2019-01-29T07:57:45-06:00 2018-06-30 310800053 CLARK SCHAEFER HACKETT & CO 14 EAST MAIN ST SUITE 500 SPRINGFIELD OH 45502 990 2017-07-01 310787073 MENTAL HEALTH SERVICES FOR CLARK CO INC MENT 9373999500 474 N YELLOW SPRINGS ST SPRINGFIELD OH 45504 CURTIS GILLESPIE CEO 9373999500 2019-01-26 1 MATTHEW SHROYER P00737986 9373992000 2019-01-26 74.121.64.251 2019-01-26 08:25:33 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 37AE4FB04CC3C859C04812217BCAEDDE34C66B0F 2017 2019-02-21 02:37:17Z MENTAL HEALTH SERVICES FOR CLARK AND MADISON COS INC CURTIS GILLESPIE 474 N YELLOW SPRINGS ST SPRINGFIELD OH 45504 12040411 0 X WWW.MHSCC.ORG X 1969 OH PROVIDES MENTAL AND BEHAVIORAL HEALTH SERVICES TO RESIDENTS OF CLARK AND MADISON COUNTIES OHIO. 14 14 256 14 0 0 4365278 4825401 7986323 6934130 82074 190334 105493 90546 12539168 12040411 0 0 0 0 9289107 9184144 0 0 0 2993126 3015533 12282233 12199677 256935 -159266 20354449 20586843 5057184 5289578 15297265 15297265 MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES WILL IMPROVE THE SAFETY AND QUALITY OF LIFE OF THOSE WE SERVE THROUGH PROMOTION OF EMOTIONAL AND BEHAVIORAL HEALTH WELLNESS AND ACCESSIBILITY TO A COMPREHENSIVE CONTINUUM OF BEHAVIORAL HEALTH SERVICES. 0 0 2906764 2883552 INPATIENT PSYCHIATRIC SERVICES OFFERING SHORT TERM, MULTIDISCIPLINARY CARE TO TREAT ACUTE EPISODES OF PSYCHOSIS AND DEPRESSIVE DISORDERS. 787 CLIENTS WERE SERVED DURING THE FISCAL YEAR. 6068415 3354713 OUTPATIENT PSYCHIATRIC SERVICES SERVED 5,700 CLIENTS DURING THE FISCAL YEAR FOR YOUTH, ADULT AND GERIATRIC POPULATIONS. 786411 786411 HOUSING ASSISTANCE SERVICES FOR CLIENTS WITH SEVERE MENTAL DISABILITIES WERE PROVIDED FOR 105 CLIENTS DURING THE FISCAL YEAR. 9761590 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 26 0 1 256 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MARY BETH TAYLOR 9373999500 474 N YELLOW SPRINGS ST SPRINGFIELD OH 45504 RICK BRODERICK CHAIR 3.00 X X 0 0 0 DOUG SCHANTZ VICE CHAIR 3.00 X X 0 0 0 HORTON HOBBS TRUSTEE 3.00 X 0 0 0 LYNN ROWLAND TRUSTEE 3.00 X 0 0 0 MARILYN KREIDER TRUSTEE 3.00 X 0 0 0 SUE MCCLELLAND TRUSTEE 3.00 X 0 0 0 BRIAN SMITH TRUSTEE 3.00 X 0 0 0 JEFF HUGHES TRUSTEE 3.00 X 0 0 0 KELLY SNYDER TRUSTEE 3.00 X 0 0 0 CHRIS ZECHMAN TRUSTEE 3.00 X 0 0 0 MARY TAYLOR TRUSTEE 3.00 X 0 0 0 ALEXIS EVANS COMER TRUSTEE 3.00 X 0 0 0 CURTIS GILLESPIE CHIEF EXECUTIVE OFFICER 40.00 X 124298 0 15285 MARY BETH TAYLOR VP FINANCE 40.00 X 77682 0 14476 SUE FRALICK VP OF ADULT AND YOUTH OUTPATIENT SERVICES 40.00 X 99583 0 14303 DR MARK A SMITH CHIEF CLINICAL OFFICER 40.00 X 272512 0 17635 DR KALPANA VISHNUPAD PHYSICIAN 40.00 X 223048 0 16907 DR YIU-CHUNG CHANG PHYSICIAN 40.00 X 218727 0 16821 DR FAWZIA TOOR PHYSICIAN 40.00 X 239474 0 7778 DR SUNITA AGARWAL PHYSICIAN 40.00 X 152085 0 3522 1407409 0 106727 6 0 1 0 0 7875 4150616 666910 4825401 TITLE XIX MEDICAID 900099 4403328 4403328 PATIENT SERVICE REVENUES 621300 1624890 