2012-09-14T13:22:44-05:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 411649502 HAMM MEMORIAL PSYCHIATRIC CLINIC HAMM 6512240614 408 ST PETER STREET NO 429 ST PAUL MN 55102 STEPHEN DWYER 6512240614 2012-09-10 1 XIAOYAN LUO P01305207 6123764500 2011 2016-02-24 21:20:13Z STEVEN DWYER 408 ST PETER STREET NO 429 ST PAUL MN 55102 2554607 0 X WWW.HAMMCLINIC.ORG X 1989 MN TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 15 15 39 4 0 0 1612355 1691927 857987 854807 14352 7873 0 0 2484694 2554607 20000 20000 0 0 2022094 1913859 54953 37800 203829 499878 434370 2596925 2406029 -112231 148578 1158464 1231490 462276 901786 696188 329704 X TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 0 0 1402077 842119 CLINICAL SERVICES: HAMM MEMORIAL PSYCHIATRIC CLINIC PROVIDES A VARIETY OF OUTPATIENT MENTAL HEALTH AND RELATED SERVICES TO ADULTS AND OPERATES IN THE TWIN CITIES METROPOLITAN AREA. THE CLINIC OFFERS A FULL SPECTRUM OF OUTPATIENT MENTAL HEALTH SERVICES IN ENGLISH AND SPANISH. THE CLINIC SEEKS TO TREAT SYMPTOMS AND ALSO TO HELP CLIENTS GAIN INSIGHT AND UNDERSTANDING INTO THEIR BEHAVIOR. THE CLINIC TEAM IS COMPRISED OF CLINICAL SOCIAL WORKERS, PSYCHOLOGISTS, AND PSYCHIATRISTS WORKING TOGETHER TO IMPROVE MENTAL HEALTH. ELECTRONIC HEALTH RECORDS (EHR) PROGRAM: THE CLINIC TRANSITIONED TO AN ELECTRONIC HEALTH RECORDS SYSTEM. 209003 20000 12688 TRAINING AND PROFESSIONAL DEVELOPMENT: THE CLINIC'S TRAINING PROGRAM PROVIDES SPECIALIZED TRAINING AND EDUCATION FOR GRADUATES AND POST-GRADUATES IN CLINICAL SOCIAL WORK, PSYCHOLOGY, AND PSYCHIATRY. THE CLINIC'S COMPREHENSIVE APPROACH TO TRAINING ENABLES STUDENTS TO PROVIDE DIRECT CLIENT CARE UNDER CLOSE SUPERVISION. 73378 0 0 RESEARCH AND PUBLICATION: THE CLINIC CONDUCTS EFFECTIVENESS RESEARCH. EFFECTIVENESS RESEARCH SEEKS TO DETERMINE WHETHER THE TREATMENT AT THE CLINIC IS EFFECTIVE IN A COMMUNITY MENTAL HEALTH CENTER SETTING WITH A VARIETY OF CLIENTS. 31803 0 0 COMMUNITY OUTREACH: THE CLINIC WORKS TO EDUCATE THE PUBLIC ABOUT MENTAL HEALTH ISSUES AND PROMOTES THE VALUE OF GOOD MENTAL HEALTH. IT ALSO WORKS TO BE A VOICE IN THE COMMUNITY FOR PERSONS WITH MENTAL ILLNESS AND TO IMPROVE PUBLIC AWARENESS OF THE SCOPE OF INFLUENCE ADULT MENTAL ILLNESS HAS ON THE COMMUNITY. 31803 1716261 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15 0 39 1 0 0 0 0 0 0 0 0 0 0 X 15 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X RICHARD BOURMAN CONTROLLER 6512240614 408 ST PETER STREET SUITE 429 ST PAUL MN 55102 ROGER OPP 3.00 X X 0 0 0 ABBY DAWKINS 1.00 X X 0 0 0 BETH SULLIVAN 1.00 X X 0 0 0 J LAWRENCE MCINTYRE 3.00 X X 0 0 0 DAVID W ALLEN JR 1.00 X 0 0 0 MARILYN BROUSSARD 1.00 X 0 0 0 VICTORIA COIFMAN 1.00 X 0 0 0 EDWARD H HAMM 1.00 X 0 0 0 EDWARD H HAMM III 1.00 X 0 0 0 KARI HUBBARD ROMINSKI 1.00 X 0 0 0 JEREMY T LANG 1.00 X 0 0 0 CHERYL J LEUNING PHD RN 1.00 X 0 0 0 PAUL W MATTESSICH PHD 1.00 X 0 0 0 JONATHAN H MORGAN 1.00 X 0 0 0 KELLEY O'NEILL 1.00 X 0 0 0 PAULA RICHEY 1.00 X 0 0 0 ELIZABETH WITTENBERG 1.00 X 0 0 0 ROBERT NESHEIM MD 32.00 X 128364 0 15097 STEVEN DWYER 40.00 X 99188 0 12201 RICHARD BOURMAN 24.00 X 65698 0 1755 293250 0 29053 2 0 0 0 0 1691927 489 1691927 PATIENT FEES 621400 842119 842119 SEMINAR FEES/OTHER 900099 12688 12688 854807 7873 7873 2554607 0 0 862680 20000 20000 354216 188024 118188 48004 1236279 