2015-10-05T09:17:22-05:00 2015-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-07-01 411649502 HAMM MEMORIAL PSYCHIATRIC CLINIC HAMM 6512240614 408 ST PETER STREET NO 429 ST PAUL MN 55102 STEPHEN DWYER CHIEF OPERATING OFFICER 6512240614 2015-10-01 1 AMY HENDLEY P01300654 6123764500 2014 2016-02-25 16:41:14Z STEPHEN DWYER 408 ST PETER STREET NO 429 ST PAUL MN 55102 2580976 0 X WWW.HAMMCLINIC.ORG X 1989 MN TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 14 14 34 14 0 0 1545598 1728767 875937 840852 8416 5987 63750 -14660 2493701 2560946 69139 10000 0 0 1855661 1953968 0 0 72075 545710 469903 2470510 2433871 23191 127075 1278646 1282026 692327 1121065 586319 160961 X TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 0 0 1347269 810689 CLINICAL SERVICES: HAMM MEMORIAL PSYCHIATRIC CLINIC PROVIDES A VARIETY OF OUTPATIENT MENTAL HEALTH AND RELATED SERVICES TO ADULTS AND OPERATES IN THE TWIN CITIES METROPOLITAN AREA. THE CLINIC OFFERS A FULL SPECTRUM OF OUTPATIENT MENTAL HEALTH SERVICES IN ENGLISH AND SPANISH. THE CLINIC SEEKS TO TREAT SYMPTOMS AND ALSO TO HELP CLIENTS GAIN INSIGHT AND UNDERSTANDING INTO THEIR BEHAVIOR. THE CLINIC TEAM IS COMPRISED OF CLINICAL SOCIAL WORKERS, PSYCHOLOGISTS, AND PSYCHIATRISTS WORKING TOGETHER TO IMPROVE MENTAL HEALTH. IN FY15, 701 PATIENTS WERE SERVED TOTALING 8,701 VISITS TO THE CLINIC.ELECTRONIC HEALTH RECORDS (EHR) PROGRAM: THE CLINIC TRANSITIONED TO AN ELECTRONIC HEALTH RECORDS SYSTEM. 308695 10000 30163 TRAINING AND PROFESSIONAL DEVELOPMENT: THE CLINIC'S TRAINING PROGRAM PROVIDES SPECIALIZED TRAINING AND EDUCATION FOR GRADUATES AND POST-GRADUATES IN CLINICAL SOCIAL WORK, PSYCHOLOGY, AND PSYCHIATRY. THE CLINIC'S COMPREHENSIVE APPROACH TO TRAINING ENABLES STUDENTS TO PROVIDE DIRECT CLIENT CARE UNDER CLOSE SUPERVISION. 112133 RESEARCH AND PUBLICATION: THE CLINIC CONDUCTS EFFECTIVENESS RESEARCH. EFFECTIVENESS RESEARCH SEEKS TO DETERMINE WHETHER THE TREATMENT AT THE CLINIC IS EFFECTIVE IN A COMMUNITY MENTAL HEALTH CENTER SETTING WITH A VARIETY OF CLIENTS. 101580 COMMUNITY OUTREACH: THE CLINIC WORKS TO EDUCATE THE PUBLIC ABOUT MENTAL HEALTH ISSUES AND PROMOTES THE VALUE OF GOOD MENTAL HEALTH. IT ALSO WORKS TO BE A VOICE IN THE COMMUNITY FOR PERSONS WITH MENTAL ILLNESS AND TO IMPROVE PUBLIC AWARENESS OF THE SCOPE OF INFLUENCE ADULT MENTAL ILLNESS HAS ON THE COMMUNITY. 101580 1869677 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 13 0 34 1 0 0 0 0 0 0 0 0 0 0 X 14 14 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X RICHARD BOURMAN CONTROLLER 6512240614 408 ST PETER STREET SUITE 429 ST PAUL MN 55102 ROGER OPP BOARD PRESIDENT 3.00 X X 0 0 0 ELIZABETH WITTENBERG BOARD VICE PRESIDENT 1.00 X X 0 0 0 ABBY DAWKINS BOARD SECRETARY 1.00 X X 0 0 0 J LAWRENCE MCINTYRE BOARD TREASURER 3.00 X X 0 0 0 HENRY STOCKMAN BOARD MEMBER 1.00 X 0 0 0 DINA