2017-11-14T13:09:26-06:00 2016-12-31 ERNST & YOUNG US LLP 800 YARD STREET SUITE 200 GRANDVIEW HEIGHTS OH 43212 990 2016-01-01 020633634 Samaritan Behavioral Health Inc % J MICHAEL SIMS SAMA 9372768333 110 N Main St 500 Dayton OH 45402 TIMOTHY D SNIDER TREASURER 9374999942 2017-11-08 true DIANE L BEAN P00104972 6142245678 108.206.163.59 31499120173185000012 2017-11-14 P 582F47EFACDD6166E52205D1FBFEA2601660FA18 582F47EFACDD6166E52205D1FBFEA2601660FA18 2016 2017-02-10 21:41:12Z SUE V MCGATHA 601 S EDWIN C MOSES BLVD DAYTON OH 45408 13709546 false 0928 X WWW.SBHIHELP.ORG X 2002 OH Mission: To Provide Mental Health and addiction services that touch, teach, and heal. Vision: Where help for life's challenges is openly sought and compassionately given. 7 5 262 2 0 2243457 2699047 10110161 10647081 6469 -7559 129004 370977 12489091 13709546 0 0 0 0 10060828 10935266 0 0 0 2393561 2321146 12454389 13256412 34702 453134 3720430 4383460 835134 1045030 2885296 3338430 X TO PROVIDE MENTAL HEALTH AND ADDICTION SERVICES THAT TOUCH, TEACH AND HEAL. VISION: WHERE HELP FOR LIFE'S CHALLENGES IS OPENLY SOUGHT AND COMPASSIONATELY GIVEN. false false 2271146 0 2115619 Integrated Care Solutions: Samaritan Behavioral Healths Youth and Adult Outpatient Services offer the following to adults, adolescents, and children living in Montgomery County: Behavioral health assessments to determine the nature and extent of mental health problems/concerns; Recommendations regarding services that address presenting problems/symptoms; An individualized service plan with therapeutic goals developed in collaboration with the patient/family; Individual and family counseling; Referral to psychiatric services if it appears that medication may be beneficial; Ongoing psychiatric medication management, Case management (CONTINUED IN SCHEDULE O) 2051976 0 1046050 CrisisCare: Samaritan Behavioral Healths CrisisCare Program offers the following services to any adult, adolescent or child regardless of their ability to pay: 1) Hotline 24-hour suicide prevention and crisis counseling telephone line, 2) Warmline 24-hour supportive telephone counseling service, 3) Screening & Triage Evaluation of crisis needs with follow-up recommendations for service, 4) Emergency Walk-Ins Face-to-face crisis intervention, 5) Pre-Hospital Screening Health Officers evaluate whether a person needs to be hospitalized due to life threatening circumstances, 6) mobile crisis services - crisis intervention(CONTINUED IN SCHEDULE O) 1652752 0 2481983 Substance Abuse: Samaritan Behavioral Healths Substance Abuse Services offer the following to any adult living in Montgomery County: Medication Assisted Treatment (MAT) for Opioid addiction using buprenorphine/naloxone (Suboxone) neltrexone (Vivitrol); All MAT services require participation in group and individual counseling; Individual, Group, and Family Counseling, and Case Management; Services to treat abuse and addiction to alcohol, cocaine, barbiturates, marijuana, heroin, and other addictive substances; Project Dawn Training in the use and distribution of Naloxone (Narcan) Kits, Combined Substance Abuse and Mental Health Counseling. During 2016, 1,656 patients were served. 