2013-04-12T09:57:38-05:00 2012-06-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2011-07-01 351375696 SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER SOUT 2197694005 8555 TAFT STREET MERRILLVILLE IN 46410 JUDITH K SIKORA 2177694005 2013-04-03 1 AMBER KOCHER CPA P01286298 3176334705 2011 2016-02-25 16:41:14Z REGIONAL MENTAL HEALTH CENTER JUDITH K SIKORA 8400 LOUISIANA STREET MERRILLVILLE IN 46410 35700776 0 X WWW.REGIONALMENTALHEALTH.ORG X 1974 IN REGIONAL WORKS EXCLUSIVELY WITH INDIVIDUALS NEEDING MENTAL HEALTH CARE AND INTERVENTIONS FOR SUBSTANCE ABUSE, BY PROVIDING COMPREHENSIVE AND COMMUNITY BASED MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT FOR ADULTS, AND ADOLESCENTS. 11 11 448 12 -1535 -1535 14337604 14539720 14562352 18281571 136793 122749 1355327 2084153 30392076 35028193 0 0 0 0 20896811 20339574 0 0 0 12500795 14268535 33397606 34608109 -3005530 420084 38644103 41655710 6648349 9062172 31995754 32593538 X SEE SCHEDULE O FOR COMPLETE MISSION STATEMENT 0 0 11095964 9034445 OUTPATIENT CARE-THESE PROGRAMS OFFER A WIDE RANGE OF COUNSELING SERVICES TO INDIVIDUALS, FAMILIES, COUPLES AND GROUPS. THE FOCUS IS ON SELF-EXPLORATION, EXPRESSIONS OF FEELINGS, SHARING AND PERSONAL PROBLEMS, BUILDING BETTER RELATIONSHIPS WITH OTHERS AND STRENGTHENING FAMILY STABILITY.FISCAL YEAR 2012 HOURS OF SERVICE: 90,686. 6275301 6038801 CASE MANAGEMENT SERVICES/ COMMUNITY SUPPORT-THESE PROGRAMS PROVIDE INTENSIVE, THERAPEUTIC CASE MANAGEMENT. THESE PROGRAMS ARE TARGETED TO THOSE WHO HAVE DIFFICULTY DEVELOPING FRIENDSHIPS, PURSUING EMPLOYMENT, AND PLANNING FOR UPCOMING EVENTS. THE COMMUNITY SUPPORT PROGRAM HELPS TO EASE CLIENTS BACK INTO A SATISFACTORY LIVING ROUTINE.FISCAL YEAR 2012 HOURS OF SERVICE: 74,248 AND 106,175 VISITS. 4263343 812274 RESIDENTIAL CARE-THESE PROGRAMS PROVIDE RESDENTIAL HOUSING FOR ADULTS. RESIDENTIAL SERVICES ARE UTILIZED AS AN ALTERNATIVE TO HOSPITALIZATION, AND SERVE THOSE INDIVIDUALS WHO REQUIRE HELP IN ACHIEVING SOCIAL AND INDEPENDENT LIVING SKILLS TO SUCCESSFULLY RETURN TO COMMUNITY LIFE. THE PROGRAMS PROVIDE ROOM, BOARD, COUNSELING AND TRAINING IN ACTIVITIES OF DAILY LIVING.FISCAL YEAR 2012 DAYS OF SERVICE: 75,810. 6442388 2396051 PARTIAL DAY CARE-THESE PROGRAMS PROVIDE A FULL-DAY OR HALF-DAY, TREATMENT, WHICH INCLUDES INDIVIDUAL AND GROUP COUNSELING, OCCUPATIONAL AND SKILLS DEVELOPMENT THERAPY AND SOCIALIZATION. THERAPY IS ARRANGED TO ALLOW THE CLIENT TO LIVE AS NORMAL A LIFESTYLE AS POSSIBLE, INCLUDING THE OPPORTUNITY FOR THE CLIENT TO MAINTAIN HIS/HER EMPLOYMENT OR EDUCATION WHILE IN TREATMENT.FISCAL YEAR 2012 HOURS OF SERVICE: 43,892. 