2015-12-22T08:43:25-06:00 2015-06-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2014-07-01 351375696 SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER SOUT 2197694005 8555 TAFT STREET MERRILLVILLE IN 46410 JUDITH K SIKORA CHIEF FINANCIAL OFFICER 2177694005 2015-12-11 1 AMBER KOCHER CPA P01286298 3176334705 2014 2016-04-25 22:37:26Z REGIONAL MENTAL HEALTH CENTER JUDITH K SIKORA 8400 LOUISIANA STREET MERRILLVILLE IN 46410 37497226 0 X WWW.REGIONALMENTALHEALTH.ORG X 1974 IN REGIONAL WORKS EXCLUSIVELY WITH INDIVIDUALS NEEDING MENTAL HEALTH CARE AND INTERVENTIONS FOR SUBSTANCE ABUSE, BY PROVIDING COMPREHENSIVE AND COMMUNITY BASED MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT FOR ADULTS, AND ADOLESCENTS. 13 13 544 13 9658 8658 17433152 16283460 14139911 16144876 315295 878365 1677799 3384802 33566157 36691503 0 0 0 0 21325769 23189836 0 0 0 11174723 11110320 32500492 34300156 1065665 2391347 50035808 51514600 11922690 11410308 38113118 40104292 X SEE SCHEDULE O FOR COMPLETE MISSION STATEMENT 0 0 11027729 0 8769730 OUTPATIENT CARE-THESE PROGRAMS OFFER A WIDE RANGE OF COUNSELING SERVICES TO INDIVIDUALS, FAMILIES, COUPLES AND GROUPS. THE FOCUS IS ON SELF-EXPLORATION, EXPRESSIONS OF FEELINGS, SHARING AND PERSONAL PROBLEMS, BUILDING BETTER RELATIONSHIPS WITH OTHERS AND STRENGTHENING FAMILY STABILITY.FISCAL YEAR 2015 HOURS OF SERVICE: 89,560. 6147801 0 5386401 CASE MANAGEMENT SERVICES/ COMMUNITY SUPPORT-THESE PROGRAMS PROVIDE INTENSIVE, THERAPEUTIC CASE MANAGEMENT. THESE PROGRAMS ARE TARGETED TO THOSE WHO HAVE DIFFICULTY DEVELOPING FRIENDSHIPS, PURSUING EMPLOYMENT, AND PLANNING FOR UPCOMING EVENTS. THE COMMUNITY SUPPORT PROGRAM HELPS TO EASE CLIENTS BACK INTO A SATISFACTORY LIVING ROUTINE.FISCAL YEAR 2015 HOURS OF SERVICE: 79,697 AND 107,412 VISITS. 3460118 0 902926 RESIDENTIAL CARE-THESE PROGRAMS PROVIDE RESDENTIAL HOUSING FOR ADULTS. RESIDENTIAL SERVICES ARE UTILIZED AS AN ALTERNATIVE TO HOSPITALIZATION, AND SERVE THOSE INDIVIDUALS WHO REQUIRE HELP IN ACHIEVING SOCIAL AND INDEPENDENT LIVING SKILLS TO SUCCESSFULLY RETURN TO COMMUNITY LIFE. THE PROGRAMS PROVIDE ROOM, BOARD, COUNSELING AND TRAINING IN ACTIVITIES OF DAILY LIVING.FISCAL YEAR 2015 DAYS OF SERVICE: 79,815. 7205945 0 1645645 INPATIENT PSYCHAITRIC SERVICES - A 16-BED HOSPITAL UNIT FOR ADULTS WITH ACUTE PSYCHIATRIC SYMPTOMS REQUIRING HIGH LEVEL OF CARE PROVIDES A SAFE, HIGHLY STRUCTURED, THERAPEUTIC SETTING IS AVAILABLE TO ASSIST OUR CLIENTS IN BEING ABLE TO TRANSITION FROM A HIGH LEVEL OF CARE TO A REDUCED LEVEL OF ASSITANCE THROUGH THE HELP OF ON STAFF ON HAND INCLUDING PSYCHIATRISTS, REGISTERED NURSES, PSYCHOLOGIST TECHNICIANS, AN ACTIVITY THERAPIST, AND A DIETICIAN.FISCAL YEAR 2015 DAYS OF SERVICE: 3,987. 7205945 0 1645645 27841593 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 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 1 1 0 0 0 1 43 0 1 544 0 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X JUDITH K SIKORA - GEMINUS CORPORATION 2197571921 8400 LOUISIANA STREET MERRILLVILLE IN 46410 DONALD LEVINSON CHAIRMAN 0.50 5.50 X 0 0 0 LESLIE RITTENMEYER VICE CHAIRMAN 0.50 5.50 X 0 0 0 RON BORTO SECRETARY/TREASURER 0.50 5.50 X 0 0 0 HERBERT CRUZ JR BOARD MEMBER 0.50 5.50 X 0 0 0 AUGUSTO GUS FLORES BOARD MEMBER 0.50 5.50 X 0 0 0 EDMUND GUNN BOARD MEMBER 0.50 5.50 X 0 0 0 LINDA JONAITIS