2012-03-06T16:58:08-06:00 2011-06-30 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2010-07-01 351140758 HAMILTON CENTER INC HAMI 8122318323 620 EIGHTH AVENUE TERRE HAUTE IN 47804 MEL BURKS 3179373702 2012-03-05 1 ANGELA L ZIRKELBACH CPA 3176334705 2010 2016-02-24 21:20:13Z SUE THOMPSON 620 EIGHTH AVENUE TERRE HAUTE IN 47804 32303921 0 X WWW.HAMILTONCENTER.ORG X 1966 IN HAMILTON CENTER PROVIDES OUTPATIENT AND DAY SERVICES TO MENTALLY ILL AND CHRONICALLY ADDICTED CHILDREN AND ADULTS, RESIDENTIAL AND INPATIENT SERVICES TO MENTALLY ILL ADULTS, PREVENTION AND EARLY INTERVENTION SERVICES TO CHILDREN AND FAMILIES AND REHABILITATION SERVICES TO DEVELOPMENTALLY DISABLED ADULTS. 17 17 860 20 0 0 14306560 14157766 19935339 17417746 381789 317760 265421 161888 34889109 32055160 77764 80866 0 0 27157690 26404364 0 0 0 7084962 7246488 34320416 33731718 568693 -1676558 45566646 43212291 7114970 6406591 38451676 36805700 X HAMILTON CENTER EXISTS TO PROVIDE QUALITY BEHAVIORAL HEALTHCARE, WELLNESS, AND HUMAN DEVELOPMENT SERVICES TO OUR COMMUNITY. 0 0 17502151 80866 12863864 HAMILTON CENTER PROVIDES OUTPATIENT COUNSELING SERVICES IN TEN COUNTIES THROUGHOUT CENTRAL AND WEST CENTRAL INDIANA INCLUDING VIGO, SULLIVAN, OWEN, GREENE, PUTNAM, CLAY, PARKE, VERMILLION, HENDRICKS AND MARION. SERVICES ARE PROVIDED BY A VARIETY OF PROFESSIONAL STAFF WITH VARIOUS SPECIALTY AREAS SOME OF WHOM INCLUDE: PSYCHIATRISTS, PSYCHOLOGISTS, SOCIAL WORKERS, LICENSED MENTAL HEALTH COUNSELORS, ADDICTION THERAPISTS, AND LICENSED MARRIAGE AND FAMILY THERAPISTS. TREATMENT IS INDIVIDUALIZED, PERSON CENTERED AND RECOVERY BASED. TREATMENT IS TAILORED TO BE AS BRIEF AS NECESSARY AND IS ORIENTED TOWARD IMPROVING THE PATIENT'S QUALITY OF LIFE AND FUNCTIONING - WORK, SCHOOL AND FAMILY ACTIVITIES. SERVICES INCLUDE INDIVIDUAL, MARITAL, GROUP AND FAMILY THERAPY, AS WELL AS PSYCHOLOGICAL TESTING, PSYCHIATRIC EVALUATION/TREATMENT AND ADDICTION SERVICES. DURING THE CURRENT YEAR, HAMILTON CENTER PROVIDED 341,620 OUTPATIENT VISITS TO 10,682 CLIENTS. 2792470 0 1869575 HAMILTON CENTER'S RESIDENTIAL SERVICES ARE ROOTED IN THE BELIEF THAT THE TREATMENT OF PERSONS IN NEED OF LONGER TERM CARE BE BASED IN AN AUTHENTIC AND LEAST RESTRICTIVE ENVIRONMENT WHICH IS COMMUNITY-BASED AND ENCOURAGES INTERACTION WITH OTHERS. OUR GOAL IS TO ASSIST CLIENTS IN LIVING IN THE COMMUNITY WITH INDEPENDENCE, SELF-WORTH AND DIGNITY. RESIDENTIAL SERVICES INCLUDE 24-HOUR SUPERVISED GROUP HOMES, SEMI-INDEPENDENT LIVING, AND SUPPORTED LIVING ARRANGEMENTS WHERE A CLIENT OBTAINS HIS/HER OWN HOUSING AND RECEIVES SUPERVISION FROM HAMILTON CENTER'S STAFF. RESIDENTIAL SERVICES ARE PROVIDED IN VIGO AND MARION COUNTIES. DURING THE CURRENT YEAR, HAMILTON CENTER PROVIDED 21,080 RESIDENTIAL DAYS TO 113 CLIENTS. 