2019-08-13T13:55:25-05:00 2018-09-30 341884125 CBIZ MHM LLC 4722 N 24TH ST STE 300 PHOENIX AZ 85016 990 2017-10-01 860290033 SOUTHWEST BEHAVIORAL HEALTH SERVICES INC SOUT 6022854279 3450 N 3RD STREET PHOENIX AZ 85012 MICHAEL FETT CFO 6022854279 2019-08-10 1 AMY A O'LOUGHLIN P00869687 6022646835 2019-08-09 12.221.96.220 2019-08-10 14:26:15 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 1212D86953DF9911D4E957E54162B84DD93DFAA7 2017 2019-02-21 02:37:17Z STEVEN SHEETS 3450 N 3RD STREET PHOENIX AZ 85012 86953922 0 X WWW.SBHSERVICES.ORG X 1970 AZ WE INSPIRE PEOPLE TO FEEL BETTER AND REACH THEIR POTENTIAL, THROUGH HELPING PEOPLE DISCOVER THEIR STRENGTHS, WE IMPROVE OUR COMMUNITIES. 11 11 1329 12 0 15020 72075982 78560709 2138648 3288793 75047 509561 141686 249388 74431363 82608451 118837 62981 0 0 48898341 55449868 0 0 0 26638102 26877656 75655280 82390505 -1223917 217946 34615154 35359917 13782974 14309791 20832180 21050126 WE INSPIRE PEOPLE TO FEEL BETTER AND REACH THEIR POTENTIAL, THROUGH HELPING PEOPLE DISCOVER THEIR STRENGTHS, WE IMPROVE OUR COMMUNITIES. 0 0 73899897 62981 3288793 SBH PROVIDES SERVICES IN PREVENTION, OUTREACH SERVICES, COMMUNITY INTEGRATION, HOME-BASED COUNSELING, CASE MANAGEMENT, METHADONE MAINTENANCE, CRISIS RECOVERY, COMMUNITY HOUSING, RESIDENTIAL SERVICES AND OUTPATIENT COUNSELING FOR CHILDREN AND ADULTS SUFFERING FROM VARIOUS BEHAVIORAL AND SUBSTANCE ABUSE PROBLEMS. 73899897 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 217 0 1 1329 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 1 1 0 1 1 1 1 1 1 0 0 AZ X MICHAEL FETT 6022854279 3450 N 3RD STREET PHOENIX AZ 85012 MATT HATFIELD CHAIR 0.30 X X 0 0 0 ADRIENNE SCHECK PHD IMMEDIATE PAST CHAIR 0.30 X 0 0 0 KURT BRAATZ DIRECTOR 0.30 X 0 0 0 MICHAEL CYLKOWSKI DIRECTOR 0.30 X 0 0 0 MICHAEL HARRIS DIRECTOR 0.30 X 0 0 0 RICHARD HEROLD DIRECTOR 0.30 X 0 0 0 DONALD LOGUE DIRECTOR 0.30 X 0 0 0 ROGER MORRIS DIRECTOR 0.30 X 0 0 0 MICHELLE QUINTANILLA DIRECTOR 0.30 X 0 0 0 LUCY TREIMAN DIRECTOR 0.30 X 0 0 0 PATRICIA VALADEZ DIRECTOR 0.30 X 0 0 0 JEFFREY JORDE PAST PRESIDENT/CEO 40.00 X 301716 0 24509 STEVEN SHEETS INTERIM PRESIDENT/CEO (AS OF 8/2018) 40.00 X 0 0 0 MICHAEL FETT CHIEF FINANCIAL OFFICER 40.00 X 159171 0 25971 DEBORAH WOODARD VP COMM/SECRETARY 40.00 X 106585 0 15367 SCOTT MCCALL PSYCHIATRIST 40.00 X 341158 0 400 ANDREA PUPILLO PSYCH NURSE PRACTITIONER 40.00 X 313338 0 16033 RAMIRO GUILLEN CHIEF MEDICAL OFFICER 40.00 X 292000 0 25709 SHALINI THARANI PYCHIATRIST 40.00 X 240598 0 8175 RAQUEL BALDERAS REGIONAL MEDICAL DIRECTOR 36.00 X 225407 0 18657 1979973 0 134821 