITH THE PATIENT, IF THEY ARE MENTALLY CAPABLE, AND/OR A DESIGNATED FAMILY MEMBER OR GUARDIAN INDIVIDUALLY EITHER AT TIME OF ADMISSION OR DURING THE HOSPITALIZATION PRIOR TO DISCHARGE. THE PSR PROVIDES EDUCATION REGARDING INSURANCE COVERAGE AND PERSONAL FINANCIAL RESPONSIBILITIES. THE PATIENT IS INFORMED OF PAYMENT OPTIONS WHICH INCLUDE A FINANCIAL ASSISTANCE APPLICATION. THE PSR PROVIDES ASSISTANCE IN COMPLETING THE APPLICATION AND EXPLAINS WHAT SUPPORTING DOCUMENTATION IS NEEDED FOR CONSIDERATION. PATIENT IS EXPECTED TO PROVIDE ALL RELEVANT SUPPORTING DOCUMENTATION FOR CONSIDERATION. POST DISCHARGE: PATIENTS WHO INFORM COLLECTOR THAT THEY CANNOT MEET THEIR FINANCIAL OBLIGATION ARE PROVIDED THE APPLICATION TO COMPLETE WHICH WOULD THEN BE REVIEWED FOR CONSIDERATION. PART VI, SUPPLEMENTAL INFORMATION 4 COMMUNITY INFORMATION: CARRIER CLINIC SERVES THE ENTIRE STATE OF NEW JERSEY; HOWEVER THE MAIN PATIENT POPULATION IS FROM SUBURBAN AREAS. THE MAIN SOURCE OF ADMISSIONS IN 2017 WAS FROM MIDDLESEX, SOMERSET, OCEAN, MERCER AND MONMOUTH COUNTIES, ALL LOCATED IN NEW JERSEY. OF THESE COUNTIES, AN AVERAGE OF 8.6% OF THE POPULATION FALLS BELOW POVERTY LEVEL, BASED ON 2012-2016 CENSUS STATISTICS. PART VI, SUPPLEMENTAL INFORMATION 5 In addition to the county-specific presentations done each year in response to satisfying the deliverables of our implementation strategy, Carrier Clinic offers multiple professional and community education programs throughout the year through its Speakers Bureau, as well as through multiple community partnerships where expert speakers are provided within the business community and medical community. Carrier Clinic has a certified Mental Health First Aid trainer, and offers this training to the community at large for a small fee, however most of the cost is absorbed by Carrier Clinic. This training is offered to local first responders free of charge and is provided up to 3 times per year. Carrier Clinic offers weekly support groups, alcohol use, and depression/ anxiety screenings, and over 60 educational whitepapers and videos on its website. All of these support groups and educational materials and seminars are provided to the public at no cost. Electronic and hard copy informational newsletters are provided free of charge throughout the community, each newsletter shares information and updates on topics related to mental health and addictions. Carrier Clinic hosts events such as the Walk of Hope Awareness Day, providing free educational materials as well as the opportunity for attendees to interact with other mental health service providers, free of charge to other nonprofit mental health service providers as well as to the community. Additionally, an alumni group, with more than 600 members, is invited to bimonthly programs and social events throughout the year, also free of charge. Carrier Clinic has three field representatives who work throughout the state helping the community to better understand services that are available. PART III, SECTION