2012-11-13T18:53:30-06:00 2011-12-31 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2011-01-01 020633634 Samaritan Behavioral Health Inc % KAREN GAINES SAMA 9372768333 601 S Edwin C Moses Blvd Dayton OH 45417 THOMAS R CURTIN 2012-11-12 3176817000 2011 2016-02-24 21:20:13Z SUE V MCGATHA 601 S EDWIN C MOSES BLVD DAYTON OH 45408 11578294 false 0928 X www.sbhihelp.org X 2002 OH Mission: To provide mental health and addiction services that touch, teach, and heal. Vision: Where help for life's challenges is openly sought and compassionately given. 7 3 208 3 0 0 0 10842232 11578294 -23689 -4050 0 0 10818543 11574244 0 0 0 0 8829718 9338767 0 0 0 2011534 2143428 10841252 11482195 -22709 92049 4036171 3532735 2314751 1712228 1721420 1820507 TO PROVIDE MENTAL HEALTH AND ADDICTION SERVICES THAT TOUCH, TEACH AND HEAL. false false 4870165 6181022 CRISIS CARE - PROVIDING BEHAVIORAL HEALTH CRISIS INTERVENTION AND ASSESSMENTS TO DETERMINE THE APPROPRIATE PLACEMENT FOR SERVICES OF COMMUNITY MENTAL HEALTH, ALCOHOL AND DRUG, OR OTHER RELATED SERVICES. 3856273 4153865 MONTGOMERY COUNTY MENTAL HEALTH SERVICES - PROVIDE COMMUNITY BEHAVIORAL HEALTH SERVICES TO CHILDREN AND ADULTS IN MONTGOMERY COUNTY. 1235344 1243407 PREBLE COUNTY MENTAL HEALTH SERVICES - PROVIDE COMMUNITY BEHAVIORAL HEALTH SERVICES AND CRISIS SERVICES TO PREBLE COUNTY CHILDREN AND ADULTS. 9961782 true false false false false false false false false false true false false false false true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false false true 32 0 true 208 true false false false false false false false false false false X 7 3 false false false false true true true true true false false true true true true true true true true false OH X KAREN GAINES 9372786251 601 S EDWIN C MOSES BLVD DAYTON OH 45408 SUE V MCGATHA 40.0 X X 199909 0 74198 JANET ROGERS 1.0 X 0 0 0 CAROL BAUER SC 0.5 X 0 0 0 TOM CURTIN 0.5 X 0 0 0 ROBERT HICKEY 0.5 X 0 0 0 TERESA ZRYD MD 0.5 X 0 0 0 JOHN RAHE 0.5 X 0 0 0 CARA POWERS 1.0 X 0 0 0 DR BRIEN DYER 40.0 X 188737 0 51034 DR STEPHANIE ACKNER 40.0 X 142866 0 19074 ELLEN BALLERENE 40.0 X 160027 0 33026 691539 0 177332 4 false true false Wright State University 3640 Colonel Glen Highway DAYTON OH 45435 Psychiatric Services 209521 1 0 PROGRAM SERVICE REV 900099 11578294 11578294 11578294 0 0 0 4050 -4050 -4050 -4050 0 0 0 0 11574244 11578294 -4050 0 0 0 0 735484 557571 177913 0 6792167 6185712 606455 240928 222259 18669 982819 973565 9254 587369 478348 109021 63225 9975 53250 0 15125 7000 8125 897778 702376 195402 0 0 0 9935 1748 8187 114450 98580 15870 95014 1976 93038 0 473463 422977 50486 57178 52419 4759 0 25323 18971 6352 0 0 63033 26587 36446 104783 104783 CATHOLIC HEALTH FEES 106917 92480 14437 BAD DEBT 78375 78375 TRAINING (BOOKS & MATERIAL) 23710 23310 400 DUES 8242 7367 875 6877 186 6691 11482195 9961782 1520413 0 2824183 2047213 0 0 0 0 877770 1203716 0 0 0 0 0 0 0 0 169772 130850 1290873 1139917 164446 150956 0 0 0 0 0 0 0 0 0 0 4036171 3532735 1748217 1669615 0 0 566534 42613 0 0 0 0 0 0 0 0 0 0 0 0 2314751 1712228 X 1721420 1820507 0 0 0 0 1721420 1820507 4036171 3532735 X 92049 7038 X false true true X true true X 37365 27742 23689 4050 92846 9999774 11202673 9875240 10432209 11581281 53091177 10037139 11202673 9902982 10455898 11585331 53184023 53184023 53184023 1.00000 1.00000 X 196563 196563 1094310 943354 150956 150956 0 0 11574244 11482195 92049 92049 Schedule D, Part X, Line 2: Samaritan Behavioral Health, Inc. (SBHI) is a member, under a joint operating agreement, of Premier Health Partners which is tax-exempt under Section 501(c)(3) of the Internal Revenue Code. As such, there is no income tax liability recorded at December 31, 2011 and 2010. In addition, Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the combined financial statements. SBHI is a tax-exempt corporation under Section 501(c)(3) of the Internal Revenue Code. X X X X false false false false false false false false false SUE V MCGATHA 