2016-11-12T09:41:29-06:00 2015-12-31 ERNST & YOUNG US LLP 800 YARD STREET SUITE 200 GRANDVIEW HEIGHTS OH 43212 990 2015-01-01 020633634 Samaritan Behavioral Health Inc % J MICHAEL SIMS SAMA 9372768333 110 N Main St 500 Dayton OH 45402 TIMOTHY D SNIDER OFFICER 9374999942 2016-11-08 true DIANE L BEAN P00104972 6142245678 2015 2017-02-10 21:41:12Z SUE V MCGATHA 601 S EDWIN C MOSES BLVD DAYTON OH 45408 12489091 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. 8 4 225 10 0 3827631 2243457 8520100 10110161 22984 6469 169101 129004 12539816 12489091 0 0 0 0 9732868 10060828 0 0 0 2129165 2393561 11862033 12454389 677783 34702 4415646 3720430 1565052 835134 2850594 2885296 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 4105323 0 4347365 Montgomery County Mental Health Services: 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) 2011194 0 1342595 CRISIS-CARE: Samaritan Behavioral Healths CrisisCare Program offers the following services to any adult, adolescent or child regardless of their ability to pay: Hotline 24-hour suicide prevention and crisis counseling telephone line, Warmline 24-hour supportive telephone counseling service, Screening & Triage Evaluation of crisis needs with follow-up recommendations for service, Emergency Walk-Ins Face-to-face crisis intervention, Pre-Hospital Screening Health Officers evaluate whether a person needs to be hospitalized due to life threatening circumstances, Mobile Crisis Services Crisis intervention services provided at residences (CONTINUED IN SCHEDULE O) 1315247 0 1771465 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 2015, 1,279 patients were served. 2894937 0 2777740 10326701 true true false false false false false false false true true false false true false true true true false false false 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 31 0 true 225 true false false false false false false false false false false X 8 4 false true false false true true true true true false false true true true true true true true true false 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 686548 13990 Sue V McGatha President & CEO / Vice Chair 40.0 0.0 X X 215397 0 33626 Thomas R Curtin Treasurer (To Aug) 0.5 7.5 X X 0 276277 37323 Timothy D Snider Treasurer (From Aug) 0.5 19.5 X X 0 119664 17481 Carol Bauer SC Trustee 0.5 39.5 X 0 0 0 Robert E Hickey Jr Trustee 0.5 0.0 X 0 0 0 John M Rahe MD Trustee (To Nov) 0.5 0.0 X 0 0 0 Frank E Sawyer Trustee 0.5 39.5 X 0 226322 34501 Evan Steffens Trustee (From Nov) 0.5 0.0 X 0 0 0 Teresa Zryd MD Trustee 0.5 0.0 X 0 5440 0 Jenna Downey ESQ Board Secretary 0.5 0.0 X 0 0 0 Ellen W Ballerene MD Psychiatrist 40.0 0.0 X 174459 0 23133 Elizabeth L Schmitt MD Psychiatrist 40.0 0.0 X 103911 0 15292 Melissa C Whitesell Nurse Practitioner 40.0 0.0 X 110676 0 23591 604443 1314251 198937 4 false true false Wright State Physicians 725 University Blvd FAIRBORN OH 45324 Psychiatric Services 126930 Cirrus Concept Consulting Inc 1 Elizabeth Pl DAYTON OH 45417 Personnel Consulting 172456 Qualifacts Systems Inc 200 2nd Avenue South NASHVILLE TN 37201 Medical Software 176274 3 170818 1951012 121627 2243457 PROGRAM SERVICE REV 900099 10110161 10110161 10110161 6469 6469 0 0 0 0 0 0 0 0 0 MISC REVENUE 900099 129004 129004 129004 12489091 10239165 6469 0 0 0 0 249023 225216 23807 0 0 7847472 6871055 976417 256911 239897 17014 1079464 925757 153707 627958 516828 111130 30049 13535 16514 386 386 21313 21313 0 0 0 686744 465151 221593 9699 5373 4326 276700 141634 135066 183254 6703 176551 0 649412 588792 60620 65252 57197 8055 0 44004 26215 17789 0 0 120909 60985 59924 73683 73683 CATHOLIC HEALTH FEES 121355 101099 20256 OPERATING SUPPLIES 67500 