46 0 1 0 ZONA INTEGRATED HEALTH CENTER 492 S LOWER CHORD RD VAIL AZ 85641 HEALTH CARE PROFESSIONALS 214937 ARASH ZAMAMIAN 22236 CAIRNLOCH ST CALABASAS CA 91302 HEALTH CARE PROFESSIONALS 184200 2 77910770 649939 327439 78560709 CLIENT FEES 624100 1801444 1801444 CONSULTING 624100 991641 991641 RENTAL INCOME 531120 378324 378324 MEDICAL RECORDS 624100 17209 17209 TRAINING 624100 12438 12438 87737 87737 3288793 33441 33441 4170749 650842 4170749 174722 0 476120 476120 476120 EHR INCENTIVES 900099 106250 106250 SNACK BAR/VENDING 900099 30290 30290 AMEX REWARDS 900099 19912 19912 92936 92936 249388 82608451 3288793 0 758949 62981 62981 633319 633319 43911244 39529551 4381693 209203 185011 24192 7533889 6803749 730140 3162213 2818724 343489 62654 16481 46173 122200 20500 101700 61090 57409 3681 129628 2814 126814 252153 137435 114718 235718 185582 50136 3957872 3554480 403392 2018782 1916636 102146 69476 53326 16150 699 699 2247583 2073950 173633 479818 370211 109607 SUPPLIES 12228571 12142121 86450 NURSING & PHYSICIAN SVS 2264271 1986332 277939 EQUIPMENT RENTAL/MAINT. 1452358 1002146 450212 TELEPHONE 860189 768174 92015 434594 211585 223009 82390505 73899897 8490608 0 1727078 994614 2040507 7578455 3686159 4345792 29405 12782 200943 176428 42628997 20520790 22616784 22108207 4170749 143529 143639 34615154 35359917 6476362 7706217 684482 567182 5379411 5018304 1242719 1018088 13782974 14309791 X 17748027 17794763 3084153 3255363 20832180 21050126 34615154 35359917 217946 0 X 0 1 X 1 1 1 X 53296732 60121436 65573053 72075982 78560709 329627912 53296732 60121436 65573053 72075982 78560709 329627912 329627912 9978 39265 72600 75047 33441 230331 132410 123144 118531 141686 249388 765159 330623402 12384676 0.99700 0.99710 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2013 AMOUNT: $ 1,943. 2014 AMOUNT: $ 511. 2015 AMOUNT: $ 37,065. 2016 AMOUNT: $ 27,091. 2017 AMOUNT: $ 92,936. INSURANCE REFUND - 2013 AMOUNT: $ 109,820. 2014 AMOUNT: $ 89,926. 2015 AMOUNT: $ 55,074. 2016 AMOUNT: $ 61,714. 2017 AMOUNT: $ 0. SNACK BAR/VENDING - 2013 AMOUNT: $ 20,647. 2014 AMOUNT: $ 32,707. 2015 AMOUNT: $ 26,392. 2016 AMOUNT: $ 28,939. 2017 AMOUNT: $ 30,290. AMEX REWARDS - 2016 AMOUNT: $ 23,942. 2017 AMOUNT: $ 19,912. EHR INCETIVES - 2017 AMOUNT: $ 106,250. 