RAUKER BOARD MEMBER 1.00 X 0 0 0 VICTORIA COIFMAN BOARD MEMBER 1.00 X 0 0 0 ANNE R GEARITY BOARD MEMBER 1.00 X 0 0 0 EDWARD H HAMM BOARD MEMBER 1.00 X 0 0 0 EDWARD H HAMM III BOARD MEMBER 1.00 X 0 0 0 JAMES F HART MD BOARD MEMBER 1.00 X 0 0 0 JEREMY T LANG BOARD MEMBER 1.00 X 0 0 0 MICKEY MULCAHY BOARD MEMBER 1.00 X 0 0 0 PAUL W MATTESSICH PHD BOARD MEMBER 1.00 X 0 0 0 JONATHAN H MORGAN BOARD MEMBER 1.00 X 0 0 0 KELLEY O'NEILL BOARD MEMBER 1.00 X 0 0 0 PAULA RICHEY BOARD MEMBER 1.00 X 0 0 0 KARI HUBBARD ROMINSKI BOARD MEMBER 1.00 X 0 0 0 MARK E SUNDBY PHD BOARD MEMBER 1.00 X 0 0 0 ROBERT NESHEIM MD EXECUTIVE MEDICAL DIRECTOR 32.00 X 142465 0 15000 STEPHEN DWYER CHIEF OPERATING OFFICER 40.00 X 101901 0 12000 RICHARD BOURMAN CONTROLLER 24.00 X 68512 0 1500 312878 0 28500 2 0 1 0 0 34486 1694281 54570 1728767 PATIENT FEES 621400 810689 810689 SEMINAR FEES/OTHER 900099 30163 30163 840852 5987 5987 5370 34486 20030 -14660 -14660 2560946 840852 0 -8673 10000 10000 341377 212671 109443 19263 1307294 1098427 183334 25533 201292 160645 36168 4479 104005 80855 20134 3016 6570 6570 13331 13331 20618 10038 10580 17899 453 17446 33904 20659 13245 72378 32599 39779 150997 133449 15210 2338 8601 5107 3494 28581 24827 3754 41746 20873 20873 42373 33925 8448 DUES 12989 12989 BAD DEBTS 10868 10868 MISCELLANEOUS 6368 321 6047 EQUIPMENT MAINTENANCE 1709 1709 971 971 2433871 1869677 492119 72075 272461 243480 3169 42000 10000 62617 64002 30798 24240 459061 393896 106849 65165 396444 482824 364308 392315 1278646 1282026 249196 253445 443131 867620 692327 1121065 X 180011 -241354 406308 402315 586319 160961 1278646 1282026 X 127075 -13407 -539026 X 0 1 X 1 0 X 1610996 1691927 1598888 1545598 1728767 8176176 1610996 1691927 1598888 1545598 1728767 8176176 5744109 2432067 14352 7873 2837 1844 5978 32884 63750 63750 8272810 4269373 0.29400 0.30580 X SCHEDULE A, PART II, LINE 17A, EXPLANATION FOR FACTS AND CIRCUMSTANCES TESTTHE CLINIC MAINTAINS ACTIVE COMMUNITY SUPPORT WHICH HAS SUCCESSFULLY ATTRACTED CONTRIBUTIONS FROM THE GENERAL PUBLIC. THEIR ANNUAL FUNDRAISING EFFORTS PROVIDE AN OPPORTUNITY FOR THE GENERAL PUBLIC TO KNOW MORE ABOUT THE ORGANZATION AND TO SUPPORT THE CLINIC'S PROGRAMS. THE CLINIC'S BOARD OF DIRECTORS REPRESENTS LEADERSHIP FROM AND OF THE COMMUNITY, AS WELL AS NONPROFIT MANAGEMENT EXPERTISE. THE BOARD HAS BEEN DESIGNED BOTH TO FACILIATE INVOLVEMENT BY FUNDERS AND TO ENSURE ACCOUNTABILITY TO THE BROAD COMMUNITY THE CLINIC SERVES. THE CLINIC HAS MANY PROGRAMS, COLLABORATIONS, AND RESOURCES AVAILABLE BOTH ON-SITE AND OFF-SITE THAT PROVIDE THE PUBLIC AND COMMUNITY WITH MENTAL HEALTH AND RELATED SERVICES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 364309 32150 13093 14434 2795 392323 286729 39775 53093 13135 2153 364309 230151 40538 44750 26082 2628 286729 215675 18747 -3814 457 230151 