5081176 0 5374406 11057050 true true false false false false false false false true true false false true false true true true false false true false false false false false false false false true false false false false false false false false false false false false false true true false false false true 30 0 true 262 true false false false false false false false false false false X 7 5 false true false false true true true true true false false true true true true true true true true false OH X J MICHAEL SIMS 9374999942 110 N MAIN ST SUITE 500 DAYTON OH 45402 Eloise P Broner Chair 0.5 39.5 X X 0 802556 36119 Sue V McGatha President & CEO / Vice Chair 40.0 0.0 X X 243755 0 26798 Carol Bauer SC Trustee 0.5 39.5 X 0 0 0 Robert Hickey JR Trustee 0.5 0.0 X 0 0 0 Thomas R Parker Trustee (From AUG) 0.5 7.5 X 0 0 0 Frank E Sawyer Trustee (To May) 0.5 39.5 X 0 303651 34708 Evanthia Steffens Trustee 0.5 0.0 X 0 0 0 Teresa Zryd MD Trustee 0.5 0.0 X 0 3720 0 Timothy D Snider Treasurer 0.5 19.5 X 0 133804 20099 Jenna Downey ESQ Secretary 0.5 0.0 X 0 0 0 Ellen W Ballerene MD Psychiatrist 40.0 0.0 X 169309 0 34276 Shirley Budding Nurse Practitioner 40.0 0.0 X 113057 0 13308 Elizabeth L Schmitt MD Psychiatrist 40.0 0.0 X 204202 0 18339 Luis Tellez MD Physician 40.0 0.0 X 143657 0 22362 873980 1243731 206009 5 false true false Wright State Physicians 725 University Blvd FAIRBORN OH 45324 Psychiatric Services 180449 Impact Data Imaging 2647 MORGAN LN HAMILTON OH 45013 Document Management 101454 Qualifacts Systems Inc 315 DEADERICK STREET NASHVILLE TN 37238 Medical Software 174656 3 150354 2296601 252092 2699047 PROGRAM SERVICE REV 900099 10647081 10647081 10647081 -7559 -7559 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MISC REVENUE 900099 370977 370977 370977 13709546 11018058 -7559 0 0 0 0 270553 244688 25865 0 0 8527513 7553480 974033 332659 244638 88021 1141641 977045 164596 662900 565894 97006 29841 11500 18341 12121 12121 30796 30796 0 0 0 553029 379111 173918 7187 3813 3374 323285 153131 170154 187272 2364 184908 0 637522 579046 58476 61724 58641 3083 0 31197 17994 13203 0 0 66054 47370 18684 89655 89655 CATHOLIC HEALTH FEES 127327 106191 21136 OPERATING SUPPLIES 94112 89563 4549 REPAIRS AND MAINTENANCE 47442 19840 27602 ALL OTHER EXPENSES 22582 2741 19841 13256412 11057050 2199362 0 2340132 836179 0 0 0 0 602229 2584899 0 0 0 0 0 0 0 0 63279 117147 575699 385949 154167 189750 0 0 0 0 0 0 0 0 560623 655485 3720430 4383460 708995 877056 0 0 126139 167974 0 0 0 0 0 0 0 0 0 0 0 0 835134 1045030 X 2324673 2682945 166853 257044 393770 398441 2885296 3338430 3720430 4383460 453134 X false true X true true true X 9757 3947674 3827631 2243457 2699047 12727566 11229707 7666530 8520100 10110161 10647081 48173579 0 11239464 11614204 12347731 12353618 13346128 60901145 9433005 51468140 48828 43454 22984 6469 -7559 114176 0 0 61015321 855174 0.84353 0.99795 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 560623 121814 -8031 18921 655485 556820 5845 -603 1439 560623 543318 4141 15718 6357 556820 536233 4728 37682 35326 543317 530903 9757 43753 48180 536233 0.61000 0.39000 true false 220057 162424 57633 355642 223525 132117 189750 FUNDS HELD BY GOOD SAMARITAN 655485 655485 0 0 X 13709546 13709546 13709546 13256412 13256412 13256412 Schedule D, Part X, Line 2: THE FOLLOWING FOOTNOTE IS FROM THE AUDITED COMBINED FINANCIAL STATEMENTS FOR PREMIER HEALTH AND AFFILIATES. SAMARITAN HEALTH PARTNERS IS THE PARENT ORGANIZATION OF SAMARITAN BEHAVIORAL HEALTH, INC. PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), SAMARITAN HEALTH PARTNERS (SHP), ATRIUM HEALTH SYSTEM (AHS), AND UVMC have been determined by the Internal Revenue Service to be tax-exempt nonprofit corporations and public charities under Sections 501(c)(3) and 509(a), respectively, of the Internal Revenue Code. As tax-exempt organizations, their income is exempt from federal income tax except to the extent of any unrelated business activities. PREMIER, SHP AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. Taxes payable at December 31, 2016 and 2015, for such unrelated business activities are not