2016-11-15T15:29:40-06:00 2015-12-31 EISNERAMPER LLP 111 WOOD AVE SO STE 600 ISELIN NJ 088302700 990 2015-01-01 221714106 CARRIER CLINIC INC % DONALD PARKER CARR 9082811000 PO BOX 147 BELLE MEAD NJ 085020147 RANDOLPH JACOBSON VP/CFO 9082811560 2016-11-14 true RICHARD A SACKIN P00184276 7322437000 2015 2017-02-10 21:41:12Z DONALD PARKER PO BOX 147 BELLE MEAD NJ 08502 85336479 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 1081 0 0 0 773962 333322 65916117 69532228 2737017 1143970 722990 1109999 70150086 72119519 1000 1000 0 0 49670952 53134323 0 0 235499 16507619 18442804 66179571 71578127 3970515 541392 66303600 74910160 27184355 36392105 39119245 38518055 X REFER TO SCHEDULE O FOR MISSION STATEMENT. false false 43319359 1000 44554376 PSYCHIATRIC HOSPITAL WHICH CARED FOR 4,672 INPATIENTS AND HAD A TOTAL OF 50,308 PATIENT DAYS. 7165064 7200883 EAST MOUNTAIN SCHOOL WHICH PROVIDED QUALITY SPECIAL EDUCATION AND THERAPEUTIC SERVICES FOR 95 ADOLESCENTS AFFECTED BY BEHAVIORAL AND PSYCHIATRIC DISORDERS BASED ON 2015 AVERAGE DAILY ENROLLMENT. 5483561 5158896 BLAKE RECOVERY CENTER WHICH CARED FOR 1,453 INPATIENTS AND HAD A TOTAL OF 8,735 PATIENT DAYS. 12237521 12618073 68205505 true true false true false false false false false true true false false true 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 26 0 true 1081 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 DONALD PARKER 252 RT 601 BLAWENBE 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 KOLLIGAN JR PHD VICE CHAIRMAN 0.0 0.0 X 0 0 0 THOMAS R WILSON TRUSTEE 0.0 0.0 X 0 0 0 THOMAS HARTMANN SECRETARY 0.0 0.0 X 0 0 0 DAVID BUCH MD MEDICAL DIRECTOR 40.0 0.0 X X 305630 0 38128 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 DONALD PARKER PRESIDENT & CEO 40.0 0.0 X X 449616 0 71365 ROBERT SAINT-VIL MD MEDICAL STAFF PRESIDENT 40.0 0.0 X 246306 0 25733 JAIME ROBERTSON-LAVALLE TRUSTEE 0.0 0.0 X 0 0 0 MARILOUISE VENDITTI MD TRUSTEE 0.0 0.0 X 0 0 0 RANDOLPH JACOBSON VP & CFO 40.0 0.0 X 284003 0 43689 PATRICIA TOOLE VP & COMPLIANCE OFFICER 40.0 0.0 X 232906 0 32090 CAROL KOSZTYO VICE PRESIDENT 40.0 0.0 X 208572 0 23385 UMESH MEHTA MD PSYCHIATRIST 40.0 0.0 X 482083 0 37334 ABDUL KAZI MD PSYCHIATRIST 40.0 0.0 X 284523 0 39681 ANTHONY MARINO MD PSYCHIATRIST 40.0 0.0 X 251482 0 20176 JAGWINDER SANDHU MD PSYCHIATRIST 40.0 0.0 X 253358 0 38915 JOSEPH VERRET MD PSYCHIATRIST 40.0 0.0 X 244810 0 39738 3243289 0 410234 51 false true false SODEXO INC AFFILIATES PO BOX 905374 CHARLOTTE NC 282905374 DIETARY & HOUSEKEEP 2329254 DRINKER BIDDLE REATH LLP 500 CAMPUS DRIVE FLORHAM PARK NJ 07932 LEGAL SERVICES 130000 KPMG LLP 150 JOHN F KENNEDY PARKWAY SHORT HILLS NJ 07078 AUDITING SERVICES 176657 PRINCETON MEDICAL BEHAVIORAL HEAL 445 WHITEHORSE AVE SUITE 101 HAMILTON NJ 08610 INTERNAL MEDICINE 586133 4 X 149129 184193 17455 333322 NET PATIENT SERVICES 624100 62330945 62330945 EDUCATIONAL PROGRAMS 611710 7201283 7201283 69532228 750372 750372 0 0 252571 252571 0 0 0 13049417 12655819 393598 393598 393598 85960 149129 85960 0 0 309608 222610 86998 86998 SERVICES AGREEMENT 900099 861444 861444 INS SETTLEMENT/PHONE/VENDING 900099 27332 27332 PURCHASING DISCOUNTS 900099 62744 62744 71481 71481 1023001 72119519 70393672 1392525 X 1000 1000 0 0 0 1666403 439246 1227157 0 41174860 35324981 5695332 154547 2331300 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RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 50905 false false 50905 false PART II-B, LINE 1 (I), OTHER LOBBYING ACTIVITIES: This expense represents RETAINER PAID TO KAUFMAN ZITA GROUP WHICH SERVES AS PUBLIC AFFAIRS COUNSEL TO CARRIER CLINIC AND ALSO 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. 