154197 0 45712 0 0 0 68938 0 5260 0 274107 0 45712 0 DR BRIEN DYER 188737 0 0 0 0 0 37640 0 13394 0 239771 0 0 0 DR STEPHANIE ACKNER 142866 0 0 0 0 0 5615 0 13459 0 161940 0 0 0 ELLEN BALLERENE 160027 0 0 0 0 0 19644 0 13382 0 193053 0 0 0 Form 990 - Part VI, Question 6: Samaritan Behavioral Health Inc. (SBHI) has one member. The member is Samaritan Health Partners, Inc the parent company of SBHI. Samaritan Health Partners, Inc is an Ohio not-for-profit entity. Form 990 - Part VI, Section A, Question 7a: Samaritan Health Partners, Inc (SHP) has the sole authority to elect the Board of Trustees for Samaritan Behavioral Health Inc (SBHI). SHP has the authority to remove trustees at any regular or special meeting or by written consent. In addition to removal by SHP, a trustee may be removed from the office with the approval by SHP, by the affirmative vote of not less than two-thirds of the entire Board of Trustees. Form 990 - Part VI, Section A, Question 7b: Samaritan Behavioral Health Inc. (SBHI) develops and submits an annual capital and operating budget to Samaritan Health Partners (SHP) for approval. SBHI shall adopt and implement the capital and operating budget approved and/or revised by SHP. SBHI periodically develops and submits a business plan approved by SHP. SHP is the sole agent to negotiate all relationships with payors on behalf of SBHI with all third party payors and alternative delivery systems including, but not limited to insurers. SBHI must have approval from SHP to borrow in any fiscal year, guarantee in any year, or incur any lien or other encumbrance on any property in an amount equal to or greater than $500,000. SBHI must seek SHP approval for any acquisitions, sale or transfer of any material asset used in SHP activities. Form 990 - Part VI, Section B, Question 11B: This 990 tax return and attached schedules (the return) are prepared by the Controller of Samaritan Behavioral Health Inc. (SBHI). It is reviewed by the Chief Financial Officer of SBHI and the Manager of the Tax Department of Premier Health Partners and subsequently sent to Ernst & Young U.S. LLP for review. After all changes from the above group are made, the return is reviewed again by the Chief Financial Officer of this entity. A final version of the return is sent to Ernst & Young U.S. LLP for a final review and then provided to the Board of Directors for review. The Board of Directors is provided an electronic copy at least one week prior to the Board meeting. At the meeting, the Chief Financial Officer of SBHI shares detailed information on compensation and community benefits, as well as addresses any other questions from the Board of Directors. Form 990 - Part VI, Section B, Question 12c: Premier Health Partners (PHP), of which Samaritan Behavioral Health Inc. (SBHI) is a member, requires all board members, officers, executives, and management personnel to annually review the PHP Comprehensive Conflict of Interest Statement, and explanatory memorandum, the Antitrust Compliance Policy and complete an individual questionnaire disclosing any potential conflicts as defined in the Conflicts of Interest Policy or Statement. This is accomplished with a memo sent out annually from the Chairman of the Board and Chief Executive Officer of PHP to all board members, executive directors, management personnel, purchasing staff department and authorized purchasers. It also includes an explanatory memorandum of specific activities that might give cause to a conflict and an individual questionnaire to disclose such activities. This questionnaire must be completed and signed by the individual. Last, this memo includes a copy of the Antitrust Compliance Policy that must be signed by the individual. All of these documents are sent to the Corporate Compliance Officer. The Corporate Compliance Department ensures all forms are returned and retains the documents for five years. In addition, at each meeting of the Board or any Board Committee, following