2018-01-16T09:34:44-06:00 2017-06-30 351178661 Blue & Co LLC 500 N Meridian St Suite 200 Indianapolis IN 46204 990 2016-07-01 351135451 Park Center Inc PARK 2604812719 909 East State Blvd Fort Wayne IN 46805 Paul Wilson CEO 2604812719 2018-01-16 1 Amber Kocher CPA P01286298 3176334705 2018-01-04 38.109.186.2 2018-01-16 09:34:42 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48BB13F909289851469C7DA648BAC11FC748AA42 2016 2021-01-29 14:40:06Z Paul Wilson 909 East State Blvd Fort Wayne IN 46805 31749271 0 X www.parkcenter.org X 1967 IN PARK CENTER, INC. IS A COMPREHENSIVE MENTAL HEALTH CENTER LOCATED IN FORT WAYNE, INDIANA. THE CENTER PROVIDES A FULL CONTINUUM OF BEHAVIORAL HEALTHCARE TO THE RESIDENTS OF ADAMS, ALLEN AND WELLS COUNTIES. THE CENTER PROVIDES SERVICES TO ELIGIBLE PATIENTS UNDER REIMBURSEMENT AGREEMENTS WITH MEDICARE, MEDICAID, AND OTHER THIRD PARTY CARRIERS. ADDITIONALLY, THE CENTER ACCEPTS PATIENTS REGARDLESS OF THEIR RACE, AGE, SEX, CREED, OR NATIONAL ORIGIN. IN THE FISCAL YEAR ENDED JUNE 30, 2017, THE CENTER PROVIDED UNCOMPENSATED CARE OF APPROXIMATELY $2.62 MILLION.THE CONTINUUM OF BEHAVIORAL HEALTHCARE INCLUDES: INPATIENT, SUBACUTE, GROUP HOMES, COMMUNITY HOUSING, DAY TREATMENT, OUTPATIENT THERAPY, CASE MANAGEMENT, ACTIVITIES OF DAILY LIVING, PSYCHOLOGICAL TESTING, MEDICAL SERVICES, VOCATIONAL, AND SCREENING. THESE SERVICES ARE PROVIDED TO PERSONS WITH MENTAL ILLNESS AND/OR CHEMICAL DEPENDENCY. 14 13 655 0 -8196 -8196 11754682 12350514 16494153 19154279 154547 -38492 97412 185776 28500794 31652077 0 0 0 0 22865771 23521908 0 0 0 7797996 7372695 30663767 30894603 -2162973 757474 15028129 15083421 7953165 7107969 7074964 7975452 X Meeting the behavioral health needs of consumers is Park Center's singular focus. Through responsive programming and continous improvement, we strive to exceed expectations. 0 0 12754633 0 7263708 Outpatient psychiatric and addiction services are provided by Park Center in several different locations. These services involve counseling, case management and medication support. 8990416 0 9964247 Casemanagement, Vocational, Partial Hospitalization, and Apple Spice Junction (affirmative business) 2795394 0 1879153 INPATIENT PSYCHIATRIC HOSPITAL 148626 0 63361 Consultation and Education 148626 0 63361 24689069 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 1 0 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 0 0 1 33 0 1 655 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 IN X Brandy Campbell CFO 2604812719 909 EAST STATE BLVD Fort Wayne IN 46805 Carolyn Brody Chairperson 1.00 X X 0 0 0 J Phillip Tyndall MD Vice Chairperson 1.00 X X 0 0 0 Teresa Hatten Secretary 1.00 X X 0 0 0 Mark Blessing Board Member 1.00 X 0 0 0 Bill Brown Board Member 1.00 X 0 0 0 Lanni Connelly Board Member 1.00 X 0 0 0 travis friend Board Member 1.00 X 0 0 0 tim gall Board Member 1.00 X 0 0 0 Larry Lambertson MD Board Member/Medical Director 41.00 X 291099 0 53791 Jodi Leas Board Member 1.00 X 0 0 0 Beth Lock Board Member 1.00 X 0 0 0 Jan Nes Board Member 1.00 X 0 0 0 Wylie Sirk Board Member 1.00 X 0 0 0 angela stewart-martin Board Member 1.00 X 0 0 0 Victor Torres Board Member 1.00 X 0 0 0 PAUL WILSON MSSW MHA PRESIDENT & CEO 40.00 X 115789 0 34333 Clyde A Nix COO 40.00 X 103788 0 34097 Brandy Campbell CFO 40.00 X 56735 0 13161 Syed Mumtaz MD Assoc. Medical Director 34.00 X 249492 0 53888 Ruben Singh MD Psychiatrist 29.00 X 218697 0 29947 Ronald Pancner Psychiatrist 23.00 X 166822 0 4562 Jay Patel MD Psychiatrist 17.00 X 122031 0 562 Ina Carlson PhD VP-Child & Adult Services 40.00 X 106656 0 30994 1431109 0 255335 9 0 1 0 Parkview Memorial Hospital 10501 Corporate Drive Fort WAYNE IN 46845 Inpatient Bed Contract Svc 580329 LocumTenenscom LLC PO Box 405547 Atlanta GA 303845547 LocumTenens doctors on contract 458183 Crossroads 2525 Lake Avenue Fort Wayne IN 46805 contract for treatment services 289162 claimaid 8141 zionville rd indianapolis IN 46268 medicaid enrollment services 210810 Executive Management PO Box 501818 Indianapolis IN 462506818 Housekeeping cleaning contract 180383 8 11856849 493665 12350514 Net Patient Service Revenue 621300 18750483 18750483 APPLE SPICE SALES 722320 403796 403796 19154279 3536 3536 16190 0 16190 16190 16190 55166 97194 -42028 -42028 -42028 DSH Federal Funds 900099 73458 73458 IN Employment Security Inc 900099 52727 52727 PHT, LLC Income 541511 -8196 -8196 51597 51597 169586 31652077 19170469 -8196 139290 567411 483042 84369 17276122 14707330 2568792 577979 486196 91783 3765451 3167500 597951 1334945 1122957 211988 34534 23341 11193 54750 37004 17746 