552563 356664 347801 561426 505721 829629 782787 552563 423297 1249018 1166594 505721 262419 183076 22198 423297 177973 133977 49531 262419 1.00000 false false 278290 278290 42760635 18256252 24504383 8047082 6293536 1753546 13530519 6372167 7158352 33694571 OTHER RECEIVABLES 1379066 ASSETS WHOSE USE IS LIMITED 732178 CHARITABLE REMAINDER TRUST 543929 FUNDED DEFERRED COMPENSATION 402823 INSURANCE CLAIMS RECOVERY 1800000 4857996 0 DEFERRED COMPENSATION 657823 DUE TO THIRD-PARTY PAYORS 380559 ACCRUED PENSION AND BENEFITS 6694081 7732463 X 69082587 436880 436880 68645707 3473812 3473812 72119519 69921659 436880 436880 69484779 2093348 2093348 71578127 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 185,309 RENTAL EXPENSE 252,571 TOTAL PART XI, LINE 2D 436,880 PART XI, LINE 4B - OTHER ADJUSTMENTS: PATIENT BAD DEBTS 2,093,348 ACTUAL DONATIONS VS. INCOME STATEMENT <17,290> INVESTMENT INCOME 1,143,970 NET ASSETS RELEASED-CAPITAL 253,784 TOTAL PART XI, LINE 4B 3,473,812 PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 184,309 RENTAL EXPENSE 252,571 TOTAL PART XII, LINE 2D 436,880 PART XII, LINE 4B - OTHER ADJUSTMENTS: PATIENT BAD DEBTS 2,093,348 TOTAL PART XII, LINE 4B 2,093,348 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 126900 81432 45468 32022 13446 GOLF OUTING 58728 34665 24063 19763 4300 1 49461 33032 16429 16429 235089 149129 85960 51785 34175 85960 true true X true X true true true true false true true 670480 670480 0.00970 5859454 5052713 806742 0.01160 6529934 5052713 1477222 0.02130 3437 3437 0.00010 12416 12416 0.00020 6568080 3824409 2743671 0.03950 17181 17181 0.00020 6601114 3824409 2776705 0.04000 13131048 8877122 4253927 0.06130 15823 15823 0.00020 15823 15823 0.00020 true 1174913 11943379 11311462 631917 X true false 1 1 CARRIER CLINIC INC PO BOX 147 BELLE MEAD NJ 08502 WWW.CARRIERCLINIC.ORG 51806 X CARRIER CLINIC INC 1 false false true X X X X X X X X X 13 true true false true X WWW.CARRIERCLINIC.ORG X true 13 true WWW.CARRIERCLINIC.ORG false false true X 100 100 X true true X true X WWW.CARRIERCLINIC.ORG X X X X true false true X X false false PART V, SECTION B, LINE 5 WHILE CONDUCTING CARRIER CLINIC'S CHNA, A REPRESENTATIVE OF CARRIER CLINIC INTERVIEWED MENTAL HEALTH ADMINISTRATORS FROM MIDDLESEX, SOMERSET, MONMOUTH, OCEAN, MORRIS, HUNTERDON AND MERCER COUNTIES TO DISCUSS SERVICE GAPS IN THE COMMUNITY. THESE COUNTIES REPRESENT APPROXIMATELY 75% 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 CONDUCTED IN 2013. 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 2013, 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, 2015 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 F BAD DEBT EXPENSE FOR 2015 IS $2,093,348 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 2013-2016 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 14 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 OF PSYCHIATRIC HEALTH SYSTEMS, 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 78,000 IN 2015, 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 2015 WAS FROM MIDDLESEX, SOMERSET, OCEAN, MERCER, HUNTERDON, MORRIS AND MONMOUTH COUNTIES, ALL LOCATED IN NEW JERSEY. OF THESE COUNTIES, AN AVERAGE OF 7.84% OF THE POPULATION FALLS BELOW POVERTY LEVEL, BASED ON 2010-2014 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. CARRIER ALSO 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. CARRIER CLINIC SUBMITS PUBLIC SERVICE ANNOUNCEMENTS (PSAS) TO LOCAL BROADCAST STATIONS AND THROUGH SOCIAL MEDIA EDUCATING THE PUBLIC ABOUT MENTAL HEALTH AND ADDICTION