2023-05-15T15:41:33-05:00 2022-06-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2021-07-01 351362298 FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER INC FOUR 5747225151 401 E 8TH STREET ROCHESTER IN 46975 CARRIE CADWELL CEO 5747225151 2023-05-15 1 CARRIE CADWELL 999009999 EMILIE M KNIERIEM CPA P01330194 3176334705 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z 4C HEALTH CARRIE CADWELL 401 E 8TH STREET ROCHESTER IN 46975 37588603 0 X WWW.FOURCOUNTY.ORG X 1975 IN TO PROVIDE QUALITY MENTAL HEALTH CARE 8 8 42 8 0 0 7251515 7345874 27891503 29536545 143427 16026 490969 489352 35777414 37387797 50868 55118 0 0 19634801 22458391 0 0 0 5842905 6603643 25528574 29117152 10248840 8270645 43990806 50716842 6816800 5395867 37174006 45320975 X DEDICATED TO HOLISTIC CARE GIVEN WITH COMPASSION, RESPECT, ACCEPTANCE AND HOPE. ACHIEVING EMOTIONAL WELL BEING AND INDEPENDENCE. 0 0 22829859 55118 29873434 THE CENTER PROVIDES COMPREHENSIVE MENTAL HEALTH SERVICES TO THE RESIDENTS OF CARROLL, CASS, CLINTON, FULTON, MIAMI, PULASKI, HOWARD, TIPTON, & WHITE COUNTIES ON BOTH AN INPATIENT AND OUTPATIENT BASIS. CARE IS PROVIDED TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET SERVICE REVENUE. THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE CENTER'S CHARITY CARE POLICY IS $260,848 IN 2022. THE AMOUNT INCLUDES REDUCTIONS IN FEES BASED ON THE CLIENT'S ABILITY TO PAY AND CLIENT SERVICES PERFORMED FREE OF CHARGE. PLEASE CONTACT THE COMMUNITY RELATIONS DEPARTMENT FOR ADDITIONAL DETAILS RELATED TO THE CENTER'S EXEMPT PURPOSE.THE MED CLINIC ASSISTS IN MAINTAINING OUTPATIENT CLIENTS PSYCHIATRIC SYMPTOMS WITH THE LOWEST POSSIBLE DOSE OF MEDICATION AND THE LEAST AMOUNT OF SIDE EFFECTS WHILE OBTAINING AN OPTIMAL LEVEL OF FUNCTIONING. ALL OUTPATIENT CANDIDATES FOR MEDICATION INTERVENTION WILL BE EVALUATED PER STAFF PSYCHIATRIST/APN AND ENCOURAGED TO FOLLOW ALL TREATMENT RECOMMENDATIONS AS PRESCRIBED WITH THE ASSISTANCE OF THE MEDICATION CLINIC RN. 22829859 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 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 0 0 1 618 0 1 42 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IN X DIANA ELLIOTT DIRECTOR OF ACCOUNTING AND HUMAN RESOURCES 5747322410 800 FULTON STREET LOGANSPORT IN 46947 LINDA WEBB PRESIDENT 2.00 X X 0 0 0 KEITH KOLB PRESIDENT ELECT 2.00 X X 0 0 0 JASON SEE SECRETARY/TREASURER 2.00 X X 0 0 0 DEAN MCCURDY BOARD MEMBER 2.00 X 0 0 0 GLORIA CALHOUN PAST PRESIDENT 2.00 X 0 0 0 MARY KAY BOARD MEMBER 2.00 X 0 0 0 MACKENZIE LEDLEY BOARD MEMBER 2.00 X 0 0 0 TARA MCVAY BOARD MEMBER 2.00 X 0 0 0 CARRIE CADWELL CHIEF EXECUTIVE OFFICER 40.00 X 359048 0 46149 JASON CADWELL CHIEF FINANCIAL OFFICER 40.00 X 277639 0 14553 KATHLEEN MILLER CHIEF MEDICAL OFFICER 40.00 X 392195 0 40323 NICOLE HIATT-DRANG VP OF OPERATIONS NORTHERN 40.00 X 153740 0 8079 ANDREW HARTLEY CHIEF OPERATING OFFICER 40.00 X 73431 0 44 LISA WILLIS-GIDLEY VP OF OPERATIONS SOUTHERN REGION 40.00 X 127957 0 25210 HOPE KERNS VP OF QUALITY & COMPLIANCE 40.00 X 108529 0 36322 MICHAEL KESSLER VP OF INFORMATION SYSTEMS 40.00 X 35997 0 7244 DAWN COBURN DIRECTOR OF REVENUE CYCLE 40.00 X 88970 0 14835 DIANA ELLIOTT DIRECTOR OF ACCOUNTING & HR 40.00 X 116381 0 16600 DAWN GRIFFITH DIRECTOR OF NURSING 40.00 X 44252 0 6633 KRISTA CATT DIRECTOR OF COMMUNITY AND SCHOOL BASED SERVICES 40.00 X 60017 0 32663 JESSICA CRUME DIRECTOR OF COMMUNITY AND SCHOOL BASED SERVICES 40.00 X 77947 0 4127 BRENT KELLEY DIRECTOR OF CLINIC SERVICES 40.00 X 61478 0 29824 MELISSA ROBERTSON DIRECTOR OF ADULT INTENSIVE SERVICES 40.00 X 83899 0 22766 BETHANY SCHOENRADT VP OF OPERATIONS CENTRAL REGION 40.00 X 0 0 0 WONDA ELMORE ADVANCED PRACTICE NURSE 40.00 X 137141 0 7234 MATTHEW TANNER ADVANCED PRACTICE NURSE 