2017-01-31T07:09:58-06:00 2016-06-30 310800053 CLARK SCHAEFER HACKETT & CO 14 East Main Street Springfield OH 45502 990 2015-07-01 310787073 MENTAL HEALTH SERVICES FOR CLARK CO INC MENT 9373999500 474 N Yellow Springs St SPRINGFIELD OH 45504 MARY BETH TAYLOR VP FINANCE 9373999500 2017-01-30 1 DEVESH KAMAL CPA P00201226 9373992000 2017-01-30 2015 2021-01-29 14:40:06Z Mental Health Services for Clark and Madison Cos Inc CURT GILLESPIE 474 N Yellow Springs St SPRINGFIELD OH 45504 13420933 0 X WWW.MHSCC.ORG X 1969 OH PROVIDES MENTAL AND BEHAVIORAL HEALTH SERVICES TO RESIDENTS OF CLARK AND MADISON COUNTIES OHIO. 19 19 255 19 0 0 4480188 4476261 7951771 8902838 6571 5220 1074148 33768 13512678 13418087 0 0 0 0 8889502 9206741 0 0 0 3343406 3338042 12232908 12544783 1279770 873304 20149690 20458783 6204932 5628344 13944758 14830439 Mental health Services of Clark and Madison Counties will improve the safety and quality of life of those we serve through promotion of emotional and behavioral health wellness and accessibility to a comprehensive continuum of behavioral health services. 0 0 2886883 2247635 ADULT CARE OR INPATIENT PSYCHIATRIC MENTAL HEALTH SERVICES SERVED 700 CLIENTS IN the FISCAL YEAR. 6507110 5964445 OUTPATIENT PSYCHIATRIC SERVICES SERVED 5,700 CLIENTS DURING THE FISCAL YEAR. 717763 724526 RESIDENTIAL SERVICES FOR CLIENTS WITH SEVERE MENTAL DISABILITIES WERE PROVIDED FOR 102 CLIENTS DURING THE FISCAL YEAR. 10111756 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 56 0 1 255 1 0 0 0 0 0 0 0 0 0 0 X 19 19 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 Marilyn Kreider chair 3.00 X X 0 0 0 shawn taylor vice chair 3.00 X X 0 0 0 rick broderick TRUSTEE 3.00 X 0 0 0 george degenhart TRUSTEE 3.00 X 0 0 0 alexis evans comer trUSTEE 3.00 X 0 0 0 tom FRANZEN TRUSTEE 3.00 X 0 0 0 lynn zechman TRUSTEE 3.00 X 0 0 0 jeff hughes TRUSTEE 3.00 X 0 0 0 Horton Hobbs TRUSTEE 3.00 X 0 0 0 lee ann lopez tRUSTEE 3.00 X 0 0 0 sue MCCLELLAND tRUSTEE 3.00 X 0 0 0 Henry Comer tRUSTEE 3.00 X 0 0 0 doug schantz TRUSTEE 3.00 X 0 0 0 Lori Dodge Dorsey trUSTEE 3.00 X 0 0 0 brian smith trUSTEE 3.00 X 0 0 0 Lynn Rowland trUSTEE 3.00 X 0 0 0 Nab Kundu truSTEE 3.00 X 0 0 0 Diane Turner-Sharazz trustEE 3.00 X 0 0 0 Kelly Snyder tRUSTEE 3.00 X 0 0 0 Curt Gillespie CHIEF EXECUTIVE OFFICER 40.00 X 112264 0 15419 Mary beth taylor Vp fINANCE 40.00 X 77020 0 14651 dr mark a smith chief clinical officer 40.00 X 267732 0 17863 DR KALPANA VISHNUPAD PHYSICIAN 40.00 X 213203 0 17036 DR YIU-CHUNG CHANG PHYSICIAN 40.00 X 210703 0 16966 Dr Sunita Agarwal PhYSICIAN 40.00 X 140770 0 3295 1021692 0 85230 5 0 1 0 0 15362 4327309 133590 4476261 TITLE XIX MEDICAID 900099 5765023 5765023 PATIENT SERVICE REVENUES 621300 1689335 1689335 UPL Payments 900099 1187767 1187767 Rental revenue from client suppor 623990 142785 142785 TITLE XX 900099 117928 117928 8902838 8066 8066 2846 -2846 -2846 -2846 OTHER SERVICE REVENUE 621300 33768 33768 33768 13418087 8936606 0 5220 880922 812370 68552 6840090 5752504 1087586 972941 790681 182260 512788 434182 78606 651513 354703 296810 146241 62498 83743 627173 554657 72516 107715 97950 9765 161554 117937 43617 363811 251896 111915 Operating Expenses 656386 309119 347267 OPerating SUPPLIES 375510 354114 21396 EQUIPMENT EXPENSES 136546 107552 28994 Bad Debts 111593 111593 12544783 10111756 2433027 0 5709270 4378122 1485529 1493064 2677944 2046463 5184 4225 194072 191906 14207071 4437616 10011674 9769455 65017 2574548 1000 1000 20149690 20458783 2192365 2203853 22187 20312 3990380 3404179 6204932 5628344 X 13944758 14830439 13944758 14830439 20149690 20458783 873304 12377 0 X X 0 1 X 1 0 X 4145915 4700152 4882789 4480188 4476261 22685305 4145915 4700152 4882789 4480188 4476261 22685305 22685305 34342 15048 6178 6571 8066 70205 104412 64831 128926 33768 331937 23087447 46253589 0.98260 0.80400 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 2500000 14933 4332 2510601 1.00000 1 0 1560377 1560377 9743540 1913554 7829986 525843 508627 17216 2160250 1809916 350334 217061 205519 11542 9769455 Other Investments 63947 F Interest in assets held by Community Foundation 2510601 F 2574548 X 13430464 12377 12377 13418087 0 13418087 12544783 0 12544783 0 12544783 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. No income tax provision has been included in the financial statements as the Agency has determined it does not have unrelated business income subject to taxation. 