2137326 0 2040666 HAMILTON CENTER OPERATES A 24-HOUR ADULT PSYCHIATRIC INPATIENT UNIT WHICH IS LICENSED BY THE INDIANA DIVISION OF MENTAL HEALTH AND ADDICTION. OUR 16-BED UNIT PROVIDES SHORT-TERM STABILIZATION AND TREATMENT FOR BEHAVIORAL AND ADDICTION DISORDERS. INPATIENT TREATMENT USUALLY BEGINS WITH A HOLISTIC ASSESSMENT OF THE INDIVIDUAL'S PHYSICAL HEALTH, EMOTIONAL HEALTH, FAMILY LIFE, SOCIAL INTERACTION AND EMPLOYMENT HISTORY. TREATMENT IS CONDUCTED BY A TEAM OF PROFESSIONALS WHICH INCLUDES PHYSICIANS, PSYCHIATRISTS, SOCIAL WORKERS, NURSES, ACTIVITY THERAPISTS, PSYCHIATRIC TECHNICIANS, PSYCHOLOGISTS, CASE MANAGERS AND OTHER SPECIALISTS. STAFF PSYCHIATRISTS MAKE PSYCHIATRIC EVALUATIONS AND DIAGNOSES, PROVIDE DIRECT TREATMENT AND MONITOR INDIVIDUAL PROGRESS. TREATMENT GOALS ARE INDIVIDUALIZED AND DEVELOPED BY THE CLIENT AND THE TREATMENT TEAM. SERVICES TAKE PLACE IN A SUPPORTIVE ENVIRONMENT, WHICH PROMOTES UNDERSTANDING OF THE ILLNESS, IMPROVES SELF-ESTEEM AND COMMUNICATION SKILLS, AND HELPS THE CLIENT'S SUPPORT SYSTEM UNDERSTAND THE ILLNESS AND ASSIST IN CARE. THE OBJECTIVE DURING A CLIENT'S STAY IS TO ACHIEVE STABILIZATION SO THAT HE/SHE CAN RETURN TO A LESS RESTRICTIVE ENVIRONMENT AS SOON AS POSSIBLE WITH FOLLOW-UP OUTPATIENT CARE. DURING THE CURRENT YEAR, HAMILTON CENTER PROVIDED 4,880 INPATIENT DAYS TO 546 CLIENTS. 2121128 0 0 INFANT AND TODDLER SERVICES PROGRAMS ARE EARLY CHILDHOOD PROGRAMS FOR FAMILIES WITH CHILDREN FROM BIRTH TO THREE YEARS OF AGE. THEIR FOCUS IS TO PROVIDE EXCELLENT SUPPORTIVE, EDUCATIONAL AND THERAPEUTIC SERVICES TO ENHANCE THE LIVES OF INFANTS, YOUNG CHILDREN AND THEIR FAMILIES. ADMISSION CRITERIA IS DIFFERENT FOR EACH PROGRAM, BUT ALL SERVICES ARE FREE OF CHARGE TO FAMILIES. INFANT AND TODDLER SERVICES PROGRAMS ARE PREVENTATIVE IN NATURE AND WORK WITH CHILDREN AND FAMILIES TO BUILD ON THEIR STRENGTHS. WE RECOGNIZE THAT FAMILIES WITH YOUNG CHILDREN DEAL WITH CHALLENGING AND OFTEN STRESSFUL SITUATIONS. OUR PROGRAMS ARE DESIGNED TO MEET EACH FAMILY'S INTERESTS AND PRIORITIES AS RELATED TO THEIR CHILD'S GROWTH AND DEVELOPMENT. SERVICES INCLUDE WRITTEN INFORMATION, ASSISTANCE IN CONNECTING WITH COMMUNITY SERVICES AND/OR EXTENDED SUPPORT THROUGH HOME VISITS OR GROUP ACTIVITIES. INFANT AND TODDLER SERVICES CONSISTS OF THREE MAJOR PROGRAMS INCLUDING FIRST STEPS, EARLY HEAD START AND HEALTHY FAMILIES. EARLY HEAD START IS OFFERED IN VIGO COUNTY. HEALTHY FAMILIES IS OFFERED IN GREENE, VERMILLION, VIGO AND SULLIVAN COUNTIES IN INDIANA. FIRST STEPS IS OFFERED IN CLAY, DAVIESS, GREENE, KNOX, MARTIN, OWEN, PARKE, PUTNAM, SULLIVAN, VERMILLION AND VIGO COUNTIES. DURING THE CURRENT YEAR, FIRST STEPS SERVED 2618 CHILDREN, EARLY HEAD START SERVED 128 CHILDREN, AND HEALTHY FAMILIES SERVED 325 CHILDREN. 