0.00000 1.00000 0.00000 1 0 15854 15854 0 377801 323529 54272 65406 54513 10893 65165 CERTIFICATES OF DEPOSIT 399928 F CERTIFICATES OF DEPOSIT - DEFERRED COMP 82896 F 482824 FUNDS HELD BY THE SAINT PAUL FOUNDATION 392315 392315 LIABILITY FOR PENSION BENEFITS 860386 LIABILITY FOR CAPITAL LEASE 7234 867620 X 2563426 -13407 15887 2480 2560946 0 2560946 2453901 20030 20030 2433871 0 2433871 PART V, LINE 4: TO PROVIDE SUPPORT TO ACCOMPLISH THE ORGANIZATION'S EXEMPT PURPOSE. PART X, LINE 2: THE CLINIC HAS BEEN CLASSIFIED AS A PUBLICLY SUPPORTED CLINIC, AND IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CLINIC HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION OF UNCERTAIN TAX POSITIONS. THE GUIDANCE PRESCRIBES RECOGNITION THRESHOLD PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX FILING THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS GUIDANCE HAD NO IMPACT ON THE CLINIC'S FINANCIAL STATEMENTS. THE CLINIC'S TAX FILINGS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE CLINIC IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS. THE CLINIC IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES. THE FILINGS FOR THE YEARS 2010 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS -4,143. SPECIAL EVENT EXPENSES 20,030. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 20,030. 60TH ANNIVERSARY CELEBRATION 39856 34486 5370 700 8621 1500 9209 39856 34486 5370 700 8621 1500 9209 20030 -14660 1 GRANTS, IN THE FORM OF STIPENDS, ARE GIVEN TO PSYCHOLOGY STUDENTS IN BI-WEEKLY PAYMENTS OVER A PERIOD OF ONE YEAR. 2 10000 N/A N/A PART I, LINE 2: GRANTS, IN THE FORM OF STIPENDS, ARE GIVEN TO PSYCHOLOGY STUDENTS IN BI-WEEKLY PAYMENTS OVER A PERIOD OF ONE YEAR. THE CLINIC HAS THREE TYPES OF STUDENT PLACEMENTS: MASTERS LEVEL SOCIAL WORK STUDENTS, POST-GRADUATE PSYCHOLOGY STUDENTS AND POST DOCTORAL FELLOWS. EACH YEAR THE CLINIC DECIDES HOW MANY OF WHICH TYPE OF STUDENT THAT WILL BE ADMITTED. AFTER DETERMINATIONS ARE MADE, THE CLINIC NOTIFIES THE LOCAL SCHOOLS WITH WHOM THE CLINIC HAS AN ONGOING WORKING RELATIONSHIP WITH AND THE AMERICAN PSYCHOLOGICAL ASSOCIATION. THE LOCAL SCHOOLS ADVERTISE THE SOCIAL WORK AND POST-DOCTORAL OPENINGS AND THE AMERICAN PSYCHOLOGICAL ASSOCIATION ADVERTISES THE POST-GRADUATE PSYCHOLOGY POSITIONS. APPLICANTS WHO ARE VETTED BY THEIR RESPECTIVE ORGANIZATIONS ARE ELIGIBLE TO APPLY FOR A STUDENT PLACEMENT. THE CLINIC REVIEWS ALL APPLICATIONS AND THEN ARRANGE INTERVIEWS. A STAFF COMMITTEE MAKES THE ULTIMATE DECISION WHO TO ADMIT. X 0 0 0 0 0 0 0 0 0 ROBERT NESHEIM MD EXECUTIVE MEDICAL DIRECTOR 142465 0 0 0 0 0 0 0 15000 0 157465 0 0 0 X 1 54570 STOCK MARKET QUOTES 0 0 0 0 PART I, COLUMN (B): THE CLINIC REPORTS THE NUMBER OF CONTRIBUTORS ON PART I, COLUMN B. FORM 990, PART VI, SECTION A, LINE 1 THE HAMM CLINIC EXECUTIVE COMMITTEE IS COMPRISED OF THE