1007536 171976 56767 18202 13459 3492 1251 202207 155638 34860 11709 102955 76126 19751 7078 4485 4485 12073 12073 37800 37800 17849 13198 3424 1227 17222 489 16733 33215 18129 13489 1597 50625 34934 15691 146763 129094 14714 2955 6725 6725 19824 16292 3530 2 35300 17650 17650 43829 32406 8408 3015 BAD DEBTS & MISCELLANEO 16510 16510 DUES 13196 13196 PROGRAM EXPENSES 8299 8299 MISCELLANEOUS EXPENSES 5170 5170 3285 3285 2406029 1716261 485939 203829 61270 218358 5051 3090 164135 109272 49867 41583 44392 34505 417431 350667 86489 66764 558059 527767 189201 230151 1158464 1231490 183951 276828 278325 624958 462276 901786 X 333915 -47846 28394 38394 333879 339156 696188 329704 1158464 1231490 X 148578 -515062 X 0 1 1 X 0 X 1579147 1692347 1795730 1610996 1691927 8370147 1579147 1692347 1795730 1610996 1691927 8370147 4984726 3385421 41428 30289 12700 14352 7873 106642 8476789 4430986 0.39940 0.51160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 215675 18747 -3814 457 230151 1.00000 1 0 35125 28287 6838 334770 278145 56625 47536 44235 3301 66764 MONEY MARKET FUNDS AND CD 427710 F MUTUAL FUNDS 100057 F 527767 THE SAINT PAUL FOUNDATION 230151 230151 LIABILITY FOR PENSION BENEFITS 624958 624958 2554607 2406029 148578 7413 -522475 -515062 -366484 2552374 7413 -9646 -2233 2554607 0 2554607 2406029 0 2406029 0 2406029 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO PROVIDE SUPPORT TO ACCOMPLISH THE ORGANIZATION'S EXEMPT PURPOSE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CLINIC HAS BEEN CLASSIFIED AS A PUBLICLY SUPPORTED CLINIC, AND IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CLINIC HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION OF UNCERTAIN TAX POSITIONS. THE GUIDANCE PRESCRIBES RECOGNITION THRESHOLD PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX FILING THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS GUIDANCE HAD NO IMPACT ON THE CLINIC'S FINANCIAL STATEMENTS. THE CLINIC'S TAX FILINGS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE CLINIC IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS. THE CLINIC IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES. THE FILINGS FOR THE YEARS 2007 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS -9,646. CHANGE IN LONG-TERM PENSION OBLIGATION -512,829. TOTAL TO SCHEDULE D, PART XI, LINE 8: -522,475. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS -9,646. X X X X X X 1 HASKINS CONSULTING 5037 GLADSTONE AVENUE MINNEAPOLIS MN 55419 DEVELOPMENT CONSULTING 0 100000 37800 62200 100000 37800 62200 MN 1 GRANTS, IN THE FORM OF STIPENDS, ARE GIVEN TO PSYCHOLOGY STUDENTS IN BI-WEEKLY PAYMENTS OVER A PERIOD OF ONE YEAR. 3 20000 0 N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS, IN THE FORM OF STIPENDS, ARE GIVEN TO PSYCHOLOGY STUDENTS IN BI-WEEKLY PAYMENTS OVER A PERIOD OF ONE YEAR. THE CLINIC HAS THREE TYPES OF STUDENT PLACEMENTS: MASTERS LEVEL SOCIAL WORK STUDENTS, POST-GRADUATE PSYCHOLOGY STUDENTS AND POST DOCTORAL FELLOWS. EACH YEAR THE CLINIC DECIDES HOW MANY OF WHICH TYPE OF STUDENT THAT WILL BE ADMITTED. AFTER DETERMINATIONS ARE MADE, THE CLINIC NOTIFIES THE LOCAL SCHOOLS WITH WHOM THE CLINIC HAS AN ONGOING WORKING RELATIONSHIP WITH AND THE AMERICAN PSYCHOLOGICAL ASSOCIATION. THE LOCAL SCHOOLS ADVERTISE THE SOCIAL WORK AND POST-DOCTORAL