1017085 0 734511 SPECTRUM SERVICES IS THE NAME OF HAMILTON CENTER'S REHABILITATION DIVISION. THIS DIVISION PROVIDES SERVICES FOR PERSONS WITH DISABILITIES IN THE FORM OF COMMUNITY AND FACILITY HABILITATION, MUSIC THERAPY, PRE-VOCATIONAL AND SUPPORTED EMPLOYMENT. THE ULTIMATE GOAL FOR THIS PROGRAMMING IS TO MAXIMIZE INDEPENDENT LIVING AND FULL COMMUNITY INCLUSION. SPECTRUM SERVICES IS ACCREDITED BY CARF, THE REHABILITATION ACCREDITATION COMMISSION. DURING THE CURRENT YEAR, HAMILTON CENTER REHABILITATION SERVICES SERVED 180 CLIENTS. 3138213 734511 25570160 1 1 0 1 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 81 0 1 860 1 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X SUE THOMPSON 8122318323 620 EIGHTH AVENUE TERRE HAUTE IN 47804 LOUISE ANDERSON 1.00 X 0 0 0 RICHARD PITTELKOW 1.00 X 0 0 0 CARY SPARKS 1.00 X 0 0 0 REBECCA PORTER 1.00 X 0 0 0 TERRY BARR 1.00 X 0 0 0 TONY BREWER 1.00 X 0 0 0 JAMES CLAYTON 1.00 X 0 0 0 MICHAEL HAGEMEYER 1.00 X 0 0 0 JOHN HANCEWICS 1.00 X 0 0 0 MARJORIE HAYS 1.00 X 0 0 0 JAMES JENKINS 1.00 X 0 0 0 JIM LUZAR 1.00 X 0 0 0 SHARON MELLOH 1.00 X 0 0 0 MAX MILLER 1.00 X 0 0 0 BOBBY MOORE 1.00 X 0 0 0 RYAN OILAR 1.00 X 0 0 0 ROBERT RENDACI 1.00 X 0 0 0 ROBERT RHODES 1.00 X 0 0 0 SARAH THOMAS 1.00 X 0 0 0 DONNA WILSON 1.00 X 0 0 0 GALEN GOODE 40.00 X 218624 0 34698 SUE THOMPSON 40.00 X 98172 0 10157 MEL BURKS 0.00 X 0 0 0 DAVID K HILTON 40.00 X 223271 0 23129 ABDUL SUBHAN 40.00 X 185962 0 18528 SHASHIKANT S PATEL 40.00 X 185674 0 26973 MATHEWS JOHN 40.00 X 183391 0 36276 RUTHGAYLE STITH 40.00 X 180850 0 21391 DAVID M THOMAS 40.00 X 171230 0 17388 1447174 0 188540 11 0 1 0 NETECH CORPORATION 12272 HANCOCK ST CARMEL IN 46032 CONTRACTED PHONE SYSTEM SERVICES 558481 JR SCRIPTS PHARMACY NO 1 LLC 13 MEADOWS CT TERRE HAUTE IN 47803 PHARMACY SERVICES 189584 UNION HOSPITAL 1606 N 7TH ST TERRE HAUTE IN 47804 DIETARY, LAUNDRY AND PHARMACY SERVICES 133957 ADVANTAGE COUNSELING 1005 E MAIN ST PLAINFIELD IN 46168 CONTRACTED DIRECT SERVICE PROVIDER 127032 UNICARE SYSTEMS 540 NORTH TAMIAMI TRRAIL SARASOTA FL 34236 CONTRACTED COMPUTER MAINTENANCE 111404 5 13999829 157937 14157766 NET PATIENT SERVICE RE 900099 17417746 17417746 17417746 363500 363500 152057 40800 135102 103495 16955 -62695 -45740 -45740 17566 10164 7402 7402 REPREST. PAYEE FEES 900099 90870 90870 63616 63616 154486 32055160 17508616 0 388778 80866 80866 537705 261928 275777 19430677 14836308 