significant. Management annually reviews the tax positions and has determined that there are no material uncertain tax positions. Central America and the Caribbean Investments 11000 East Asia and the Pacific Investments 38000 Europe (Including Iceland and Greenland) Investments 88000 Middle East and North Africa Investments 1000 North America Investments 9000 Russia and the Newly Independent States Investments 3000 South America Investments 7000 South Asia Investments 4000 Sub-Saharan Africa Investments 1000 162000 162000 true false true false true false X X X X false true false false false false false false false Eloise P Broner Chair 0 429630 0 186519 0 186407 0 33264 0 2855 0 838675 0 0 Sue V McGatha President & CEO / Vice Chair 198837 0 40620 0 4298 0 18571 0 8227 0 270553 0 0 0 Frank E Sawyer Trustee (To May) 0 232260 0 70795 0 596 0 9389 0 25319 0 338359 0 0 Timothy D Snider Treasurer 0 99202 0 34103 0 499 0 7116 0 12983 0 153903 0 0 Ellen W Ballerene MD Psychiatrist 169014 0 132 0 163 0 6726 0 27550 0 203585 0 0 0 Elizabeth L Schmitt MD Psychiatrist 204182 0 20 0 0 0 0 0 18339 0 222541 0 0 0 Luis Tellez MD Physician 143637 0 20 0 0 0 2166 0 20196 0 166019 0 0 0 SCHEDULE J, PART I, LINE 4B: DUE TO RESTRICTIONS IMPOSED BY THE INTERNAL REVENUE CODE, CERTAIN PERSONS ARE LIMITED IN THE AMOUNT OF BENEFIT THAT CAN BE EARNED UNDER A QUALIFIED RETIREMENT PLAN. LIKE MANY EMPLOYERS, SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI) AND ITS AFFILIATED ORGANIZATIONS COMPENSATE FOR THIS LIMITATION AND SUPPLEMENT THE AFFECTED EXECUTIVES' QUALIFIED PENSION THROUGH CERTAIN NONQUALIFIED PLANS. SBHI SUPPLEMENTS THE AFFECTED EXECUTIVES THROUGH A PENSION RESTORATION PLAN AND A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE BENEFITS UNDER THESE SUPPLEMENTAL NONQUALIFIED PLANS ARE SUBJECT TO MULTI-YEAR VESTING AND A PARTICIPANT CAN FORFEIT BENEFITS EARNED IF VESTING REQUIREMENTS ARE NOT SATISFIED. UNDER THE TERMS OF THE SUPPLEMENTAL PLANS, AND BECAUSE OF TAX RULES PERTAINING TO TAXATION OF THE EARNED BENEFITS UPON VESTING, A CERTAIN INDIVIDUAL RECEIVED A PAYOUT OF THE CUMULATIVE VESTED BENEFITS UNDER THEIR SUPPLEMENTAL PLAN DURING 2016. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2016: ELOISE BRONER $164,035. BASED ON THE GUIDANCE PROVIDED IN THE INSTRUCTIONS TO THE FORM 990, ANY PAYMENTS TO THE PARTICIPANTS RELATED TO THESE PLANS THAT WERE MADE WITHIN 2-1/2 MONTHS AFTER THE END OF THE ORGANIZATION'S TAX YEAR ARE NOT TREATED AS DEFERRED COMPENSATION FOR PURPOSES OF SCHEDULE J. SUCH AMOUNTS ARE PROPERLY REPORTED AS COMPENSATION FOR FORM 990 PURPOSES WHEN INCLUDED IN THE PARTICIPANTS' FORM W-2 WAGES. ANY PAYMENTS MADE AFTER THE 2-1/2 MONTHS WERE PROPERLY REPORTED ON PRIOR YEARS' FILED IRS FORM 990 RETURNS, DISCLOSING COMPENSATION EARNED BY THESE INDIVIDUALS UNDER THE PLANS FOR EACH SUCH YEAR. Form 990 - Part III, Question 4A (CONTINUED): (Community Psychiatric Supportive Treatment) services to further support therapeutic interventions and link patient/family to community resources. During 2016, 3,107 patients were served. Form 990 - Part III, Question 4b (CONTINUED): services provided at residences and/or in the community for those who are at risk of harm to themselves or others, 7) Crisis Counseling Provides counseling up to 4 sessions for acute stabilization and on-going support, 8) Crisis Debriefing Services are available for individuals or groups involved in traumatic events. CrisisCare served 1,444 patients and provided 6,007 units of services for 2016. Form 990, Part III, Question 4d: This number represents the balance of total expenditures of temporarily restricted funds for Samaritan Behavorial Health net of programs described in service accomplishments. Form 990 - Part VI, Section A, Question 3: Premier Health (Premier), as the operator of Samaritan Bevavioral Health, Inc.