66770 730 REPAIRS AND MAINTENANCE 34743 12984 21759 ALL OTHER EXPENSES 8558 1510 7048 12454389 10326701 2127688 0 2874210 2340132 0 0 0 0 771508 602229 0 0 0 0 0 0 0 0 35154 63279 634459 480292 177954 154167 0 0 0 0 0 0 0 0 556820 560623 4415646 3720430 1197754 708995 0 0 367298 126139 0 0 0 0 0 0 0 0 0 0 0 0 1565052 835134 X 2293774 2324673 165899 166853 390921 393770 2850594 2885296 4415646 3720430 34702 X false true X true true true X 4050 9757 3947674 3827631 2243457 10032569 11581281 11229707 7666530 8520100 10110161 49107779 0 11585331 11239464 11614204 12347731 12353618 59140348 0 59140348 48828 43454 22984 6469 121735 0 0 59262083 484107 0.99795 0.99799 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 556820 5845 -603 1439 560623 543318 4141 15718 6357 556820 536233 4728 37682 35326 543317 530903 9757 43753 48180 536233 0.70000 0.30000 true false 168442 153814 14628 466017 326478 139539 154167 FUNDS HELD BY GOOD SAMARITAN 560623 560623 0 0 X 12489093 2 2 12489091 12489091 12454389 12454389 12454389 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 THE SAMARITAN BEHAVIORAL HEALTH, INC. PREMIER HEALTH (PREMIER), MEDAMERICA HEALTH SYSTEMS (MAHS), 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. SHP is tax-exempt under Section 501(c)(3) and is a public charity by reason of being included in the group ruling issued to the U.S. Catholic Church. As tax-exempt organizations, their income is exempt from federal income tax except to the extent of any unrelated business activities. PREMIER, MAHS, SHP, AHS, AND UVMC ALSO OWN OR CONTROL CERTAIN SUBSIDIARIES, WHICH ARE FOR PROFIT CORPORATIONS SUBJECT TO FEDERAL INCOME TAXES. Taxes payable at December 31, 2015 and 2014, 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. X X X X false true false false false false false false false Eloise P Broner Chair 0 433215 0 113857 0 139476 0 11050 0 2940 0 700538 0 0 Sue V McGatha President & CEO / Vice Chair 174314 0 36620 0 4463 0 22759 0 10867 0 249023 0 0 0 Thomas R Curtin Treasurer (To Aug) 0 217858 0 55160 0 3259 0 8232 0 29091 0 313600 0 0 Frank E Sawyer Trustee 0 192254 0 33469 0 599 0 9640 0 24861 0 260823 0 0 Ellen W Ballerene MD Psychiatrist 174090 0 200 0 169 0 0 0 23133 0 197592 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 COMPENSATES FOR THIS LIMITATION AND SUPPLEMENTS 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 2015. THE INDIVIDUAL LISTED BELOW HAS MET THE MULTI-YEAR VESTING REQUIREMENT UNDER THE PENSION RESTORATION PLAN AND RECEIVED THE ASSOCIATED PAYMENT IN 2015: ELOISE BRONER $118,605. 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 2015, 3,674 patients were served. Form 990 - Part III, Question 4b (CONTINUED): and/or in the community for those who are at risk of harm to themselves or others, Crisis Counseling Provides counseling up to 4 sessions for acute stabilization and on-going support, Crisis Debriefing Services are available for individuals or groups involved in traumatic events. Crisis-Care served 1,518 patients and provided 8,614 in services for 2015. 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, which is Samaritan Health Partners, Inc. (SHP), the parent company of SBHI. 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. (SBHI). SHP has the authority to remove trustees at any regular or special meeting or by written consent. Form 990 - Part VI, Section A, Question 7b: SEE THE RESPONSE ABOVE FOR FORM 990, PART VI, SECTION A, QUESTION 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 address 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 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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