4594369 1042342 745136 297206 3869517 3134858 734659 1524123 1195207 328916 49437 22022 27415 79858 35573 44285 31191 13894 17297 159076 70862 88214 154482 70987 83495 965599 795727 169872 1318556 952954 365602 620123 519961 100162 207711 94979 112732 1291854 979164 312690 594063 410077 183986 PURCHASED SERVICES 513025 489234 23791 DUES AND SUSBSRIPT 463368 254129 209239 BAD DEBTS 450913 405386 45527 347232 200908 146324 33731718 25570160 8161558 0 24552575 22536134 49629 379049 2864097 2484360 329131 233767 28345385 14286402 14688735 14058983 824066 1216924 2258413 2303074 45566646 43212291 4239780 3660502 43521 57670 2831669 2688419 7114970 6406591 X 36911350 35267166 1540326 1538534 38451676 36805700 45566646 43212291 X -1676558 30582 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4892 4892 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: PORTION OF DUES ATTRIBUTED TO LOBBYING PAID TO THE FOLLOWING ORGANIZATIONS: IN ASSOCIATION OF REHABILITATION FACILITIES, INDIANA HEALTH AND HOSPITAL, IN COUNCIL OF COMMUNITY MENTAL HEALTH CENTERS AND THE TERRE HAUTE CHAMBER OF COMMERCE. 1 123743 2140340 1819589 444493 0 1553224 142333 331 141481 148 1553597 1539336 111145 97225 32 1553224 1758265 -98725 120204 1539336 0.00970 0.99170 1 0 2491572 2491572 20396412 10554187 9842225 21263 21263 0 5395758 3710952 1684806 40380 40380 14058983 HCI PROPERTY DEV RELATED PARTY RECEIVABLE 2303074 2303074 ESTIMATED THIRD-PARTY SETTLEMENT 2688419 2688419 PART IV, LINE 1B: HELD FUNDS FOR PATIENTS - REPRESENTATIVE PAYEE ACCOUNTS DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE MAJORITY OF ENDOWMENT FUNDS ARE TEMPORARILY RESTRICTED NET ASSETS. THESE FUNDS ARE LIMITED BY DONORS TO A SPECIFIC TIME PERIOD OR PURPOSE. RESTRICTIONS PRIMARILY RELATE TO UTILIZING ASSETS FOR SPECIFIC BEHAVIORAL HEALTH AND EDUCATION PROGRAMS. THE REMAINDER OF THE ENDOWMENT FUNDS ARE HELD BY A COMMUNITY FOUNDATION TRUST ON BEHALF OF HAMILTON CENTER WITH ONLY THE INVESTMENT INCOME AVAILABLE FOR THE CENTER'S CHARITABLE PURPOSE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2011 AND 2010, 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. PARTS XI, XII, AND XIII 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. HAMILTON CENTER GOLF TOURNAMENT 17366 17366 300 2740 5775 1349 17366 17366 300 2740 5775 1349 10164 7202 1 1 0 1 X 1 1 0 1 1 4989169 4989169 0.14790 20920652 12282139 8638513 0.25610 118969 61564 57405 0.00170 26028790 12343703 13685087 0.40570 218868 49760 169108 0.00500 81766 900 80866 0.00240 300634 50660 249974 0.00740 26329424 12394363 13935061 0.41310 0 532558 891018 949005 -57987 X 1 1 1 1 HAMILTON CENTER INC