B THE AMOUNTS REPORTED ON LINES 5, 6 AND 7 ARE TAKEN FROM CARRIER CLINIC'S FILED 2017 MEDICARE COST REPORT PURSUANT TO THE SCHEDULE H INSTRUCTIONS. THESE AMOUNTS DO NOT INCLUDE INCURRED LOSSES FROM PHYSICIAN SERVICES TOTALING OVER $576,000 AS FOLLOWS: PHYSICIAN COST (SALARIES, FRINGES, MALPRACTICE INSURANCE) $1,434,497 REIMBURSEMENT RECEIVED FROM MEDICARE $858,114, UNREIMBURSED COST $576,383. THE HOSPITAL BELIEVES THAT IN YEARS OF A MEDICARE SHORTFALL, IT SHOULD BE CONSIDERED AS A COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THIS YEAR, MEDICARE ACCOUNTED FOR 24% OF HOSPITAL REVENUES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS. MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE OUR MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. TAX-EXEMPT HOSPITALS ARE EXPECTED TO PARTICIPATE IN THE MEDICARE PROGRAM. PART III, LINE 2 BAD DEBT EXPENSE FOR THE YEAR IS $3,358,087, WHICH IS BASED ON CHARGES. THE RATIO OF PATIENT CARE COST-TO-CHARGE IS 58.2% WHICH IS APPLIED TO THE BAD DEBT AMOUNT FOR AN ESTIMATED COST OF $1,954,382. THIS EXPENSE IS REPORTED ON PART III, LINE 2. X X X X true true false false false false false false false TIN CHIN MD PSYCHIATRIST 260153 7600 22235 289988 RANDOLPH JACOBSON VP & CFO 270367 10952 13100 30000 26291 350710 ABDUL KAZI MD PSYCHIATRIST 301606 5614 4100 40266 351586 ANTHONY MARINO MD MEDICAL STAFF PRESIDENT 275526 5100 33700 20154 334480 UMESH MEHTA MD MEDICAL DIRECTOR 535479 6500 12600 32411 586990 DONALD PARKER PRESIDENT & CEO 381879 36951 11100 50000 22705 502635 ROBERT SAINT-VIL MD PSYCHIATRIST 298261 5100 29115 332476 JAGWINDER SANDHU MD PSYCHIATRIST 258036 4890 600 39940 303466 PATRICIA TOOLE VP & COMPLIANCE OFFICER 239987 9595 1400 30000 11923 292905 JOSEPH VERRET MD PSYCHIATRIST 289519 5100 11100 40621 346340 SHAUN SWEENEY VICE PRESIDENT 164014 3400 24923 192337 PART I, LINE 3 THE BOARD OF TRUSTEE EXECUTIVE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE FOR CARRIER CLINIC, INC. PART II DRS. MEHTA, MARINO AND SAINT-VIL RECEIVE COMPENSATION FOR ELECTRO-CONVULSIVE THERAPY (ECT) SERVICES THAT IS INCLUDED IN THEIR BASE COMPENSATION. OTHER REPORTABLE COMPENSATION REPRESENTS PENSION CONTRIBUTION THAT FAILED DISCRIMINATION TESTING. RETIREMENT AND OTHER DEFERRED COMPENSATION INCLUDES BENEFIT PLAN 457 (f) THAT SELECT EXECUTIVES PARTICIPATE IN. THE PLAN IS ESTABLISHED UNDER CODE SECTION 409A. NON-TAXABLE BENEFITS INCLUDE MEDICAL, DENTAL AND PRESCRIPTION INSURANCE PREMIUMS, LIFE INSURANCE, LTD AND METLIFE NON-TAXABLE PENSION CONTRIBUTIONS. PART I, LINE 4B SELECT EXECUTIVES PARTICIPATE IN A 457(f) PLAN: THE 2017 REPORTABLE AMOUNTS FOR 457(f) PLAN ARE $30,000 EACH FOR RANDOLPH JACOBSON AND PATRICIA TOOLE AND $50,000 FOR DONALD PARKER. PART I, LINE 4A CAROL KOSZYTO RETIRED ON 1/4/17 AS VICE PRESIDENT AND RECEIVED SEVERANCE/TERMINAL BENEFITS OF $28,219. PART III, LINE 1, MISSION TO INSPIRE HOPE AND RECOVERY THROUGH EXPERT TREATMENT, EDUCATION, COMPASSIONATE CARE AND OUTSTANDING SERVICE. PART III, LINE 4D, OTHER