BOARD OF OFFICERS (PRESIDENT, VICE PRESIDENT, TREASURER AND SECRETARY); THE ASSISTANT SECRETARY; THE COMMITTEE CHAIRPERSONS; THE EXECUTIVE MEDICAL DIRECTOR AND THE CHIEF OPERATING OFFICER; AND ANY OTHER BOARD MEMBER THE PRESIDENT APPOINTS TO THE EXECUTIVE COMMITTEE. AD HOC RESPONSIBILITIES (PERFORMED ON AN AS NEEDED BASIS): - ADVISE EXECUTIVE MEDICAL DIRECTOR AND CHIEF OPERATING OFFICER ON PERSONNEL MATTERS, AS REQUESTED. - CONDUCT THE BUSINESS FOR THE BOARD, IF NECESSARY BEFORE THE FULL BOARD CAN MEET. - IMPLEMENT PROCESS AND PROCEDURES FOR SELECTION OF A NEW EXECUTIVE MEDICAL DIRECTOR AND THE CHIEF OPERATING OFFICER. - MONITOR THE PERFORMANCE OF THE BOARD COMMITTEES. TAKE ACTION TO CORRECT ANY DEFICIENCIES. - REVIEW OPERATIONAL RESULTS AND STATISTICS. - REVIEW INFORMATION ABOUT EXTERNAL TRENDS AND DEVELOPMENTS. FORM 990, PART VI, SECTION A, LINE 2 EDWARD H. HAMM AND EDWARD H. HAMM III, BOTH BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE WILL MEET WITH THE AUDITORS ON OR BEFORE SEPTEMBER 10TH TO REVIEW THE AUDIT RESULTS AND FINANCIAL REPORTS. THE FORM 990 WILL BE EMAILED TO ALL FINANCE COMMITTEE MEMBERS FOR THEIR REVIEW AND EDIT COMMENTS. THE CONTROLLER AND COO WILL ALSO REVIEW THE FORM 990. A COPY OF THE FORM 990 WILL BE PROVIDED TO THE WHOLE BOARD BEFORE IT IS FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS FILL OUT AN ANNUAL DISCLOSURE FORM. IN THE CASE OF A CONFLICT, OR THE APPEARANCE THEREOF, BOARD MEMBERS ARE EXPECTED TO DISCLOSE THE CONFLICT PRIOR TO THE CLINIC'S MAKING ANY RELATED DECISIONS. IF A CONFLICT OF INTEREST IS PRESENT, THE DIRECTOR INVOLVED MUST IDENTIFY THE CONFLICT AND MAY, AT THE REQUEST OF THE BOARD OR COMMITTEE, REMAIN IN THE ROOM TO ANSWER QUESTIONS OF A FACTUAL NATURE THAT MAY ASSIST THE BOARD OR COMMITTEE IN ITS DELIBERATION AND DETERMINATION OF WHETHER OR NOT AN ACTUAL CONFLICT OF INTEREST EXISTS. BOARD MEMBERS HAVING A CONFLICT OF INTEREST ON A GIVEN ISSUE DO NOT VOTE ON THAT ISSUE. PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE CHIEF OPERATING OFFICER INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION. THE EXECUTIVE COMMITTEE ALSO REVIEWS THE COMPENSATION AND BONUS PLAN. THE PROCESS WAS LAST UNDERTAKEN FOR THE EXECUTIVE MEDICAL DIRECTOR, DR. R. NESHEIM, AND CHIEF OPERATING OFFICER, S. DWYER IN 2013. THE PROCESS FOR DETERMINING OTHER OFFICERS' COMPENSATION INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, CONTEMPORANEOUS SUBSTANTIATION, AND A REVIEW BY THE EXECUTIVE AND FINANCE COMMITTEES WITH THE CHIEF OPERATING OFFICER AND THE BOARD PRESIDENT. THE PROCESS WAS LAST UNDERTAKEN FOR THE CONTROLLER, R. BOURMAN IN 2012; AND MEDICAL DIRECTOR, R. NESHEIM IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE CLINIC'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS -4,143. CHANGE IN LONG-TERM PENSION OBLIGATION -534,883.