620 EIGHTH AVENUE TERRE HAUTE IN 47804

X INPATIENT UNIT HAMILTON CENTER - SECTION NOT REQUIRED 1 24 HAMILTON CENTER

620 EIGHTH AVENUE TERRE HAUTE IN 47804

ADMINISTRATIVE/OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

1175 FT HARRISON RD TERRE HAUTE IN 47805

COMMUNITY BASED RESIDENTIAL HOME HAMILTON CENTER

1636 KESSLER BLVD N DRIVE INDIANAPOLIS IN 46222

COMMUNITY BASED RESIDENTIAL HOME HAMILTON CENTER

2701 CRAWFORD ST TERRE HAUTE IN 47802

COMMUNITY BASED RESIDENTIAL HOME HAMILTON CENTER

9221 E US 40 TERRE HAUTE IN 47803

COMMUNITY BASED RESIDENTIAL HOME HAMILTON CENTER

1410 E CROSSING BLVD TERRE HAUTE IN 47802

SUB-ACUTE UNIT HAMILTON CENTER

3911 E LEE DRIVE ROCKVILLE IN 47872

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

6919 E 10TH STREET STE B1 INDIANAPOLIS IN 46219

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

1616 WABASH AVE TERRE HAUTE IN 47807

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

18 N 1ST STREET TERRE HAUTE IN 47807

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

5621 NORTH TACOMA AVE A INDIANAPOLIS IN 46220

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

500 EIGHTH AVENUE TERRE HAUTE IN 47804

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

2134 MARY SHERMAN DR SULLIVAN IN 47882

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

510 S MAIN ST CLINTON IN 47842

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

PO BOX 553 LINTON IN 47441

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

66 WABASH CT TERRE HAUTE IN 47807

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

1211 E NATIONAL AVE BRAZIL IN 47834

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

215 N JEFFERSON ST ROCKVILLE IN 47872

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

239 HILLSDALE AVE GREENCASTLE IN 46135

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

431 E MAIN BLOOMFIELD IN 47424

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

900 SOUTHFIELD DR PLAINFIELD IN 46168

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

909 W HILLSIDE AVE SPENCER IN 47460

OUTPATIENT CLINICAL SERVICE CLINIC HAMILTON CENTER

36 S 14TH STREET TERRE HAUTE IN 47807

EARLY HEAD START DAYCARE HAMILTON CENTER

42 S 15TH STREET TERRE HAUTE IN 47807

EARLY HEAD START DAYCARE PART I, LINE 3C: CHARITY CARE APPLICATION PROCESS WILL DETERMINE A PERSON'S ELIGIBILITY. CHARITY CARE REVIEW COMMITTEE REVIEWS HEALTH AND MEDICAL INSURANCE COVERAGE, AVAILABLILITY OF PAYMENT UNDER FEDERAL, STATE OR OTHER REIMBURSMENT PROGRAM, CURRENT FEDERAL POVERTY INCOME GUIDELINES, TOTAL HOUSEHOLD INCOME, HOUSEHOLD SIZE, MEDICAL/FINANCIAL OBLIGATIONS AND LIVING EXPENSES, AND AVAILABLILTY OF ALL OTHER ASSETS WHEN DETERMINING AN INDIVIDUALS ELIGIBILY FOR CHARITY CARE. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES ARE FOR THE ACCESS CENTER THAT PROVIDES 24 HOUR CRISIS RESPONSE AND REFERRAL ASSISTANCE. THE ORGANIZATION DOES NOT PROVIDE ANY SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO PHYSICIAN CLINICS. PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. LINE 2 FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES: MANAGEMENT ESTIMATES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS RECEIVABLE BASED ON AN EVALUATION OF HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO ITS CUSTOMER BASE.PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. LINE 3 EXPLANATION FOR RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: NO OTHER BAD DEBT AMOUNTS HAVE