PROGRAMS EAST MOUNTAIN YOUTH LODGE, SWAN LODGE, SUNFLOWER LODGE AND LOTUS LODGE FOR EMOTIONALLY DISTURBED ADOLESCENTS WHICH CARED FOR 116 RESIDENTS AND HAD A TOTAL OF 30,701 PATIENT DAYS. PART VI, SECTION B, LINE 11 A&B THE BOARD OF TRUSTEES HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE BOARD OF TRUSTEES FINANCE COMMITTEE. THE FINANCE COMMITTEE WILL REVIEW THE DOCUMENT IN ADVANCE OF THE FILING WITH THE IRS. THE FINANCE COMMITTEE WILL ACKNOWLEDGE AND REPORT ON THE STATUS OF ITS REVIEW PROCESS TO THE FULL BOARD IN ADVANCE OF THE FILING DEADLINE. THE BOARD OF TRUSTEES IS PROVIDED A COPY OF THE REVIEWED AND APPROVED 990 PRIOR TO FILING. PART VI, SECTION B, LINE 12C EACH TRUSTEE, OFFICER AND MEDICAL STAFF MEMBER ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY AND UNDERSTANDS CARRIER CLINIC IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. PART VI, SECTION B, LINE 15B CARRIER CLINIC UTILIZES THE NEW JERSEY HOSPITAL ASSOCIATION, SULLIVAN AND COTTER, HOSPITAL AND HEALTHCARE COMPENSATION SERVICE, MODERN HEALTHCARE PUBLICATIONS AND OTHER VARIOUS SALARY SURVEYS FOR MARKET COMPARISONS. THE INFORMATION IS THEN PROVIDED TO THE BOARD OF TRUSTEES AND IS REVIEWED BY THE BOARD'S EXECUTIVE COMMITTEE TO ENSURE THE SALARIES ARE WITHIN APPROPRIATE MARKET AND NONPROFIT EXECUTIVE COMPENSATION BASES. THIS COMMITTEE SERVES AS THE COMPENSATION COMMITTEE AND REVIEWS THE REASONABLENESS OF THE SALARY STRUCTURE FOR EXECUTIVES AND KEY TOP INDIVIDUALS WITHIN THE ORGANIZATION. THIS COMMITTEE IS ONLY COMPRISED OF COMMUNITY TRUSTEES AND REVIEWS AND ESTABLISHES THESE SALARIES ANNUALLY IN ACCORDANCE WITH THE REBUTTABLE PRESUMPTION OF REASONABLENESS. PART VI, SECTION C, LINE 19 CARRIER CLINIC PROVIDES DOCUMENTS TO THE PUBLIC UPON REQUEST. THE IRS FORM 990 IS ALSO ACCESSIBLE FROM GUIDESTAR ON THE INTERNET. PART IX, LINE 24E OVERHEAD ALLOCATION REPRESENTS FACILITY SUPPORT AND CORPORATE COSTS ALLOCATED TO CARRIER'S VARIOUS PROGRAMS USING ACCEPTED MEDICARE COST REPORT ALLOCATION PRINCIPLES. PART XI, LINE 9 CHANGES IN NET ASSETS: PLEDGES RECEIVABLE (12,852) MINIMUM PENSION LIABILITY 326,729 CHANGE IN TRUST 70,309 CHANGE IN DERIVATIVE INVESTMENT (1,815,138) GOLF OUTING DEPOSIT PAID IN 2016 2,000 TOTAL (1,428,952) PART VI, QUESTION 1A THE EXECUTIVE COMMITTEE OF THE BOARD EXERCISES ALL POWERS AND AUTHORITY OF THE BOARD IN THE MANAGEMENT OF AFFAIRS OF CARRIER CLINIC DURING INTERVALS BETWEEN BOARD MEETINGS. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED SINCE LAST YEAR. CARRIER CLINIC BOARD OF TRUSTEES AUDIT COMMITTEE MAINTAINS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. PART VI, SECTION B, LINE 16 IN 2017, CARRIER CLINIC SIGNED A NON-BINDING LETTER OF INTENT WITH TWO OTHER PARTIES THAT SETS FORTH CERTAIN UNDERSTANDINGS IN PRINCIPLE WITH RESPECT TO A CONTEMPLATED JOINT VENTURE FOR A SUBSTANCE ABUSE AND REHABILITATION CENTER. HOWEVER, DURING 2018 UPON FURTHER EVALUATION, CARRIER CLINIC TERMINATED THE LETTER OF INTENT AND DECIDED NOT TO ENTER INTO THE JOINT VENTURE.