BOARD MEMBER 0.50 5.50 X 0 0 0 GINA JONES BOARD MEMBER 0.50 5.50 X 0 0 0 DANIEL KLEIN BOARD MEMBER 0.50 5.50 X 0 0 0 DONNA STATH BOARD MEMBER 0.50 5.50 X 0 0 0 TERRENCE M QUINN BOARD MEMBER 0.50 5.50 X 0 0 0 WENDY ACEVEDO HEAD START PARENT REP 0.50 0.50 X 0 0 0 TAMEKA MULLINGS HEAD START PARENT REP 0.50 0.50 X 0 0 0 ROBERT D KRUMWIED PRESIDENT/CEO 20.00 20.00 X 248059 0 34940 JOHN KERN MD CHIEF MEDICAL OFFICER 40.00 0.00 X 273142 0 53496 SHARON KRAUS CHIEF CLINCIAL OFFICER 40.00 0.00 X 144340 0 36654 JUDITH K SIKORA CHIEF FINANCIAL OFFICER 20.00 20.00 X 0 157544 14241 MOHAMMAD ILYAS PSYCHIATRIST 40.00 0.00 X 256911 0 51420 EPIFANIO SANDOVAL PSYCHIATRIST 40.00 0.00 X 251969 0 51031 JOSE RAMIREZ PSYCHIATRIST 40.00 0.00 X 217937 0 28389 PRAKASH VARGHESE PSYCHIATRIST 40.00 0.00 X 215477 0 30253 PAUL DOBRANSKY PSYCHIATRIST 40.00 0.00 X 215671 0 34062 1823506 157544 334486 13 0 1 0 QOL MEDS LLC PO BOX 6074 HERMITAGE PA 16148 PHARMACY SERVICES 407860 BLUE & CO LLC PO BOX 66568 INDIANAPOLIS IN 46266 ACCOUNTING SERVICES 114216 LOCUMTENENSCOM LLC PO BOX 405547 ATLANTA GA 30384 EMPLOYMENT SERVICES 112217 3 16281908 1552 16283460 NET SERVICE REVENUE 900099 16144876 16144876 16144876 640510 640510 618654 42705 575949 575949 559826 9658 6465 1000873 754308 8710 246565 -8710 237855 237855 EHR INCENTIVE PAYMENTS 900099 136000 136000 CAFETERIA INCOME 900099 22702 22702 VENDING INCOME 900099 14903 14903 2635248 2635248 2808853 36691503 16704702 9658 3693683 X 665541 540378 125163 17550810 16390760 1160050 990284 924628 65656 2660850 2485898 174952 1322351 1234679 87672 99575 24139 75436 86096 20869 65227 4853416 1176437 3676979 74389 60326 14063 1588464 1288177 300287 1464070 1238284 225786 425525 406600 18925 79320 73811 5509 136120 110388 25732 1105946 813045 292901 596703 483901 112802 HOSPITAL ASSESSMENT FEE 552397 552397 48299 16876 31423 34300156 27841593 6458563 0 573994 252311 488878 1235853 3728711 3782637 10467 12282 1289065 1429214 37477960 26874650 10195061 10603310 13918073 12888482 13189295 15378302 54483 48843 6587781 5883366 50035808 51514600 3830688 3956692 19 19 2968484 2868192 405629 489136 4717870 4096269 11922690 11410308 X 38113118 40104292 38113118 40104292 50035808 51514600 2391347 -400173 0 X X 0 1 X 0 1 1 X PART I, LINE 3: REGIONAL MENTAL HEALTH CENTER HAS BEEN DETERMINED BY THE IRS TO BE A PUBLIC CHARITY UNDER IRS CODE SECTION 170(B)(1)(A)(III). PER SCHEDULE H INSTRUCTIONS ONLY ORGANIZATIONS THAT OPERATE AT LEAST ONE FACILITY THAT IS, OR IS REQUIRED TO BE, LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY A STATE AS A HOSPITAL IS REQUIRED TO COMPLETE THE SCHEDULE. REGIONAL MENTAL HEALTH CENTER IS A MENTAL HEALTH CENTER AND IS NOT LICENSED AS A HOSPITAL FOR THE STATE OF INDIANA. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 150740 1277680 1278289 150131 0 11648118 1116798 339888 1150291 11954513 10252634 1193886 1450154 1248556 11648118 9033015 1054279 1023636 858296 10252634 8123393 1096524 186902 9033015 8738948 1389280 1465064 3469899 8123393 1.00000 0 0 671905 671905 23074269 15591446 7482823 657642 122925 534717 11549003 10565794 983209 1525141 594485 930656 10603310 15378302 C 15378302 DUE FROM AFFILIATES 1922301 ASSETS WHOSE USE IS LIMITED 119055 OTHER RECEIVABLES 3842010 5883366 DUE TO AFFILIATES 3874398 ESTIMATED THIRD PARTY LIABILITIES 221871 4096269 X PART IV, LINE 1B: THE ORGANIZATION IS AN AGENT FOR HELD FUNDS FOR PATIENTS - REPRESENTATIVE PAYEE ACCOUNTS. PART V, LINE 4: THE BOARD HAS DESIGNATED CERTAIN INVESTMENTS FOR PROPERTY AND EQUIPMENT REPLACEMENT AND EXPANSION. CONTRIBUTIONS LISTED FOR THE YEAR WERE A PORTION OF GENERAL UNRESTRICTED NET ASSETS THAT WERE BOARD DESIGNATED FOR CAPITAL IMPROVEMENT PROJECTS. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATIONS AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATIONS HAVE 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 ORGANIZATIONS, AND HAS CONCLUDED THAT AS OF JUNE 30, 2015 AND 2014, 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 ORGANIZATIONS ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. SCHEDULE D, PART XI AND XII: PART XI AND XII ARE NOT REQUIRED AS THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. THE CONSOLIDATED FINANCIAL STATEMENTS ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM AND PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROBERT D KRUMWIED PRESIDENT/CEO 243204 0 0 0 4855 0 25434 0 9506 0 282999 0 0 0 JOHN KERN MD CHIEF MEDICAL OFFICER 256803 0 0 0 16339 0 27229 0 26267 0 326638 0 0 0 SHARON KRAUS CHIEF CLINCIAL OFFICER 129208 0 0 0 15132 0 10387 0 26267 0 180994 0 0 0 JUDITH K SIKORA CHIEF FINANCIAL OFFICER 0 157236 0 0 0 308 0 14086 0 155 0 171785 0 0 MOHAMMAD ILYAS PSYCHIATRIST 241072 0 0 0 15839 0 25153 0 26267 0 308331 0 0 0 EPIFANIO SANDOVAL PSYCHIATRIST 238130 0 0 0 13839 0 24764 0 26267 0 303000 0 0 0 JOSE RAMIREZ PSYCHIATRIST 208584 0 0 0 9353 0 20864 0 7525 0 246326 0 0 0 PRAKASH VARGHESE PSYCHIATRIST 207701 0 0 0 7776 0 20747 0 9506 0 245730 0 0 0 PAUL DOBRANSKY PSYCHIATRIST 206318 0 0 0 9353 0 7795 0 26267 0 249733 0 0 0 PART I, LINE 1A THE ORGANIZATION REIMBURSES HEALTH CLUB DUES, UP TO A LIMIT, FOR ALL EMPLOYEES AS A WELLNESS BENEFIT. PART I, LINE 4B MR. KRUMWIED PARTICIPATED IN A 457B PROGRAM OF WHICH THE TOTAL AMOUNT CONTRIBUTED IN FY 2014 WAS EMPLOYEE DEFERRAL ONLY. NO CONTRIBUTIONS WERE MADE BY REGIONAL MENTAL HEALTH CENTER. A INDIANA FINANCING AUTHORITY 351602316 2013-08-30 3000000 SEE PART VI 0 0 0 A 3000000 735483 47983 2216534 1 0 1 1 A 0 1 0 0 0.03100 0.03100 0 0 0 A 0 0 1 0 0 1 HORIZON BANK NATIONAL 10.000000000000 0 0 0 0 0 A 0 PART I, LINE (A), COLUMN (F): DESCRIPTION OF PURPOSE: THE PROCEEDS WILL BE (1) REFUNDING THE INDIANA HEALTH FACILITY FINANCING AUTHORITY HEALTH CARE FACILITIES REVENU BONDS, SERIES 2007; (2) FINANCING AND REFINANCING THE RENOVATION AND MAINTENANCE OF HEALTH FACILITY; (3) REFINANCING TAXABLE DEBT FOR A HEALTH FACILITY IN HAMMOND, INDIANA; (4) REFINANCING TAXABLE DEBT FOR A HEALTH FACILILTY IN MERRILLVILLE, INDIANA; AND (5) FINANCING COSTS OF ISSUANCE IN CONNECTION WITH THE ISSUNCE OF THE BONDS. FORM 990, PART III, LINE 1, MISSION STATEMENT: THE MISSION OF REGIONAL MENTAL HEALTH CENTER IS AS FOLLOWS: A. TO PROVIDE A COST-EFFECTIVE, CONSUMER-DRIVEN CONTINUUM OF PREVENTATIVE, CONSULATATIVE AND DIRECT-TREATMENT BEHAVIORAL HEALTH SERVICES. B. TO STRATEGICALLY POSITION THE CENTER FOR LONG-TERM FINANCIAL VIABILITY. C. TO PLAN, EVALUATE, AND SEEK CONTINUOUS IMPROVEMENT OF THE CENTER'S SERVICES THROUGH BROAD-BASED PROCESSES. D. TO EDUCATE THE PUBLIC AND ADVOCATE FOR THE NEEDS OF THE MENTALLY ILL, EMOTIONALLY DISTURBED, AND CHEMICALLY DEPENDENT. E. TO