ISSUES, AND ALSO SPONSORS, AT COST TO CARRIER, A 60 SECOND "EMPOWERED MOMENT" ON LOCAL RADIO STATIONS TO EDUCATE THE PUBLIC ABOUT COMMON MENTAL HEALTH AND ADDICTION ISSUES. THIS SEGMENT IS AIRED 420 TIMES THROUGHOUT THE YEAR AND ENCOURAGES THE COMMUNITY TO CONTACT THEIR DOCTOR TO DISCUSS MENTAL HEALTH TREATMENT OPTIONS, IF NEEDED. PART III, SECTION B IN ADDITION TO THE AMOUNTS REPORTED IN LINES 5, 6 AND 7, WHICH ARE TAKEN FROM CARRIER CLINIC'S 2015 MEDICARE COST REPORT PURSUANT TO THE SCHEDULE H INSTRUCTIONS, CARRIER ALSO INCURRED LOSSES FROM PHYSICIAN SERVICES TOTALING OVER $677,000 AS FOLLOWS: PHYSICIAN COST (SALARIES, FRINGES, MALPRACTICE INSURANCE) $1,433,819 REIMBURSEMENT RECEIVED FROM MEDICARE $ 756,609 UNREIMBURSED COST $ 677,210 PART III, LINE 2 BAD DEBT EXPENSE FOR THE YEAR IS $2,093,348, WHICH IS BASED ON CHARGES. THE RATIO OF PATIENT CARE COST-TO-CHARGE IS 56.13% WHICH IS APPLIED TO THE BAD DEBT AMOUNT FOR AN ESTIMATED COST OF $1,174,913. THIS EXPENSE IS REPORTED ON PART III, LINE 2. X X X X false true false false false false false false false RANDOLPH JACOBSON VP & CFO 263603 0 8000 0 12400 0 20000 0 23689 0 327692 0 0 0 PATRICIA TOOLE VP & COMPLIANCE OFFICER 232906 0 0 0 0 0 20000 0 12090 0 264996 0 0 0 CAROL KOSZTYO VICE PRESIDENT 208572 0 0 0 0 0 20000 0 3385 0 231957 0 0 0 UMESH MEHTA MD PSYCHIATRIST 470883 0 0 0 11200 0 0 0 37334 0 519417 0 0 0 DAVID BUCH MD MEDICAL DIRECTOR 294830 0 0 0 10800 0 0 0 38128 0 343758 0 0 0 ABDUL KAZI MD PSYCHIATRIST 281423 0 0 0 3100 0 0 0 39681 0 324204 0 0 0 DONALD PARKER PRESIDENT & CEO 366115 0 72101 0 11400 0 50000 0 21365 0 520981 0 0 0 ROBERT SAINT-VIL MD MEDICAL STAFF PRESIDENT 246306 0 0 0 0 0 0 0 25733 0 272039 0 0 0 ANTHONY MARINO MD PSYCHIATRIST 233582 0 0 0 17900 0 0 0 20176 0 271658 0 0 0 JAGWINDER SANDHU MD PSYCHIATRIST 252458 0 0 0 900 0 0 0 38915 0 292273 0 0 0 JOSEPH VERRET MD PSYCHIATRIST 244810 0 0 0 0 0 0 0 39738 0 284548 0 0 0 PART I, LINE 3 THE BOARD OF TRUSTEE EXECUTIVE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE FOR CARRIER CLINIC, INC. PART II 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 409(a)(1)(A). PART I, LINE 4B SELECT EXECUTIVES PARTICIPATE IN A 457(f) PLAN: THE 2015 REPORTABLE AMOUNTS FOR 457(f) PLAN ARE $20,000 EACH FOR RANDOLPH JACOBSON, CAROL KOSZTYO AND PATRICIA TOOLE AND $50,000 FOR DONALD PARKER. PART III, LINE 1, MISSION PROVIDING CARING SOLUTIONS SINCE 1910, CARRIER CLINIC'S MISSION IS TO PROVIDE THE BEST CARE AND TREATMENT TO THESE PERSONS WHO COME TO US STRUGGLING WITH EMOTIONAL AND BEHAVIORAL DISTRESS AND ADDICTIVE AND PSYCHIATRIC DISORDERS. AS ONE OF NEW JERSEY'S LARGEST, NOT-FOR-PROFIT BEHAVIORAL HEALTHCARE ORGANIZATIONS, WE REMAIN DEDICATED TO HEALING, SUPPORTING AND TEACHING ADOLESCENTS, ADULTS AND THEIR FAMILIES IN A SAFE, COMPASSIONATE AND RESPECTFUL ENVIRONMENT. WITHIN OUR CONTINUUM OF CARE, HOPE IS RESTORED AND RECOVERY BEGINS. PART III, LINE 4D, OTHER PROGRAMS EAST MOUNTAIN YOUTH LODGE, SWAN LODGE, SUNFLOWER LODGE AND LOTUS LODGE FOR EMOTIONALLY DISTURBED ADOLESCENTS WHICH CARED FOR 111 RESIDENTS AND HAD A TOTAL OF 30,446 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 VII, SECTION A DRS. MEHTA, MARINO, SAINT-VIL AND SANDHU RECEIVE COMPENSATION FOR ELECTRO-CONVULSIVE THERAPY (ECT) SERVICES IN ADDITION TO THEIR BASE SALARY. 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 45,829 MINIMUM PENSION LIABILITY 219,417 CHANGE IN DERIVATIVE INSTRUMENT 59,725 CHANGE IN TRUST (37,960) HEALING ARTS (OPERATIONS vs CASH) (16,176) 2016 RESTRICTED EXPENSE NOT RELEASED (3,500) TOTAL 267,335 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.