approval of the minutes, the Board Committee Chair shall request any board member who perceives a potential conflict of interest on any of the meeting's agenda items to disclose the potential conflict. Additionally, any Board or Board Committee meeting where the subject of conflicts of interest is discussed, the normally taken minutes shall contain the name of the party discussing a potential conflict of interest, the nature of the potential conflict of interest and whether a conflict of interest was found to exist. If a conflict of interest does exist, the member will be excused from participating in any discussion or voting on the particular agenda item. The Corporate Compliance Officer reports the results of the PHP Conflicts of Interest questionnaires no less than annually to the Board of Trustees by way of the Compliance and Audit Committee. This review is documented in the minutes of the meeting. Periodically, the Internal Audit department will review a sample of completed Conflict of Interest questionnaires and report the results to the Compliance and Audit Committee. The annual conflicts of interest questionnaires are summarized by person in a word document and sent electronically to the Finance department for any necessary disclosures required on the 990 tax return. Form 990 - Part VI, Section B, Question 15A and 15B: Premier Health Partners (PHP), of which Samaritan Behavioral Health Inc (SBHI) is a member, follows a market-based compensation philosophy designed to attract and retain the executive talent required to meet the high performance standards of our board and our community. PHP annually reviews executive compensation survey data for a peer group of systems and hospitals that are similar in size and complexity to PHP and its subsidiaries. The data for the survey is provided by a third party consultation group that is independent of PHP. This report includes comparability for key employees, vice presidents and director level positions. The independent comparability data is reviewed by the executive compensation committee on an annual basis. This committee is comprised of three members, all of which are independent. This committee reviews in detail the compensation for the PHP CEO, PHP CFO, and the subsidiary CEOs. Other positions are reviewed at a high level for reasonableness. All the meeting minutes are documented and kept on file along with any comparability data and the consultant report. After the compensation committee reviews and approves the compensation actions, the process is audited by the internal audit department. The executive compensation committee presents the compensation actions to the PHP board annually. Form 990 - Part VI, Section C Question 19: The governing documents, conflicts of interest policy and financial statements are made available to the public when required by law or for accreditation purposes. Form 990 - Part XI: Net Assets or fund balances at end of year is $1,820,507 less Net Assets of fund balances at beginning of year is $1,721,420 which equal $99,087. Revenue less Expenses equal $92,049. Change in Net Asset balance of $99,087 less Revenue less Expenses of $92,049 equal Other changes in net assets or fund balances of $7,038. Statement pertaining to 2011 Form 5471: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(a) AND (b), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCs). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCs BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. Samaritan Health Partners 110 North Main St, Suite 500 Dayton, OH 45402 EIN: 31-1107411 THE FILING ORGANIZATION, SAMARITAN BEHAVIORAL HEALTH, INC., IS NOT FILING A SEPARATE FORM 5471 - SCHEDULE I BECAUSE IT HAS NO INCOME FROM THE FOREIGN CORPORATION. Samaritan Health Partners 110 NORTH MAIN Dayton OH 45402 311107411 Parent OH 501(c)(3) 11-I NA false false false false false false false false false false false false false false false false false false false