(SBHI), develops and oversees the implementation of the strategic plan for SBHI, which includes (but is not limited to) such matters as location of clinical and administrative expenses and the consolidation of such services. SBHI shall comply with and implement this plan and shall not take any action that materially departs from this plan without Premier's approval. SBHI shall implement any capital and operating budget so approved and/or revised for it by Premier. SBHI shall implement the business plan approved by Premier. Premier is the sole agent to negotiate all relationships with payors on behalf of SBHI with all third party payors and alternative delivery systems including, but not limited to insurers. SBHI must have approval from Premier to borrow in any fiscal year, guarantee in any year, or incur any lien or other encumbrance on any property in an amount equal to or greater than $1,000,000. SBHI must seek Premier's approval for any acquisitions, sale or transfer of any material asset used in Premier's activities. Form 990 - Part VI, Question 6: Samaritan Behavioral Health Inc. (SBHI) has one corporate member. This member is Samaritan Health Partners. Form 990 - Part VI, Section A, Question 7a: Samaritan Health Partners (SHP) has the sole authority to elect the Board of Trustees for Samaritan Behavioral Health, Inc. Form 990 - Part VI, Section A, Question 7b: See the response above for Form 990, Part VI, Section A, Line 3. Form 990 - Part VI, Section B, Question 11B: This 990 tax return and attached schedules (the return) are prepared by a staff member in the Tax Department of Premier Health (Premier), which Samaritan Behavorial health, Inc. is an affiliate. The return is reviewed by the Tax Manager and the Director of Tax Compliance of Premier. The return is concurrently sent to Ernst & Young U.S. LLP for their review. After all changes from the above groups are made, the return is reviewed by the Vice President/Controller of Premier and the Chief Financial Officer of this entity. A final version of the return is sent to Ernst & Young U.S. LLP for a final review and then provided to the Board of Trustees for review. At the Board of Trustees meeting, the Vice President/Controller of Premier (or designee) shares detailed information on compensation and other key areas, as well as addresses any other questions from the Board of Trustees, pending their review. The 990 tax return is also shared with the Audit Committee of Premier. Form 990 - Part VI, Section B, Question 12c: PREMIER HEALTH (PREMIER), OF WHICH Samaritan Behavioral Health, Inc. IS AN AFFILIATE, REQUIRES ALL BOARD MEMBERS, OFFICERS, EXECUTIVE DIRECTORS, VICE PRESIDENTS, DIRECTORS, PURCHASING DEPARTMENT STAFF, AUTHORIZED PURCHASERS, MEDICAL DIRECTORS, DEPARTMENT AND SECTIONS CHAIRS, AND ALL EMPLOYED PHYSICIANS TO ANNUALLY REVIEW THE PREMIER COMPREHENSIVE CONFLICT OF INTEREST STATEMENT, AN EXPLANATORY MEMORANDUM, THE ANTITRUST COMPLIANCE POLICY, AND COMPLETE AN INDIVIDUAL QUESTIONNAIRE DISCLOSING ANY POTENTIAL CONFLICTS AS DEFINED IN THE CONFLICT OF INTEREST POLICY. THIS IS ACCOMPLISHED EITHER BY WAY OF AN ELECTRONIC COMMUNICATION SENT OUT DIRECTLY BY THE CORPORATE COMPLIANCE DEPARTMENT OR BY WAY OF A MEMO SENT OUT FROM THE CHAIRMAN OF THE BOARD AND CHIEF EXECUTIVE OFFICER OF PREMIER. IT ALSO INCLUDES AN EXPLANATORY MEMORANDUM OF SPECIFIC ACTIVITIES THAT MIGHT GIVE CAUSE TO A CONFLICT AND AN INDIVIDUAL QUESTIONNAIRE TO DISCLOSE ALL SUCH ACTIVITIES. THIS