PROVIDE RESEARCH AND TRAINING OPPORTUNITIES THAT FALL APPROPRIATELY WITHIN THE FIELD OF MENTAL HEALTH AND CHEMICAL DEPENDENCY. FORM 990, PART I, ITEM C, DOING BUSINESS AS: REGIONAL MENTAL HEALTH CENTER REGIONAL HEALTH CLINIC FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS OF REVIEWING THE FORM 990 INCLUDES A DETAILED REVIEW BY THE CHIEF FINANCIAL OFFICER. THE GOVERNING BODY RECEIVES A COPY OF THE FORM 990, AS ULTIMATELY FILED WITH THE IRS, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD IS EDUCATED ABOUT THE POLICY AT THE ANNUAL COMBINED BOARD RETREAT. ALL BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. MEMBERS ARE ASKED TO RECUSE THEMSELVES IF THEY ARE IN ANY CONFLICT WITH THE MATTER BEING REVIEWED. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT/CEO IS EVALUATED BY THE BOARD OF DIRECTORS EVALUATION COMMITTEES. INFORMATION ABOUT PERFORMANCE, COMPARABLE DATA AND ANY OTHER INFORMATION REQUESTED IS PROVIDED. THE COMMITTEE RECOMMENDATION IS REVIEWED AND ACTED UPON BY THE FULL BOARD AT THE NEXT REGULAR MEETING. OTHER EMPLOYEES HAVE JOB DESCRIPTIONS AND ANNUAL REVIEWS BY THEIR SUPERVISOR, WHICH ARE DOCUMENTED IN EACH EMPLOYEE'S PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,047,259. MANAGEMENT AND GENERAL EXPENSES 3,273,230. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,320,489. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 129,178. MANAGEMENT AND GENERAL EXPENSES 403,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 532,927. FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351859562 DEVELOPMENT OF COLLABORATIVE RELATIONSHIPS IN SOCIAL SERVICE PROGRAMS IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 SOUTHLAKE TRI-CITY RBA CORP 8400 LOUISIANA STREET MERRILLVILLE IN 46410 205153554 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 9 REGIONAL MENTAL HEALTH CENTER 1 SOUTHLAKE RESIDENTIAL INC 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351821789 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 11A, I REGIONAL MENTAL HEALTH CENTER 1 BELL TOWER 8400 LOUISIANA STREET MERRILLVILLE IN 46410 542194413 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 BELL TOWER NORTH 8400 LOUISIANA STREET MERRILLVILLE IN 46410 800293130 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 WATERTOWER RESIDENTIAL 8400 LOUISIANA STREET MERRILLVILLE IN 46410 710919446 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 WATERTOWER SOUTH 8400 LOUISIANA STREET MERRILLVILLE IN 46410 300449524 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 WATERTOWER WEST 8400 LOUISIANA STREET MERRILLVILLE IN 46410 200475502 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 SCHAADT APARTMENT CORPORATION 8400 LOUISIANA STREET MERRILLVILLE IN 46410 800791184 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 TRI-CITY HOUSING CORPORATION 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351907579 LOW INCOME HOUSING FOR THE MENTALLY ILL IN 501(C)(3) LINE 11A, I REGIONAL MENTAL HEALTH CENTER 1 TRI-CITY HEALTH CENTER INC 8400 LOUISIANA STREET MERRILLVILLE IN 46410 351181194 FEDERALLY QUALIFIED HEALTH CENTER IN 501(C)(3) LINE 7 REGIONAL MENTAL HEALTH CENTER 1 0 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION C 8361435 FAIRMARKET VALUE SOUTHLAKETRI-CITY MANAGEMENT DBA GEMINUS CORPORATION M 3396840 FAIRMARKET VALUE