40.00 X 137230 0 36625 JOHN YARLING PSYCHIATRIST 40.00 X 154088 0 16899 AMY HERRON-MILLER ADVANCED PRACTICE NURSE 40.00 X 159881 0 8460 QUN WU PSYCHIATRIST 40.00 X 228921 0 10788 2878741 0 385378 15 0 1 0 STREAMLINE HEALTHCARE SOLUTIONS 510 E BUTLER CT KALAMAZOO MI 49007 ELECTRONIC HEALTH RECORDS 293906 MEDICAL STAFFING SOLUTIONS 3400 KENT AVENUE LAFAYETTE IN 47906 STAFFING SERVICES 156620 PONDURANCE 500 N MERIDIAN STE 500 INDIANAPOLIS IN 46204 IT SERVICES 106547 GENOA HEALTH CARE PO BOX 77030 MINNEAPOLIS MN 55480 CLINIC SERVICES 103187 4 7073399 272475 7345874 NET PATIENT SERVICE REVENUE 621111 27530714 27530714 MENTAL HEALTH FUNDS RECOVERY PROG 621111 1862771 1862771 GROUP HOME RENTAL INCOME 143060 143060 29536545 207532 207532 9300 200806 -191506 -191506 -191506 DISPROPORTIONATE SHARE 621110 159301 159301 330051 320648 9403 489352 37387797 30016494 0 25429 55118 55118 3624436 2888893 735543 14963475 11926790 3036685 607295 513588 93707 1932555 1634357 298198 1330630 1125311 205319 30199 30199 66400 66400 2550641 1487481 1063160 28241 19127 9114 160740 108863 51877 383046 259423 123623 638231 432250 205981 500346 461529 38817 60075 60075 13215 10630 2585 660518 554189 106329 199897 135383 64514 HOSPITAL ASSESMENT FEES 831075 831075 RECRUITMENT 203032 137506 65526 DUES & SUBSCRIPTIONS 99689 67516 32173 RECOGNITION EXPENSES 56839 38495 18344 121459 82260 39199 29117152 22829859 6287293 0 267 267 33779529 40216649 75432 74905 1210944 1096972 1967058 1791394 259179 276282 14320663 7060290 6698397 7260373 43990806 50716842 1999501 2045546 421443 357921 4395856 2992400 6816800 5395867 X 37174006 45320975 37174006 45320975 43990806 50716842 8270645 -123676 0 X X 0 1 X 1 1 1 X 2106819 2363591 3974176 7251515 7345874 23041975 23458787 22715455 24749999 27891503 29393485 128209229 25565606 25079046 28724175 35143018 36739359 151251204 0 1319167 1333911 1611977 1264952 1486978 7016985 1319167 1333911 1611977 1264952 1486978 7016985 144234219 198099 415221 528249 332678 350592 1824839 198099 415221 528249 332678 350592 1824839 565565 547297 488968 367317 489352 2458499 26329270 26041564 29741392 35843013 37579303 155534542 0.92730 0.92260 0.01170 0.01140 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2017 AMOUNT: $ 565,565. 2018 AMOUNT: $ 547,297. 2019 AMOUNT: $ 488,968. 2020 AMOUNT: $ 367,317. 2021 AMOUNT: $ 489,352. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3634 3634 0 PART II-B, LINE 1: 4C HEALTH PAID MEMBERSHIP DUES TO IHA AND IN COUNCIL OF COMMUNITY MENTAL HEALTH CENTERS IN 2022. 10.78% AND 10.77% OF THE DUES, RESPECTIVELY, WERE ALLOCABLE TOWARDS LOBBYING EXPENDITURES. SCHEDULE C, PART II-B, LINE 1I: PORTION OF DUES PAID TO IHA AND ICCMHC ARE ATTRIBUTABLE TO LOBBYING. 0 0 394500 394500 11975999 6071630 5904369 1950164 988660 961504 7260373 ESTIMATED THIRD PARTY SETTLEMENTS 2992400 2992400 X 37264121 -123676 -123676 37387797 0 37387797 29117152 0 29117152 0 29117152 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY 4C HEALTH AND RECOGNIZE A TAX LIABILITY IF 4C HEALTH HAS 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 4C HEALTH, AND HAS CONCLUDED THAT AS OF JUNE 30, 2022 AND 2021, 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. 4C HEALTH HAS FILED ITS FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH JUNE 30, 2021 AND IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. AS OF THE DATE THE FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). 