6442388 2396051 28076996 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 40 0 1 448 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X JUDITH K SIKORA - GEMINUS CORPORATION 2197571921 8400 LOUISIANA STREET MERRILLVILLE IN 46410 DONALD LEVINSON 2.00 X 0 0 0 LESLIE RITTENMEYER 2.00 X 0 0 0 SANDRA F BAPPLE 2.00 X 0 0 0 MARY BETH BONAVENTURA 2.00 X 0 0 0 RON BORTO 2.00 X 0 0 0 BERNARD CARTER 2.00 X 0 0 0 JULIE GLADE 2.00 X 0 0 0 EDMUND GUNN 2.00 X 0 0 0 LINDA JONAITIS 2.00 X 0 0 0 DANIEL KLEIN 2.00 X 0 0 0 DONNA STATH 2.00 X 0 0 0 ROBERT D KRUMWIED 40.00 X 201320 0 31918 JOHN KERN MD 40.00 X 225432 0 47339 SHARON KRAUS 40.00 X 124017 0 31810 JUDITH K SIKORA 40.00 X 0 137936 12904 SCOTT SIEGALL 40.00 X 218459 0 30819 EPIFIANO SANDOVAL 40.00 X 213407 0 45330 SHYAMSUNDER CHAKILUM 40.00 X 188445 0 22509 SONIA YBALLE 40.00 X 186762 0 26918 JOSE RAMIREZ 40.00 X 178690 0 39674 1536532 137936 289221 14 0 1 0 SEYFARTH SHAW LLP 3807 COLLECTIONS CENTER DR CHICAGO IL 60693 LEGAL SERVICES 105545 ARNELL INC 2506 GROSS POINT RD EVANSTON IL 60201 RENT 101268 2 7312000 7223354 4366 14539720 NET PATIENT REVENUE 900099 18281571 18281571 18281571 172363 172363 333909 47743 286166 286166 -1535 287701 575226 624840 -49614 -49614 -49614 EHR INCENTIVE PAYMENTS 900099 298000 298000 CAFETERIA INCOME 900099 46612 46612 VENDING INCOME 900099 14100 14100 1439275 1439275 1797987 35028193 18281571 -1535 2208437 550769 440615 110154 15801574 14783565 1018009 2781374 2613039 168335 1205857 1132876 72981 194334 70808 123526 65781 23968 41813 5078759 1850508 3228251 60226 57883 2343 2275379 1349420 925959 1383955 1144685 239270 363547 347298 16249 80990 77370 3620 167477 103478 63999 1071175 822914 248261 594482 367309 227173 BAD DEBT 2164518 2164518 HOSPITAL ASSESSMENT FEE 726742 726742 41170 41170 34608109 28076996 6531113 0 460830 2480 9296481 316585 1316222 0 3835426 4341210 184279 0 27410 13185 449726 434337 34185398 24027923 10108289 10157475 2972490 11611683 9240247 9694511 3600 4350 749103 5079894 38644103 41655710 3352077 3424859 1678 0 1382361 1100419 1556825 1739761 355408 2797133 6648349 9062172 X 31995754 32593538 31995754 32593538 38644103 41655710 X 420084 177700 X X 0 1 1 X 1 1 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: REGIONAL MENTAL HEALTH CENTER HAS BEEN DETERMINED BY THE IRS TO BE A PUBLIC CHARITY UNDER IRS CODE SECTION 170(B)(1)(A)(III). PER SCHEDULE H INSTRUCTIONS ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL IS REQUIRED TO COMPLETE THE SCHEDULE. REGIONAL MENTAL HEALTH CENTER IS A MENTAL HEALTH CENTER AND IS NOT LICENSED AS A HOSPITAL FOR THE STATE OF INDIANA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 189749 1482359 1464892 207216 0 8123393 1096524 186902 9033015 8738948 1389280 1465064 3469899 8123393 4979692 6173607 1077183 3491534 8738948 6201995 1056874 -838485 1440692 4979692 1.00000 0.00000 0.00000 0 0 934191 934191 21858713 13841382 8017331 195543 69760 125783 10605265 9583015 1022250 591686 533766 57920 10157475 9694511 C 9694511 DUE FROM AFFILIATES 2016667 ASSETS WHOSE USE IS LIMITED 104369 OTHER RECEIVABLES 2958858 5079894 DUE TO AFFILIATES 2341577 ESTIMATED THIRD