1 1 1 X 175.000000000000 1 X 1 1 0 1 1 1224118 390175 833943 0.06650 1224118 390175 833943 0.06650 1224118 390175 833943 0.06650 1 74552 0 500093 474618 25475 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 14 1 1 1 1 X www.mhscc.org X 1 14 1 www.mhscc.org 0 0 1 X 175.000000000000 250.000000000000 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: In relation to the needs of the community, we also seek the input of the community during the strategic planning process based on accumulated data and feedback. For 2015, a community needs assessment was performed using feedback from of our clients and community members to identify programming needs. MENTAL HEALTH SERVICES Part V, Section B, Line 11: The hospital facility is addressing the significant needs identified in the CHNA through participation in the development of a community-wide plan, adoption of a budget for provision of services that address new programming needs identified from the Community Health Needs Assessment for dual diagnosis services. MENTAL HEALTH SERVICES Part V, Section B, Line 16i: THE BILLING CLERK PROVIDES INFORMATION TO PATIENTS ON OUR CHARITY CARE PROGRAM. WE HAVE INFORMATION ON OUR BILLING STATEMENTS REGARDING ASSISTANCE AND OUR FINANCIAL ASSISTANCE POLICY IN ON OUR WEBSITE. Part I, Line 3c: MENTAL HEALTH SERVICES OF CLARK AND MADISON COUNTIES, INC. SCREENS ALL PATIENTS FOR CHARITY CARE ELIGIBILITY BASED ON THEIR INCOME AND CURRENT FEDERAL POVERTY LEVEL GUIDELINES. IN ADDITION, SELF-PAY PATIENTS AND PATIENTS WITH OUTSTANDING MEDICAL EXPENSES THAT EXCEED $5,000 ARE ELIGIBLE FOR A 30% DISCOUNT. Part VI, Line 2: In relation to the needs of the community, we also seek the input of the community during the strategic planning process based on accumulated data and feedback. For 2015, a community needs assessment was performed as part of our strategic planning process using feedback to identify programming needs. Community members involved in the process were Clark County Combined Health District, Springfield Regional Medical Center, McKinley Hall and Mental Health Recovery Board of Clark, Greene and Madison Counties. We have identified new programming to address the dual diagnosis needs of the community. 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 MEDICAID REFERRAL COUNSELOR WHO ASSISTS CLIENTS to connect with the FQHC contact person to assist in medical enrollment. In addition, we provide a Central Pharmacy benefit for these clients needing prescription drug assistance as well as assist with drug manufacturer assistance applications. Part VI, Line 4: CLARK AND MADISON COUNTIES ARE LOCATED IN SOUTHWEST OHIO WITH AN AREA POPULATION OF APPROXIMATELY 181,000. 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 mark a smith chief clinical officer 267732 0 0 0 0 0 5300 0 12563 0 285595 0 0 0 DR KALPANA VISHNUPAD PHYSICIAN 213203 0 0 0 0 0 4473 0 12563 0 230239 0 0 0 DR YIU-CHUNG CHANG PHYSICIAN 210703 0 0 0 0 0 4403 0 12563 0 227669 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. MENTAL HEALTH RECOVERY BOARD OF CLARK GREENE AND MADISON COUNTIES DEFERRED LOAN FOR HOUSING FOR MENTALLY ILL X 75000 20312 0 1 1 20312 Form 990, Part VI, Section B, line 11 THE BOARD OF TRUSTEES AUDIT COMMITTEE REVIEWS THE FORM 990 AND APPROVES IT BEFORE FILING. Form 990, Part VI, Section B, line 12c BOARD OF TRUSTEES 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 TRUSTEES 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. Form 990, 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 112 Lohnes Ave Springfield OH 45504 311110016 Job training for individuals with disabilites OH 501(c)(3) 170(b)(1)(A)(vi) MENTAL HEALTH SERVICES 1 Resource Center Apartments INC 601 N Fountain Ave Springfield OH 45503 311307922 Affordable Housing for the disabled OH 501(c)(3) 170(b)(1)(A)(vi) MENTAL HEALTH SERVICES 1 Restan Corp 601 N Fountain Ave springfield OH 45503 311368099 affordable housing for the disabled OH 501(c)(3) 509(a)(2) MENTAL HEALTH SERVICES 1 Jani-Turf Maintenence Service Inc 112 Lohnes Ave Springfield OH 45504 311331268 Janitorial and Property Maintenece Services OH MENTAL HEALTH SERVICES C 11199 109112 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 14156 Cleaners Extraordinaire Inc K 37200 Resource Center Apartments Inc O 54528 RESTAN Corp L 600