2467678 1667838 799840 88585 44298 44287 1680787 1276586 404201 310007 103168 206839 11834 11834 861110 604744 256366 316185 226988 89197 14666 9370 5296 140949 98986 41963 833929 554727 279202 452140 452140 Dues, Licences, Fees, O 105541 63160 42381 30894603 24689069 6205534 0 1773107 2728922 30824 42828 1115555 1504522 4169365 3955760 32479 77496 95132 308245 129341 21338828 15485316 6689161 5853512 49224 58613 165840 167478 649312 514834 15028129 15083421 2316966 2193959 3282000 3054000 172721 191690 1475000 975000 706478 693320 7953165 7107969 X 7074964 7845041 130411 7074964 7975452 15028129 15083421 X 757474 33402 109612 X X 0 1 X 1 1 1 X 12706979 10689731 11527728 11754682 12350514 59029634 10361596 11343958 13286724 16494153 19154279 70640710 23068575 22033689 24814452 28248835 31504793 129670344 0 0 0 129670344 47819 41851 19630 17049 19726 146075 47819 41851 19630 17049 19726 146075 399145 84790 76927 233609 177782 972253 23515539 22160330 24911009 28499493 31702301 130788672 0.99140 0.98970 0.00110 0.00130 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6369 6369 0 Part II-B, Line 1: PORTION OF trade organization ANNUAL DUES ALLOCATED TO LOBBYING EFFORTS. 0 1 X 0 130411 130411 0.00000 0.00000 1.00000 0 0 213394 213394 15190173 10096191 5093982 376564 377382 -818 5459957 5011743 448214 98740 98740 5853512 Derivative Liability 36287 Third Party Payable 657033 693320 X 31795091 33402 109612 143014 31652077 0 31652077 30894603 0 30894603 0 30894603 Part IV, Line 2b: The organization is an agent for Held Funds for Patients' representative payee accounts. Part V, Line 4: Temporarily restricted net assets relate to contributions to assist with an integrated care clinic. Part X, Line 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE CENTER AND RECOGNIZE A TAX LIABILITY IF THE CENTER 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 THE CENTER, AND HAS CONCLUDED THAT AS OF JUNE 30, 2017 AND 2016, 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 CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. Part XI, Line 2d - Other Adjustments: Unrealized loss on derivative 109,612. X X 0 0 0 0 0 0 0 0 0 Larry Lambertson MD Board Member/Medical Director 284500 0 0 0 6599 0 30762 0 23029 0 344890 0 0 0 PAUL WILSON MSSW MHA PRESIDENT & CEO 111282 0 0 0 4507 0 17516 0 16817 0 150122 0 0 0 Syed Mumtaz MD Assoc. Medical Director 244318 0 0 0 5174 0 30411 0 23477 0 303380 0 0 0 Ruben Singh MD Psychiatrist 213908 0 0 0 4789 0 24000 0 5947 0 248644 0 0 0 Ronald Pancner Psychiatrist 166822 0 0 0 0 0 4562 0 0 0 171384 0 0 0 Part II, Larry Lamerston, MD: Dr. Lamberston 40 hours relates to his full time employment as a doctor for Park Center. Also, he serves as a board member for Park Center. A City of Fort Wayne 356001029 NoneAvail 2015-05-15 3415000 See Part IV 0 0 0 A 3415000 34715 1995654 1385171 2015 1 0 0 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 1 1 0 0 0 1 A 1 Form 990, Sch K, Part I, Column (f), Purpose of Bond: Series 2015 bond proceeds were used to construct and renovate facilities related to the inpatient unit and to retire previously issued bonds. Form 990, Part VI, Section B, line 11b The process of reviewing the Form 990 includes a detailed review by the accounting department personnel. Each voting member of the governing body receives a copy of the Form 990 including required schedules, as ultimately filed with the IRS, prior to filing. Form 990, Part VI, Section B, line 12c The Board reviews the conflict of interest policy each year and each member signs a form, documenting their understanding of the policy and how it relates to them. Staff review and sign the Code of Ethics each year during their performance evaluation. Potential conflicts are discussed either with the Board or with the employee's supervisor. Form 990, Part VI, Section B, line 15 The CEO's compensation is reviewed each year by the Executive Committee of the Board. The Executive Committee reviews compensation surveys to become aware of the compensation of comparable positions. For the other key employees of the organization, salary surveys are examined each year to compare compensation. Both the CEO and other key employees are all below the median salaries in those surveys. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part XI, line 9: Unrealized Loss on Derivative 109,612. Form 990, Part XI, Line 2c, audit oversight: The Board of Directors assumes responsibility for the oversight of the audit and selection of the independent accounting firm. No processes have changed since prior year relating to audit oversight.