1624890 UPL PAYMENTS 900099 677732 677732 TITLE XX 900099 115357 115357 RENTAL REVENUE FROM CLIENT SUPPOR 623990 112823 112823 6934130 9195 9195 181139 0 181139 181139 181139 OTHER SERVICE REVENUE 621300 90546 90546 90546 12040411 7024676 0 190334 635774 540408 95366 7178622 6077481 1101141 892408 726824 165584 477340 393871 83469 620732 339148 281584 122776 64351 58425 593193 491567 101626 92355 76170 16185 119424 62937 56487 359216 206249 152967 OPERATING SUPPLIES 595966 327011 268955 OPERATING EXPENSES 340977 320822 20155 EQUIPMENT EXPENSES 135345 99202 36143 BAD DEBTS 35549 35549 12199677 9761590 2438087 0 2693207 2810962 880634 888909 2033518 1215282 3654 5415 187851 179488 14157126 4856551 9509853 9300575 5044732 6185212 1000 1000 20354449 20586843 1931052 2408636 3126132 2880942 5057184 5289578 X 15297265 15297265 15297265 15297265 20354449 20586843 -159266 159266 0 X X 0 1 X 1 0 X 4882789 4480188 4476261 4365278 4825401 23029917 4882789 4480188 4476261 4365278 4825401 23029917 23029917 6178 6571 8066 11684 9195 41694 64831 128926 33768 105493 90456 423474 23495085 42033001 0.98020 0.97930 X 2776622 75 210551 17937 2969311 2510601 250 282931 17160 2776622 2500000 14933 4332 2510601 1.00000 1 0 1560377 1560377 9578365 2146484 7431881 564474 529438 35036 2236849 1969080 267769 217061 211549 5512 9300575 OTHER INVESTMENTS 3215901 F INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION 2969311 F 6185212 X 12199677 159266 159266 12040411 0 12040411 12199677 0 12199677 0 12199677 PART X, LINE 2: THE AGENCY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE AGENCY'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE AGENCY'S REPORTING RETURNS ARE SUBJECT TO AUDIT BY FEDERAL AND STATE TAXING AUTHORITIES. NO INCOME TAX PROVISION HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS AS THE AGENCY HAS DETERMINED IT DOES NOT HAVE UNRELATED BUSINESS INCOME SUBJECT TO TAXATION. 1 1 1 X 250.000000000000 1 X 1 1 0 1 1 907725 490672 417053 0.03420 907725 490672 417053 0.03420 907725 490672 417053 0.03420 1 23212 0 361961 301840 60121 X 1 1 1 1 MENTAL HEALTH SERVICES 474 NORTH YELLOW SPRINGS STREET SPRINGFIELD OH 45504 X 16 BED PSYCHIATRIC HOSPITAL MENTAL HEALTH SERVICES 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X WWW.MHSCC.ORG X 1 16 1 WWW.MHSCC.ORG 0 1 X 250.000000000000 400.000000000000 X X 1 1 X X X 1 X WWW.MHSCC.ORG X X 1 X 0 X X X 1 X 0 0 MENTAL HEALTH SERVICES PART V, SECTION B, LINE 5: MENTAL HEALTH SERVICES MANAGEMENT STAFF PARTICIPATES IN THE COMMUNITY HEALTH ASSESSMENT PROCESS PERFORMED BY THE CLARK COUNTY COMBINED HEALTH DISTRICT WITH OTHER COMMUNITY MEMBERS INCLUDING THE LOCAL HOSPITAL SYSTEM, OUR LOCAL ALCOHOL/DRUG TREATMENT PROGRAM, POLICE, FIRE AND ADMHS BOARD STAFF. IN ADDITION, MENTAL HEALTH SERVICES PERFORMS COMMUNITY FOCUS GROUP SESSIONS TO OBTAIN FEEDBACK AND INFORMATION FROM PATIENTS, FAMILY MEMBERS AND CONSUMER ADVOCATES TO ASSIST US IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. MENTAL HEALTH SERVICES PART V, SECTION B, LINE 11: BASED ON KEY ASSESSMENT DATA FROM THE CLARK COUNTY COMBINED HEALTH DISTRICT, MENTAL HEALTH SERVICES PROVIDES AN ONLINE DEPRESSION SCREENING FOR ADOLESCENTS AND ADULTS TO IDENTIFY DEPRESSION AND RISK OF SUICIDE. MENTAL HEALTH SERVICES PROVIDES WALK IN COUNSELING AS A PART OF OUR MENTAL HEALTH RECOVERY BOARD CONTRACT. IN ADDITION, MENTAL HEALTH SERVICES IS IMPLEMENTING EVIDENCE BASED PROGRAMMING IN THE LOCAL SCHOOLS TO REDUCE THE INCIDENCE OF SUICIDAL IDEATION AMONG MIDDLE SCHOOL AGE CHILDREN IN CLARK COUNTY. WE ARE PART OF THE CLARK COUNTY COMBINED HEALTH DISTRICT ADULT MENTAL HEALTH TASK FORCE TO ASSIST PART OF THE CLARK COUNTY COMBINED HEALTH DISTRICT ADULT MENTAL HEALTH TASK FORCE TO ASSIST IN THE REDUCTION OF SQUAD RUNS FOR MENTAL HEALTH ISSUES IN THE COMMUNITY. MENTAL HEALTH SERVICES PART V, SECTION B, LINE 13B: THE BILLING CLERK PROVIDES INFORMATION TO PATIENTS ON OUR CHARITY CARE PROGRAM. WE HAVE INFORMATION POSTED ON THE INPATIENT UNIT BULLETIN AREA AND ALSO HAVE A NOTICE ON THE PATIENT STATEMENT ALONG WITH THE BILLING CLERK PHONE NUMBER. OUR FINANCIAL ASSISTANCE COLLECTION POLICY IS POSTED ON OUR WEBSITE. FOR RESIDENTS OF CLARK AND MADISON COUNTIES WITHOUT INSURANCE, WE PROVIDE FREE INPATIENT CARE. WE OFFER A 30% DISCOUNT FOR UNINSURED OUT OF COUNTY CLIENTS AS WELL AS CLIENTS WHO HAVE OUTSTANDING MEDICAL EXPENSES EXCEEDING $5,000. PART I, LINE 3C: MENTAL HEALTH SERVICES OF CLARK AND MADISON COUNTIES, INC. SCREENED ALL ADMISSIONS AND, FOR 2017, PROVIDED FINANCIAL ASSISTANCE TO 64% OF ALL INPATIENT ADMISSIONS. PART VI, LINE 2: MENTAL HEALTH SERVICES MANAGEMENT STAFF PARTICIPATES IN THE CLARK COUNTY COMBINED HEALTH DISTRICT COMMUNITY HEALTH ASSESSMENT ALONG WITH OTHER COMMUNITY MEMBERS INCLUDING THE LOCAL HOSPITAL SYSTEM, OUR LOCAL ALCOHOL/DRUG TREATENT PROVIDER, POLICE, FIRE, AND LOCAL ALCOHOL/DRUG MENTAL HEALTH RECOVERY BOARD STAFF. IN ADDITION, MENTAL HEALTH SERVICES PERFORMS COMMUNITY FOCUS GROUP SESSIONS TO OBTAIN FEEDBACK ON SERVICE NEEDS. PART VI, LINE 3: THE INPATIENT BILLING CLERK MEETS WITH THE PATIENT, THE PATIENTS FAMILY OR ANOTHER AUTHORIZED GUARDIAN OR REPRESENTATIVE TO DISCUSS CLIENT CARE PROGRAMS. IN ADDITION, WE HAVE A MEDICAID REFERRAL COUNSELOR WHO ASSISTS CLIENTS WITH COMPLETION OF MEDICAID AND PRESCRIPTION DRUG ASSISTANCE APPLICATIONS. FOR THOSE CLIENTS OF CLARK OR MADISON COUNTY WITHOUT HEALTH INSURANCE, WE OFFER A 100% CHARITY CARE PROGRAM. IN 2017 WE WERE ABLE TO PROVIDE FINANCIAL ASSISTANCE TO 64% OF ALL ADMISSIONS. PART VI, LINE 4: CLARK AND MADISON COUNTIES ARE LOCATED IN SOUTHWEST OHIO WITH AN AREA POPULATION OF APPROXIMATELY 181,000. THE PERCENTAGE OF HOUSEHOLDS UNDER THE FEDERAL POVERTY GUIDELINES IS 15%. THE CLIENTS THAT WE SERVE ARE TYPICALLY ELIGIBLE FOR MEDICAID, MEDICARE OR OTHER FEDERAL ASSISTANCE PROGRAMS. THIS ELIGIBILITY IS