QUESTIONNAIRE MUST BE COMPLETED AND SIGNED BY THE INDIVIDUAL. THIS CORRESPONDENCE INCLUDES A COPY OF THE ANTITRUST COMPLIANCE POLICY THAT MUST BE SIGNED BY THE INDIVIDUAL. ALL OF THESE DOCUMENTS ARE SENT TO THE CORPORATE COMPLIANCE DEPARTMENT. THE CORPORATE COMPLIANCE DEPARTMENT ENSURES ALL FORMS ARE RETURNED AND RETAINS THE DOCUMENTS FOR FIVE YEARS. IN ADDITION, AT EACH MEETING OF THE BOARD OR ANY BOARD COMMITTEE, FOLLOWING APPROVAL OF THE PREVIOUS MEETING'S MINUTES, THE BOARD OR COMMITTEE CHAIR SHALL REQUEST ANY BOARD MEMBER WHO PERCEIVES A POTENTIAL CONFLICT OF INTEREST ON ANY OF THE MEETING'S AGENDA ITEMS TO DISCLOSE THE POTENTIAL CONFLICT. ADDITIONALLY, AT ANY BOARD OR BOARD COMMITTEE MEETING WHERE THE SUBJECT OF CONFLICT OF INTEREST IS DISCUSSED, THE MINUTES SHALL CONTAIN THE NAME OF THE PARTY DISCUSSING A POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE POTENTIAL CONFLICT OF INTEREST AND WHETHER A CONFLICT OF INTEREST WAS FOUND TO EXIST. IF A CONFLICT OF INTEREST IS DETERMINED BY THE BOARD TO EXIST, THE MEMBER WILL BE EXCUSED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON THE PARTICULAR AGENDA ITEM. THE CHIEF COMPLIANCE AND ENTERPRISE RISK OFFICER REPORTS THE RESULTS OF THE PREMIER CONFLICT OF INTEREST QUESTIONNAIRES NO LESS THAN ANNUALLY TO THE BOARD OF TRUSTEES BY WAY OF THE COMPLIANCE AND AUDIT COMMITTEE. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE MEETING. PERIODICALLY, THE INTERNAL AUDIT DEPARTMENT WILL REVIEW A SAMPLE OF COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND REPORT THE RESULTS TO THE COMPLIANCE AND AUDIT COMMITTEE. THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE INDIVIDUALLY SUMMARIZED IN A DOCUMENT AND SENT ELECTRONICALLY TO THE FINANCE DEPARTMENT FOR ANY NECESSARY DISCLOSURES REQUIRED ON THE 990 TAX RETURN. Form 990 - Part VI, Section B, Question 15A and 15B: COMPENSATION TO THE CEO OF SAMARITAN BEHAVIORAL HEALTH, INC. (SBHI) IS REVIEWED AND APPROVED BY PREMIER HEALTH (PREMIER), of which SBHI IS AN AFFILIATE, ON AN ANNUAL BASIS. THE REVIEW PROCESS PERFORMED BY PREMIER FOLLOWS A MARKET BASED COMPENSATION PHILOSOPHY designed to attract and retain the executive talent required to meet the high performance standards of our board and our community. PREMIER ANNUALLY REVIEWS EXECUTIVE COMPENSATION SURVEY DATA FOR A REGIONAL PEER GROUP OF SYSTEMS AND HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO PREMIER AND ITS AFFILIATES. THE DATA FOR THE SURVEY IS PROVIDED BY A THIRD PARTY CONSULTANT GROUP THAT IS INDEPENDENT OF PREMIER. THIS REPORT INCLUDES COMPARABILITY FOR KEY EXECUTIVES, VICE PRESIDENTS, AND DIRECTOR LEVEL POSITIONS. THE INDEPENDENT COMPARABILITY DATA IS REVIEWED BY THE EXECUTIVE COMPENSATION COMMITTEE ON AN ANNUAL BASIS. THIS COMMITTEE IS COMPRISED OF THREE MEMBERS, ALL OF WHICH ARE INDEPENDENT. THIS COMMITTEE REVIEWS IN DETAIL THE COMPENSATION FOR THE PREMIER CEO, COO, CFO, CHIEF INTEGRATION OFFICER, CHIEF STRATEGY OFFICER, AND THE HOSPITAL CEOS. OTHER POSITIONS ARE REVIEWED AT A HIGH LEVEL FOR REASONABLENESS. ALL THE MEETING MINUTES ARE DOCUMENTED AND KEPT ON FILE ALONG WITH ANY COMPARABILITY DATA AND THE CONSULTANT REPORT. AFTER THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE COMPENSATION ACTIONS, THE PROCESS IS AUDITED BY THE INTERNAL AUDIT DEPARTMENT. THE EXECUTIVE COMPENSATION COMMITTEE PRESENTS THE COMPENSATION ACTIONS TO THE PREMIER BOARD ANNUALLY. Form 990 - Part VI, Section C Question 19: THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUIRED BY LAW OR FOR ACCREDITATION PURPOSES. THE CONFLICT OF INTEREST POLICY IS AVAILABLE ON WWW.PREMIERHEALTH.COM. 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