4369392 4369392 29100413 12816966 16283447 1560781 1231753 329028 7405011 6472071 932940 193400 193400 22108207 X 83786912 20666 1292166 1312832 82474080 134371 134371 82608451 83730378 20666 1453578 1474244 82256134 134371 134371 82390505 PART X, LINE 2: SBH HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE AND ARIZONA DEPARTMENT OF REVENUE STATING THAT IT IS EXEMPT FROM FEDERAL AND ARIZONA INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE BASED ON THE INFORMATION SUBMITTED. SBH WILL MAINTAIN THEIR EXEMPT STATUS AS LONG AS OPERATIONS CONTINUE TO COMPLY WITH THE INTERNAL REVENUE CODE AND ARIZONA REVISED STATUTES. INCOME DETERMINED TO BE UNRELATED BUSINESS INCOME ("UBI") WOULD BE TAXABLE. MANAGEMENT DOES NOT BELIEVE SBH HAS ANY UBI FOR THE YEAR ENDED SEPTEMBER 30, 2018. THE ORGANIZATION EVALUATES THEIR UNCERTAIN TAX POSITIONS, IF ANY, ON A CONTINUAL BASIS THROUGH REVIEW OF THEIR POLICIES AND PROCEDURES AND DISCUSSIONS WITH OUTSIDE EXPERTS. THE FEDERAL EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990) FOR 2015, 2016 AND 2017 OF SBH ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM RELATED ENTITIES 1,292,166. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATING ENTRY 134,371. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM RELATED ENTITIES 1,453,578. PART XII, LINE 4B - OTHER ADJUSTMENTS: ELIMINATING ENTRY 134,371. 1 FLEX FUNDS & HOPWA EMERGENCY ASSISTANCE 175 62981 PART I, LINE 2: THE ORGANIZATION CONFIRMS THAT RECIPIENTS ARE ELIGIBLE TO RECEIVE ASSISTANCE AND THAT THEY DO NOT EXCEED THE MAXIMUM BENEFITS ALLOWANCE. CHECKS ARE WRITTEN DIRECTLY TO SERVICE VENDORS TO PAY FOR RECIPIENTS' EXPENSES. 0 0 0 0 0 0 0 1 0 JEFFREY JORDE PAST PRESIDENT/CEO 232320 0 61000 0 8396 0 3600 0 20909 0 326225 0 0 0 MICHAEL FETT CHIEF FINANCIAL OFFICER 147033 0 12000 0 138 0 3083 0 22888 0 185142 0 0 0 SCOTT MCCALL PSYCHIATRIST 340795 0 0 0 363 0 0 0 400 0 341558 0 0 0 ANDREA PUPILLO PSYCH NURSE PRACTITIONER 140952 0 0 0 172386 0 0 0 16033 0 329371 0 0 0 RAMIRO GUILLEN CHIEF MEDICAL OFFICER 291742 0 0 0 258 0 4800 0 20909 0 317709 0 0 0 SHALINI THARANI PYCHIATRIST 209788 0 3000 0 27810 0 1440 0 6735 0 248773 0 0 0 RAQUEL BALDERAS REGIONAL MEDICAL DIRECTOR 225303 0 0 0 104 0 2105 0 16552 0 244064 0 0 0 PART I, LINE 7 ANNUALLY THE BOARD CREATES AN AD HOC COMMITTEE IN CHARGE OF REVIEWING THE CEO'S AND CFO'S PERFORMANCE AND MAKING A RECOMMENDATION TO THE FULL BOARD REGARDING BONUS AND PAY INCREASE. A THE ARIZONA HEALTH FACILITIES AUTHORITY (2015 A) 860453292 040507EM3 2015-03-10 4600000 FINANCING ADMIN/OUTPATIENT BUILDING 0 0 0 B THE ARIZONA HEALTH FACILITIES AUTHORITY (2015 B) 860453292 2015-12-01 1800000 OFFICE BUILDING 0 0 0 A 4600000 150609 4600000 2015 1 0 1 1 B 1800000 41012 1800000 2016 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 1 B 0 0 0 0 1 0 0 0 1 A 0 B 1 X 20906 THRIFT SHOP VALUE X 1 286897 FAIR MARKET VALUE X SUPPLIES 1 19636 FAIR