BEEN INCLUDED AS COMMUNITY BENEFIT. THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED JUNE 30, 2011 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: INSTALLMENT ARRANGEMENTS ARE AVAILABLE TO PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE. COLLECTION OF DELINQUENT ACCOUNTS START AFTER 90 DAYS UNLESS FINANCIAL ARRANGEMENTS ARE MADE. ANY EXTENUATING CIRCUMSTANCES ARE EVALUATED BY THE CHIEF FISCAL OFFICER PROCEEDING ANY LEGAL OR WRITE-OFF ACTION. PART VI, LINE 2: THE ORGANIZATION ASSESS COMMUNITY NEEDS THROUGH VOLUNTEER BOARDS, COMMUNITY INVOLVEMENT, VOLUNTEERING, CUSTOMER SATISFACTION SURVEYS, AND BOARD SERVICE. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE DURING THE INITIAL CONTACT BY PHONE OR DURING THE FIRST "INTAKE" MEETING. DURING THE INITIAL MEETING THE INDIVIDUAL RECEIVES AN "AFFIDAVIT FOR FINANCIAL ELIGIBILITY" FORM TO COMPLETE WHICH HELPS THE ORGANIZATION DETERMINE ELIGIBILITY FOR FEE REDUCTIONS. ALSO, INDIVIDUALS CAN OBTAIN A BROCHURE FROM THE ORGANIZATION'S WEBSITE PROVIDING INFORMATION ABOUT SERVICES, FEES, AND FEE ADJUSTMENT ELIGIBILITY. PART VI, LINE 4: GEOGRAPHIC AREA:THE ORGANIZATION COMMUNITY INCLUDES THE FOLLOWING COUNTIES SERVED: CLAY, GREEN, MARION, OWEN, PARKE, PUTNAM, SULLIVAN, VERMILLION, VIGO, AND HENDRICKS. DEMOGRAPHICS:POPULATION SERVED BASED ON INCOMELESS THAN $8,000 64%$8,000 - 9,999 3%$10,000 - 14,999 5%$15,000 - 19,999 4%$20,000 - 29,999 4%$30,000 + 9%UNKNOWN 11%POPULATION SERVED BASE ON AGELESS THAN 3 11%4 - 17 27%18 - 24 12%25 - 44 28%45 - 64 19%65 + 3% PART VI, LINE 6: THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. THESE VOLUNTEERS ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. ANY SURPLUS FUNDS ARE APPLIED DIRECTLY OR INDIRECTLY TO IMPROVE SERVICES.THE ORGANIZATION HAS A PRESENCE ON MANY COMMUNITY COLLABORATIVE COMMITTEES AND GROUPS SUCH AS THE TERRE HAUTE HOMELESS COALITION, LOCAL COORDINATING COUNCILS ON DRUG ABUSE IN SEVERAL COMMUNITIES, THE STATEWIDE COMMITTEE FOR DISASTER RELIEF AND EMERGENCY RESPONSE, A SPONSOR AND CONTRIBUTOR FOR TERRE HAUTE'S MINI MEDICAL SCHOOL, AND AN ACTIVE PARTICIPANT IN DISABILITIES AWARENESS MONTH TO NAME A FEW. THE ORGANIZATION ALSO FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY PROVIDING INFORMATION BOOTHS AT COUNTY FAIRS, HEALTH FAIRS AND OTHER "HEALTH FUNCTIONS" IN OUR COMMUNITY. THE ORGANIZATION ALSO ORGANIZED A CONSUMER HEALTH FAIR FOR THE COMMUNITY. PART VI, LINE 7: NOT APPLICABLE. THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.PART VI, LINE 8: NOT APPLICABLE. THE ORGANIZATION DOES NOT FILE A COMMUNITY BENEFIT REPORT. 1 ST ANN'S CLINIC 1436 LOCUST STREET TERRE HAUTE IN 47804 351947580 501C3 12383 COST PAYMENT OF OFFICE SPACE PAYMENT OF OFFICE SPACE TO SERVE CLIENTS AT THE CLINIC. ST ANN'S CLINIC 1436 LOCUST STREET TERRE HAUTE IN 47804 351947580 501C3 23667 COST STAFF THERAPY TIME STAFF ARE PROVIDED TO ASSIST THE CLINIC WITH THERAPY TIME A COUPLE HOURS EACH WEEK. MENTAL HEALTH ASSOCIATION IN VIGO COUNTY INC 620 8TH AVENUE TERRE HAUTE IN 47804 208762173 501C3 44816 COST OFFICE SPACE & COPY MACHINE TO MAKE ASSETS AVAILABLE FOR THE USE BY THE ASSOCIATION. 