2013-09-23T09:37:28-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-07-01 411649502 HAMM MEMORIAL PSYCHIATRIC CLINIC HAMM 6512240614 408 ST PETER STREET NO 429 ST PAUL MN 55102 STEPHEN DWYER 6512240614 2013-09-20 1 JENNIFER TINGLEY P01485570 6123764500 2012 2016-02-24 21:20:13Z STEPHEN DWYER 408 ST PETER STREET NO 429 ST PAUL MN 55102 2441515 0 X WWW.HAMMCLINIC.ORG X 1989 MN TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 18 18 34 23 0 0 1691927 1598888 854807 839790 7873 2837 0 0 2554607 2441515 20000 20000 0 0 1913859 1810993 37800 0 200137 434370 519265 2406029 2350258 148578 91257 1231490 1344805 901786 870831 329704 473974 X TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 0 0 1193202 0 817064 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 FY13, 800 PATIENTS WERE SERVED TOTALING 9,879 VISITS TO THE CLINIC.ELECTRONIC HEALTH RECORDS (EHR) PROGRAM: THE CLINIC TRANSITIONED TO AN ELECTRONIC HEALTH RECORDS SYSTEM. 300911 20000 22726 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. 74325 0 0 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. 31328 0 0 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. 31328 1599766 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 12 0 34 1 0 0 0 0 0 0 0 0 0 0 X 18 18 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 3.00 X X 0 0 0 ELIZABETH WITTENBERG 1.00 X X 0 0 0 ABBY DAWKINS 1.00 X X 0 0 0 J LAWRENCE MCINTYRE 3.00 X X 0 0 0 DAVID W ALLEN JR 1.00 X 0 0 0 MARILYN BROUSSARD 1.00 X 0 0 0 VICTORIA COIFMAN 1.00 X 0 0 0 ANNE R GEARITY 1.00 X 0 0 0 EDWARD H HAMM 1.00 X 0 0 0 EDWARD H HAMM III 1.00 X 0 0 0 JAMES F HART MD 1.00 X 0 0 0 JEREMY T LANG 1.00 X 0 0 0 CHERYL J LEUNING 1.00 X 0 0 0 MICKEY MULCAHY 1.00 X 0 0 0 PAUL W MATTESSICH PHD 1.00 X 0 0 0 JONATHAN H MORGAN 1.00 X 0 0 0 KELLEY O'NEILL 1.00 X 0 0 0 PAULA RICHEY 1.00 X 0 0 0 KARI HUBBARD ROMINSKI 1.00 X 0 0 0 BETH SULLIVAN 1.00 X 0 0 0 MARK E SUNDBY PHD 1.00 X 0 0 0 ROBERT NESHEIM MD 32.00 X 118493 0 15000 STEPHEN DWYER 40.00 X 108429 0 12200 RICHARD BOURMAN 24.00 X 59888 0 1800 286810 0 29000 2 0 0 0 0 1598888 83220 1598888 PATIENT FEES 621400 817064 817064 SEMINAR FEES/OTHER 900099 22726 22726 839790 2837 2837 2441515 0 0 842627 20000 20000 361122 91262 241282 28578 1160411 988673 74494 97244 14017 12259 412 1346 173639 134352 24391 14896 101804 70793 21883 9128 2415 2415 11419 11419 13892 9660 2986 1246 38863 359 38504 37799 20713 14511 2575 100346 18644 81702 149826 131766 15033 3027 10117 4663 5454 19432 16711 2721 41140 20570 20570 40075 27868 8614 3593 PROGRAM EXPENSES 15903 15903 DUES 15565 15565 BAD DEBTS 10698 10698 EQUIPMENT MAINTENANCE 3792 3792 7983 5 7978 2350258 1599766 550355 200137 218358 119759 3090 4525 109272 103488 41583 77760 34505 26999 478704 351295 66764 127409 527767 595136 230151 289729 1231490 1344805 276828 317833 624958 552998 901786 870831 X -47846 41171 38394 70074 339156 362729 329704 473974 1231490 1344805 X 91257 4667 48346 X 0 1 X 1 0 X 1692347 1795730 1610996 1691927 1598888 8389888 1692347 1795730 1610996 1691927 1598888 8389888 5798574 2591314 30289 12700 14352 7873 2837 68051 8457939 4523696 0.30640 0.39940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 230151 40538 44750 26082 2628 286729 215675 18747 -3814 457 230151 0.00000 1.00000 0.00000 1 0 15854 14300 1554 413012 294422 118590 49838 42573 7265 127409 MONEY MARKET FUNDS AND CDS 499712 F MUTUAL FUNDS 95424 F 595136 FUNDS HELD BY THE SAINT PAUL FOUNDATION 289729 289729 LIABILITY FOR PENSION BENEFITS 552998 552998 X 2466491 4667 20309 24976 2441515 0 2441515 2350258 0 2350258 0 2350258 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO PROVIDE SUPPORT TO ACCOMPLISH THE ORGANIZATION'S EXEMPT PURPOSE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2008 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS 20,309. 1 GRANTS, IN THE FORM OF STIPENDS, ARE GIVEN TO PSYCHOLOGY STUDENTS IN BI-WEEKLY PAYMENTS OVER A PERIOD OF ONE YEAR. 3 20000 0 N/A N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 1 83220 STOCK MARKET QUOTES 0 0 0 0 THIRD PARTY USE: PART I, LINE 32B: THE CLINIC WILL APPROVE A GIFT ACCEPTANCE POLICY THAT REQUIRES REVIEW OF NON-STANDARD CONTRIBUTIONS DURING FISCAL YEAR 2014. 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 12TH 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 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 CHIEF OPERATING OFFICER, S. DWYER IN 2012. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS 20,309. CHANGE IN LONG-TERM PENSION OBLIGATION 28,037.