1 LIVING ALLOTMENT - SUPERVISED GROUP LIVING 16 24598 EDUCATION ASSISTANCE PROGRAM 14 27775 PART I, LINE 2: FOUR COUNTY MAKES ASSISTANCE AVAILABLE TO ELIGIBLE PERSONS TO FURTHER THE HEALTHCARE IN THE COMMUNITY. X 0 0 0 0 0 0 0 0 0 KATHLEEN MILLER CHIEF MEDICAL OFFICER 388299 0 3500 0 396 0 14520 0 25803 0 432518 0 0 0 CARRIE CADWELL CHIEF EXECUTIVE OFFICER 265040 0 86417 0 7591 0 17406 0 28743 0 405197 0 0 0 JASON CADWELL CHIEF FINANCIAL OFFICER 214949 0 62600 0 90 0 14010 0 543 0 292192 0 0 0 QUN WU PSYCHIATRIST 228921 0 0 0 0 0 10788 0 0 0 239709 0 0 0 MATTHEW TANNER ADVANCED PRACTICE NURSE 130440 0 6700 0 90 0 7213 0 29412 0 173855 0 0 0 JOHN YARLING PSYCHIATRIST 152125 0 727 0 1236 0 7763 0 9136 0 170987 0 0 0 AMY HERRON-MILLER ADVANCED PRACTICE NURSE 150543 0 9200 0 138 0 8029 0 431 0 168341 0 0 0 NICOLE HIATT-DRANG VP OF OPERATIONS NORTHERN 131902 0 21700 0 138 0 7684 0 395 0 161819 0 0 0 LISA WILLIS-GIDLEY VP OF OPERATIONS SOUTHERN REGION 106203 0 21700 0 54 0 6599 0 18611 0 153167 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 TWO OFFICERS AT FOUR COUNTY, JASON CADWELL, CFO AND CARRIE CADWELL, CEO HAVE A FAMILIAL RELATIONSHIP. CARRIE CADWELL REPORTS DIRECTLY TO THE PRESIDENT OF THE BOARD OF DIRECTORS AND JASON CADWELL REPORTS DIRECTLY TO THE TREASURER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE COUNTY COMMISSIONERS OR COUNTY COUNCIL OF FULTON COUNTY SELECTS ONE MEMBER TO SERVE ON THE BOARD OF DIRECTORS WHILE THE OTHER MEMBERS ARE ELECTED BY THE EXISTING MEMBERS AT THE ANNUAL MEETING OF THE ORGANIZATION. VACANCIES CAN BE FILLED BY REMAINING DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S CEO, CFO AND ACCOUNTING PERSONNEL. THE FINAL FORM INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE IS ENFORCED BY THE BOARD PRESIDENT. THE SCOPE OF THIS POLICY INCLUDES ALL DIRECTORS, OFFICERS, AND ASSOCIATES. THE POLICY IS IN PLACE TO ASSIST FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER DIRECTORS, OFFICERS, ASSOCIATES, AND AGENTS WHO GOVERN AND ADMINISTER FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER AFFAIRS TO RESOLVE SITUATIONS THAT INVOLVE A DUAL INTEREST OR THAT MAY BE INTERPRETED AS A CONFLICT OF INTEREST AND TO DEFINE CONFLICT OF INTEREST SITUATIONS AND PROCEDURES TO FOLLOW ONCE THEY ARE DISCLOSED. THE COVERED PERSONS ARE HELD TO A STRICT RULE OF HONEST AND FAIR DEALING BETWEEN THEMSELVES AND THE ORGANIZATION. THEY SHALL NOT USE THEIR POSITIONS, OR KNOWLEDGE GAINED THEREFROM, IN SUCH A WAY THAT A CONFLICT MIGHT ARISE BETWEEN THE INTEREST IN THE ORGANIZATION AND THAT OF THE INDIVIDUAL. A SELF DISCLOSURE FROM COVERED PERSONS TO OTHER BOARD MEMBERS IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. ANY DIRECTOR HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT: A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THAT A QUORUM WAS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATIONS OF FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC.'S CEO ARE MADE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS INCLUDED ANALYZING THE INDIANA COUNCIL SALARY SURVEY, LOCAL RECRUITING INFORMATION, AND MARKET RATES RELEVANT TO FOUR COUNTY'S RURAL AREA TO HELP ASSIST IN THE DECISION MAKING PROCESS. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THE FINAL COMPENSATION AMOUNTS, AND DOCUMENTATION OF THIS WAS PRESENTED TO THE FULL BOARD FOR APPROVAL AND RECORDED IN THE BOARD MINUTES. THE CEO IS NOT PRESENT DURING THESE MEETINGS DISCUSSIONS AND APPROVALS. COMPENSATION DETERMINATIONS OF FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC.'S CFO ARE MADE BY THE INTERNAL AFFAIRS COMMITTEE. THE CFO IS NOT PRESENT DURING DISCUSSIONS OR APPROVALS OF THEIR COMPENSATION. COMPENSATION DETERMINATIONS OF FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC.'S OTHER OFFICERS OR KEY EMPLOYEES WERE MADE BY THE CEO. OTHER OFFICERS AND KEY EMPLOYEES ARE NOT PRESENT DURING DISCUSSIONS OR APPROVALS OF THEIR COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C: OVERSIGHT OF AUDIT THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.