USUALLY A FUNCTION OF OUR CLIENTS PSYCHIATRIC DISABILTIIES. X X X 0 0 0 0 0 0 0 0 0 DR MARK A SMITH CHIEF CLINICAL OFFICER 272512 0 0 0 0 0 5400 0 12235 0 290147 0 0 0 DR KALPANA VISHNUPAD PHYSICIAN 223048 0 0 0 0 0 4672 0 12235 0 239955 0 0 0 DR YIU-CHUNG CHANG PHYSICIAN 218727 0 0 0 0 0 4586 0 12235 0 235548 0 0 0 DR FAWZIA TOOR PHYSICIAN 239474 0 0 0 0 0 3555 0 4223 0 247252 0 0 0 DR SUNITA AGARWAL PHYSICIAN 152085 0 0 0 0 0 3522 0 0 0 155607 0 0 0 A CLARK COUNTY OHIO 316000132 999999999 2011-12-28 5000000 CONSTRUCTING INPATIENT AND OUTPATIENT FACILITY FOR MENTAL HEALTH SERVICES 0 0 0 A 5000000 50000 4215532 734468 2013 0 0 0 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 PART III, LINE 9; PART IV, LINE 7; AND PART V: MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES, INC. HAS ESTABLISHED WRITTEN PROCEDURES (A) TO ENSURE THAT ALL NON-QUALIFIED BONDS OF AN ISSUE ARE REMEDIATED IN ACCORDANCE WITH REGULATIONS SECTIONS 1.141-12 AND 1.145-2, (B) TO MONITOR THE REQUIREMENTS OF SECTION 148 OF THE INTERNAL REVENUE CODE, AND (C) TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES AUDIT COMMITTEE REVIEWS THE FORM 990 AND APPROVES IT BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF TRUSTEES REVIEW THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS AND COMPLETE SURVEY AND STATEMENT OF UNDERSTANDING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REFERENCES VARIOUS INDUSTRY COMPENSATION STUDIES AND SALARY SCHEDULES OF COMPARABLE ORGANIZATIONS. THE HUMAN RESOURCES DIRECTOR REPORTS TO THE BOARD OF TRUSTEES REGARDING MATTERS OF COMPENSATION LEVELS AND RESULTS OF SUCH STUDIES. FORM 990, PART VI, SECTION C, LINE 18 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 FORM 1023 AND FORM 990 ARE MADE AVAILABLE FOR PUBLIC INSPECTION UPON WRITTEN REQUEST OF THE ORGANIZATION. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DID NOT CHANGE ITS ACCEPTANCE PROCEDURES FOR THE FINANCIAL STATEMENTS FROM THE PRIOR PERIOD METHOD. MANAGEMENT REVIEWS THE AUDITED FINANCIAL STATEMENTS AND PRESENTS THEM TO THE BOARD FOR APPROVAL. CLEANERS EXTRAORDINAIRE INC 112 LOHNES AVE SPRINGFIELD OH 45504 311110016 JOB TRAINING FOR INDIVIDUALS WITH DISABILITES OH 501(C)(3) 170(B)(1)(A)(VI) MENTAL HEALTH SERVICES 1 RESOURCE CENTER APARTMENTS INC 601 N FOUNTAIN AVE SPRINGFIELD OH 45503 311307922 AFFORDABLE HOUSING FOR THE DISABLED OH 501(C)(3) 170(B)(1)(A)(VI) MENTAL HEALTH SERVICES 1 RESTAN CORP 601 N FOUNTAIN AVE SPRINGFIELD OH 45503 311368099 AFFORDABLE HOUSING FOR THE DISABLED OH 501(C)(3) 509(A)(2) MENTAL HEALTH SERVICES 1 JANI-TURF MAINTENENCE SERVICE INC 112 LOHNES AVE SPRINGFIELD OH 45504 311331268 JANITORIAL AND PROPERTY MAINTENECE SERVICES OH MENTAL HEALTH SERVICES C 3833 155041 1.00000 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 JANI-TURF MAINTENANCE SERVICES INC M 14556 CLEANERS EXTRAORDINAIRE INC K 14400 RESOURCE CENTER APARTMENTS INC Q 65282 RESTAN CORP L 6276