MARKET VALUE 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM AND IS REVIEWED BY THE ACCOUNTING MANAGER, THE CONTROLLER AND CFO BEFORE BEING SIGNED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 12C THE MEMBERS OF THE SBH BOARD OF DIRECTORS AND SBH EXECUTIVE PERSONNEL ACKNOWLEDGE THE NEED FOR DISCLOSURE OF INTEREST(S). ANY SITUATION IN WHICH A POSSIBLE CONFLICT OF INTEREST MIGHT ARISE WILL BE REPORTED PROMPTLY IN WRITING TO THE CORPORATION. ALL PERSONNEL ARE REQUIRED TO REPORT A REAL OR POTENTIAL CONFLICT OF INTEREST TO THEIR IMMEDIATE SUPERVISOR PRIOR TO ENGAGING IN ANY TRANSACTION THAT MAY BE PERCEIVED AS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A ANNUALLY THE BOARD CREATES AN AD HOC COMMITTEE IN CHARGE OF REVIEWING THE CEO'S PERFORMANCE AND MAKING A RECOMMENDATION TO THE FULL BOARD REGARDING BONUS AND ANY PAY INCREASE. THE CEO'S EVALUATION IS BASED ON 20 MEASURABLE OBJECTIVES THAT ARE WEIGHTED AND TALLIED FOR A TOTAL SCORE. THE CEO'S SALARY IS COMPARED WITH SALARIES OF NOT-FOR-PROFIT COMPANIES NATIONWIDE - MEMBERS OF THE MENTAL HEALTH CORPORATION OF AMERICA. THE RECOMMENDATIONS OF THE AD HOC COMMITTEE ARE FORWARDED TO ALL BOARD MEMBERS FOR DISCUSSION AND FINAL RECOMMENDATION. REVIEWS WERE LAST PERFORMED JANUARY 2018. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION, BY-LAWS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. VILLA AGAVE CORPORATION 7439 S 7TH ST PHOENIX AZ 85042 942902649 HOUSING AZ 501(C)(3) LINE 7 N/A 0 MIHALIC'S PROJECT 1408 E HIGHLAND AVE PHOENIX AZ 85014 860667653 HOUSING AZ 501(C)(3) LINE 11 N/A 0 VILLA DE CONFIANZA 2060 N 35TH AVE PHOENIX AZ 85009 742537585 HOUSING AZ 501(C)(3) LINE 11 N/A 0 TOBY HOUSE II 3450 NORTH THIRD STREET PHOENIX AZ 85012 742420528 HOUSING AZ 501(C)(3) LINE 11 N/A 0 TOBY HOUSE III 3450 NORTH THIRD STREET PHOENIX AZ 85012 860742062 HOUSING AZ 501(C)(3) LINE 11 N/A 0 TOBY HOUSE IV 3450 NORTH THIRD STREET PHOENIX AZ 85012 860897449 HOUSING AZ 501(C)(3) LINE 11 N/A 0 TOBY HOUSE V 3450 NORTH THIRD STREET PHOENIX AZ 85012 860950586 HOUSING AZ 501(C)(3) LINE 11 N/A 0 TOBY HOUSE VI 3450 NORTH THIRD STREET PHOENIX AZ 85012 860981650 HOUSING AZ 501(C)(3) LINE 7 N/A 0 TOBY HOUSE VII 3450 NORTH THIRD STREET PHOENIX AZ 85012 861025879 HOUSING AZ 501(C)(3) LINE 11 N/A 0 TOBY HOUSE VIII 3450 NORTH THIRD STREET PHOENIX AZ 85012 710931900 HOUSING AZ 501(C)(3) LINE 7 N/A 0 AGAVE HEALTH INC PO BOX 22489 SANTA FE NM 875022489 462971316 ADULT AND CHILDREN BEHAVIORAL HEALTH SERVICES NM 501(C)(3) LINE 11 SOUTHWEST BEHAVIORAL HEALTH SERVICES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0