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: NO GRANT FUNDS WERE AWARDED TO THE RECIPIENTS INCLUDED ON SCHEDULE I. THE ASSISTANCE PROVIDED WERE ONE TIME CONTRIBUTIONS TO OTHER ORGANIZATIONS THAT DO NOT REQUIRE MONITORING OF THE RECIPIENT'S USE BY HAMILTON CENTER. X X X X 0 0 0 0 0 1 0 0 0 GALEN GOODE 212173 0 0 0 6451 0 15461 0 19237 0 253322 0 0 0 DAVID K HILTON 218627 0 4230 0 414 0 15648 0 7481 0 246400 0 0 0 ABDUL SUBHAN 179800 0 6000 0 162 0 0 0 18528 0 204490 0 0 0 SHASHIKANT S PATEL 184455 0 0 0 1219 0 13445 0 13528 0 212647 0 0 0 MATHEWS JOHN 183211 0 0 0 180 0 13218 0 23058 0 219667 0 0 0 RUTHGAYLE STITH 180436 0 0 0 414 0 12741 0 8650 0 202241 0 0 0 DAVID M THOMAS 164816 0 6000 0 414 0 0 0 17388 0 188618 0 0 0 PART I, LINE 6 HAMILTON CENTER HAS A PERFORMANCE BASED EVALUATION SYSTEM THAT INCLUDES INDIVIDUAL GOAL SETTING AND EVALUATION ANNUALLY. IF THRESHOLDS FOR PERFORMANCE ARE MET AND HCI HAS INCOME IN EXCESS OF BUDGETED LEVELS EMPLOYEES SHARE IN THE EXCESS AND ARE PAID AS A PERCENTAGE OF SALARY. FIRST FINANCIAL BANK ENTITY OF WHICH CURRENT BOARD MEMBER SERVES AS VICE PRESIDENT 35855 TRUST AND PENSION SERVICES.BOARD MEMBER, CARY SPARKS, SERVES AS VICE PRESIDENT FOR FIRST FINANCIAL BANK'S TRUST DEPARTMENT. FIRST FINANCIAL PROVIDES TRUST AND PENSION SERVICES WITH APPROXIMATELY $11.5 MILLION IN PENSION DEPOSITS. IN ADDITION FIRST FINANCIAL ALSO HOLDS THE CENTER'S PRIMARY OPERATING CHECKING AND PAYROLL ACCOUNTS. 0 FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATIVE COMMITTEE OF THE BOARD OF DIRECTORS WERE PROVIDED WITH A COPY AND REVIEWED THE COMPLETED FORM 990 AS PRESENTED BY BLUE AND CO., LLC. THE ADMINISTRATIVE COMMITTEE REPORTED TO THE FULL BOARD THEIR UNDERSTANDING AND ACCEPTANCE OF THE DOCUMENTED INFORMATION. THE REVIEW IS RECORDED IN THE ADMINISTRATIVE COMMITTEE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 12C HAMILTON CENTER REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE WRITTEN CONFLICT OF INTEREST POLICY AS FOLLOWS: 1. COMPLETION OF A UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT AS DESIGNATED IN THE CORPORATE POLICY. 2. NOTIFICATIONS TO SUPERVISORS AND BOARD PRESIDENT AS CONFLICTS ARE DETERMINED. 3. BARRING ACTION BY THE EMPLOYEE OR RECUSING FROM ACTIVITIES BOARD MEMBERS UNTIL THE CONFLICT IS RESOLVED. 4. ALTERNATIVES ARE INVESTIGATED AND DECISIONS ARE MADE TO SATISFACTORILY RESOLVE THE CONFLICT UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR BOARD RESIGNATION. THE CHIEF EXECUTIVE OFFICER HAS FINAL DECISION AUTHORITY WHEN EMPLOYEES ARE INVOLVED AND THE BOARD PRESIDENT HAS FINAL DECISION AUTHORITY WHEN BOARD MEMBERS ARE INVOLVED. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, EXECUTIVE DIRECTORS, AND MEDICAL DIRECTOR ARE DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS AS FOLLOWS: 1. COMPARABILITY DATA IS GATHERED BASED ON SIMILAR ORGANIZATIONS, SIMILAR CIRCUMSTANCES, GEOGRAPHICAL APPLICABILITY, EDUCATION, AND EXPERIENCE. 2. ONLY INDEPENDENT MEMBERS OF THE BOARD ARE ALLOWED TO REVIEW AND ESTABLISH COMPENSATION. 3. COMPENSATION DECISIONS ARE DOCUMENTED CONCURRENTLY DURING THE DECISION MAKING PROCESS AND ARE REFLECTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 UPON WRITTEN REQUEST RECEIVED VIA U.S. MAIL TO 620 EIGHTH AVENUE, TERRE HAUTE, IN 47804, HAMILTON CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY RETURN MAIL. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 30,582. OVERSIGHT OF AUDIT FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. HCI PROPERTY DEVELOPMENT LANGE APARTMENTS 620 EIGHTH AVENUE TERRE HAUTE IN 47804 800077891 LOW INCOME HOUSING IN HCI PROPERTY DEVELOPMENT ORGANIZATION INC RELATED -52527 0 1 HCI PROPERTY DEVELOPMENT ORGANIZATION INC 620 EIGHTH AVENUE TERRE HAUTE IN 47804 562396950 REAL ESTATE IN N/A C -5710 -51543 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0