OPENINGS AND THE AMERICAN PSYCHOLOGICAL ASSOCIATION ADVERTISES THE POST-GRADUATE PSYCHOLOGY POSITIONS. APPLICANTS WHO ARE VETTED BY THEIR RESPECTIVE ORGANIZATIONS ARE ELIGIBLE TO APPLY FOR A STUDENT PLACEMENT. THE CLINIC REVIEWS ALL APPLICATIONS AND THEN ARRANGE INTERVIEWS. A STAFF COMMITTEE MAKES THE ULTIMATE DECISION WHO TO ADMIT. FORM 990, PART VI, SECTION A, LINE 1 THE HAMM CLINIC EXECUTIVE COMMITTEE IS COMPRISED OF THE BOARD OF OFFICERS (PRESIDENT, VICE PRESIDENT, TREASURER AND SECRETARY); THE ASSISTANT SECRETARY; THE COMMITTEE CHAIRPERSONS; THE EXECUTIVE MEDICAL DIRECTOR AND THE CHIEF OPERATING OFFICER; AND ANY OTHER BOARD MEMBER THE PRESIDENT APPOINTS TO THE EXECUTIVE COMMITTEE. AD HOC RESPONSIBILITIES (PERFORMED ON AN AS NEEDED BASIS): - ADVISE EXECUTIVE MEDICAL DIRECTOR AND CHIEF OPERATING OFFICER ON PERSONNEL MATTERS, AS REQUESTED. - CONDUCT THE BUSINESS FOR THE BOARD, IF NECESSARY BEFORE THE FULL BOARD CAN MEET. - IMPLEMENT PROCESS AND PROCEDURES FOR SELECTION OF A NEW EXECUTIVE MEDICAL DIRECTOR AND THE CHIEF OPERATING OFFICER. - MONITOR THE PERFORMANCE OF THE BOARD COMMITTEES. TAKE ACTION TO CORRECT ANY DEFICIENCIES. - REVIEW OPERATIONAL RESULTS AND STATISTICS. - REVIEW INFORMATION ABOUT EXTERNAL TRENDS AND DEVELOPMENTS. FORM 990, PART VI, SECTION A, LINE 2 EDWARD HAMM AND EDWARD HAMM III, BOTH BOARD MEMBERS, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE WILL MEET WITH THE AUDITORS ON OR BEFORE SEPTEMBER 12TH TO REVIEW THE AUDIT RESULTS AND FINANCIAL REPORTS. THE FORM 990 WILL BE EMAILED TO ALL FINANCE COMMITTEE MEMBERS FOR THEIR REVIEW AND EDIT COMMENTS. THE CONTROLLER AND COO WILL ALSO REVIEW THE FORM 990. A COPY OF THE 990 WILL BE PROVIDED TO THE WHOLE BOARD BEFORE IT IS FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS FILL OUT AN ANNUAL DISCLOSURE FORM. IN THE CASE OF A CONFLICT, OR THE APPEARANCE THEREOF, BOARD MEMBERS ARE EXPECTED TO DISCLOSE THE CONFLICT PRIOR TO THE CLINIC'S MAKING ANY RELATED DECISIONS. IF A CONFLICT OF INTEREST IS PRESENT, THE DIRECTOR INVOLVED MUST IDENTIFY THE CONFLICT AND MAY, AT THE REQUEST OF THE BOARD OR COMMITTEE, REMAIN IN THE ROOM TO ANSWER QUESTIONS OF A FACTUAL NATURE THAT MAY ASSIST THE BOARD OR COMMITTEE IN ITS DELIBERATION AND DETERMINATION OF WHETHER OR NOT AN ACTUAL CONFLICT OF INTEREST EXISTS. BOARD MEMBERS HAVING A CONFLICT OF INTEREST ON A GIVEN ISSUE DO NOT VOTE ON THAT ISSUE. PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE CHIEF OPERATING OFFICER INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION. THE EXECUTIVE COMMITTEE ALSO REVIEWS THE COMPENSATION AND BONUS PLAN. THE PROCESS WAS LAST UNDERTAKEN FOR THE CHIEF OPERATING OFFICER, S. DWYER IN 2012. THE PROCESS FOR DETERMINING OTHER OFFICERS' COMPENSATION INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, CONTEMPORANEOUS SUBSTANTIATION, AND A REVIEW BY THE EXECUTIVE AND FINANCE COMMITTEES WITH THE CHIEF OPERATING OFFICER AND THE BOARD PRESIDENT. THE PROCESS WAS LAST UNDERTAKEN FOR THE CONTROLLER, R. BOURMAN IN 2012; AND MEDICAL DIRECTOR, R. NESHEIM IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE CLINIC'S CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 7,413. CHANGE IN VALUE - COMMUNITY FOUNDATION FUNDS -9,646. CHANGE IN LONG-TERM PENSION OBLIGATION -512,829. TOTAL TO FORM 990, PART XI, LINE 5: -515,062.