PARTY LIABILITIES 455556 2797133 PART IV, LINE 1B: THE ORGANIZATION IS AN AGENT FOR HELD FUNDS FOR PATIENTS - REPRESENTATIVE PAYEE ACCOUNTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE BOARD HAS DESIGNATED CERTAIN INVESTMENTS FOR PROPERTY AND EQUIPMENT REPLACEMENT AND EXPANSION. CONTRIBUTIONS LISTED FOR THE YEAR WERE A PORTION OF GENERAL UNRESTRICTED NET ASSETS THAT WERE BOARD DESIGNATED FOR CAPITAL IMPROVEMENT PROJECTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATIONS AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATIONS HAVE TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATIONS, AND HAS CONCLUDED THAT AS OF JUNE 30, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATIONS ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, XII, AND XIII ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROBERT D KRUMWIED 201320 0 0 0 0 0 23779 0 8139 0 233238 0 0 0 JOHN KERN MD 225432 0 0 0 0 0 24830 0 22509 0 272771 0 0 0 SHARON KRAUS 124017 0 0 0 0 0 9301 0 22509 0 155827 0 0 0 JUDITH K SIKORA 0 137936 0 0 0 0 0 12161 0 743 0 150840 0 0 SCOTT SIEGALL 218459 0 0 0 0 0 22955 0 7864 0 249278 0 0 0 EPIFIANO SANDOVAL 213407 0 0 0 0 0 22821 0 22509 0 258737 0 0 0 SHYAMSUNDER CHAKILUM 188445 0 0 0 0 0 0 0 22509 0 210954 0 0 0 SONIA YBALLE 186762 0 0 0 0 0 18779 0 8139 0 213680 0 0 0 JOSE RAMIREZ 178690 0 0 0 0 0 18204 0 21470 0 218364 0 0 0 PART I, LINE 1A THE ORGANIZATION REIMBURSES HEALTH CLUB DUES, UP TO A LIMIT, FOR ALL EMPLOYEES AS A WELLNESS BENEFIT. PART I, LINE 4B MR. KRUMWIED PARTICIPATED IN A 457B PROGRAM OF WHICH THE TOTAL AMOUNT CONTRIBUTED IN FY 2012 WAS EMPLOYEE DEFERRAL ONLY. NO CONTRIBUTIONS WERE MADE BY REGIONAL MENTAL HEALTH CENTER. INDIANA HEALTH FACILITY FINANCING AUTHORITY 351611409 2004-03-31 1600000 FACILITY RENOVATION; REMODELING & EQUIPMENT PURCHASE; REFINANCE 1999 BONDS 0 0 0 INDIANA HEALTH FACILITY FINANCING AUTHORITY 351611409 2007-03-08 1180000 BUILDING AND STRUCTURES 0 0 0 1600000 18307 684640 897053 2009 1 0 1 1 1180000 1180000 2007 1 0 1 1 0 1 0 0 0.00000 0.03080 0.03080 1 0 1 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 MISSION STATEMENT FORM 990, PART III, LINE 1 THE MISSION OF REGIONAL MENTAL HEALTH CENTER IS AS FOLLOWS: A. TO PROVIDE A COST-EFFECTIVE, CONSUMER-DRIVEN CONTINUUM OF PREVENTATIVE, CONSULATATIVE AND DIRECT-TREATMENT BEHAVIORAL HEALTH SERVICES. B. TO STRATEGICALLY POSITION THE CENTER FOR LONG-TERM FINANCIAL VIABILITY. C. TO PLAN, EVALUATE, AND SEEK CONTINUOUS IMPROVEMENT OF THE CENTER'S SERVICES THROUGH BROAD-BASED PROCESSES. D. TO EDUCATE THE PUBLIC AND ADVOCATE FOR THE NEEDS OF THE MENTALLY ILL, EMOTIONALLY DISTURBED, AND CHEMICALLY DEPENDENT. E. TO PROVIDE RESEARCH AND TRAINING OPPORTUNITIES THAT FALL APPROPRIATELY WITHIN THE FIELD OF MENTAL HEALTH AND CHEMICAL DEPENDENCY. FORM 990, PART VI, SECTION B, LINE 11 CFO REVIEWS AND COPY OF THE FORM 990 IS PRESENTED/PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C BOARD IS EDUCATED ABOUT POLICY AT ANNUAL COMBINED BOARD RETREAT. ALL BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. MEMBERS ARE ASKED TO RECUSE THEMSELVES IF THEY ARE IN ANY CONFLICT WITH THE MATTER BEING REVIEWED. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT/CEO IS EVALUATED BY THE BOARD OF DIRECTORS EVALUATION COMMITTEES. INFORMATION ABOUT PERFORMANCE, COMPARABLE DATA AND ANY OTHER INFORMATION REQUESTED IS PROVIDED. THE COMMITTEE RECOMMENDATION IS REVIEWED AND ACTED UPON BY THE FULL BOARD AT THE NEXT REGULAR MEETING. OTHER EMPLOYEES HAVE JOB DESCRIPTIONS AND ANNUAL REVIEWS BY THEIR SUPERVISOR, WHICH ARE DOCUMENTED IN EACH EMPLOYEE'S PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 325,888. NET ASSET TRANSFER TO AFFILIATES -148,188. TOTAL TO FORM 990, PART XI, LINE 5: 177,700. OVERVIEW OF AUDIT FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. BELL TOWER 8400 LOUISIANA STREET MERRILLVILLE IN 46410 542194413 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 11 REGIONAL MENTAL HEALTH CENTER 1 SOUTHLAKE RESIDENTIAL INC 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351821789 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 11 REGIONAL MENTAL HEALTH CENTER 1 WATERTOWER RESIDENTIAL 8400 LOUISIANA STREET MERRILLVILLE IN 46410 710919446 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 11 REGIONAL MENTAL HEALTH CENTER 1 WATERTOWER WEST 8400 LOUISIANA STREET MERRILLVILLE IN 46410 200475502 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 11 REGIONAL MENTAL HEALTH CENTER 1 SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351859562 DEVELOPMENT OF COLLABORATIVE RELATIONSHIPS IN SOCIAL SERVICE PROGRAMS IN 501C3 LINE 7 REGIONAL MENTAL HEALTH CENTER 1 SOUTHLAKE TRI-CITY RBA CORP 8400 LOUISIANA STREET MERRILLVILLE IN 46410 205153554 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 9 REGIONAL MENTAL HEALTH CENTER 1 BELL TOWER NORTH 8400 LOUISIANA STREET MERRILLVILLE IN 46410 800293130 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 7 REGIONAL MENTAL HEALTH CENTER 1 WATERTOWER SOUTH 8400 LOUISIANA STREET MERRILLVILLE IN 46410 300449524 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 7 REGIONAL MENTAL HEALTH CENTER 1 TRI-CITY HOUSING CORPORATION 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351907579 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501C3 LINE 11 REGIONAL MENTAL HEALTH CENTER 1 TRI-CITY HEALTH CENTER INC 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351181194 FEDERALLY QUALIFIED HEALTH CENTER IN 501C3 LINE 3 REGIONAL MENTAL HEALTH CENTER 1 0 0 1 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION C 7312000 FAIRMARKET VALUE SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION L 3397000 FAIRMARKET VALUE SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION P 224000 FAIRMARKET VALUE