2011-09-22T09:34:14-05:00 2011-06-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 411649502 HAMM MEMORIAL PSYCHIATRIC CLINIC HAMM 6512240614 408 ST PETER STREET NO 429 ST PAUL MN 55102 STEVEN DWYER 6512240614 2011-09-19 1 XIAOYAN LUO 6123764500 2010 2016-03-07 17:11:31Z STEVEN DWYER 408 ST PETER STREET NO 429 ST PAUL MN 55102 2585395 0 X WWW.HAMMCLINIC.ORG X 1989 MN TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 16 16 47 10 0 0 1795730 1612355 997052 857987 12700 14352 0 0 2805482 2484694 20000 20000 0 0 2095057 2022094 45778 54953 145084 650085 499878 2810920 2596925 -5438 -112231 1399444 1158464 782440 462276 617004 696188 X TO PROVIDE QUALITY MENTAL HEALTH TREATMENT, REGARDLESS OF ABILITY TO PAY. 0 0 1491071 0 847010 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. 321644 20000 10977 TRAINING & 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. 68913 0 0 RESEARCH & 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. 23720 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. 23720 1905348 1 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15 0 1 47 1 0 0 0 0 0 0 0 0 0 0 X 16 16 1 0 0 0 0 0 0 1 1 0 0 0 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 1.00 X X 0 0 0 ABBY DAWKINS 1.00 X X 0 0 0 THOMAS J MARR MD 1.00 X X 0 0 0 BETH SULLIVAN 1.00 X X 0 0 0 J LAWRENCE MCINTYRE 1.00 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 STEVEN DWYER 40.00 X 92940 0 10372 ROBERT NESHEIM MD 32.00 X 94625 0 13865 DR MICHAEL CESTA 40.00 X 87380 0 0 RICHARD BOURMAN 24.00 X 60440 0 1519 DR JAMES J JORDAN 40.00 X 126682 0 10451 462067 0 36207 1 1 0 0 0 1612355 1359 1612355 PATIENT FEES 621400 847010 847010 SEMINAR FEES/OTHER 900099 10977 10977 857987 14352 14352 100701 100701 0 0 2484694 857987 0 14352 20000 20000 399507 222365 122133 55009 1313179 1110266 194333 8580 191234 144342 43087 3805 118174 91694 22163 4317 11197 11197 12864 12864 54953 54953 29350 19256 9488 606 13090 1135 11955 36226 22362 12886 978 66314 29595 36719 154260 135698 15469 3093 8276 8110 166 15424 13409 1997 18 47525 23762 23763 48456 37598 9088 1770 PROGRAM EXPENSES 15334 15334 0 0 BAD DEBTS 12775 0 12775 0 DUES 10422 10422 0 0 EQUIPMENT MAINTENANCE 9270 0 9270 0 MISCELLANEOUS 441 0 441 0 8654 8654 2596925 1905348 546493 145084 270149 61270 60 5051 244375 164135 97673 49867 41164 44392 401856 315367 75482 86489 653056 558059 17485 189201 1399444 1158464 229236 183951 553204 278325 782440 462276 X 373902 333915 103394 28394 139708 333879 617004 696188 1399444 1158464 X -112231 191415 X 0 1 1 X 0 X 1627946 1579147 1692347 1795730 1610996 8306166 1627946 1579147 1692347 1795730 1610996 8306166 3978174 4327992 54581 41428 30289 12700 14352 153350 8459516 4345402 0.51160 0.61000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 35125 23002 12123 320483 250179 70304 46248 42186 4062 86489 MONEY MARKET FUNDS AND CD 491942 F MUTUAL FUNDS 66117 F 558059 COMMUNITY FOUNDATION HOLDINGS 189201 189201 LIABILITY FOR PENSION BENEFITS 278325 278325 2484694 2596925 -112231 9610 181805 191415 79184 2499274 9610 4970 14580 2484694 0 2484694 2596925 0 2596925 0 2596925 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 OF DONOR DESIGNATED FUND 4,970. CHANGE IN LONG-TERM PENSION OBLIGATION 176,835. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF DONOR DESIGNATED FUND 4,970. X X X X X X X 1 HASKINS CONSULTING 5037 GLADSTONE AVENUE MINNEAPOLIS MN 55419 DEVELOPMENT CONSULTING 0 200000 54953 145047 200000 54953 145047 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 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. X X 0 1 0 0 0 0 0 0 0 DR JAMES J JORDAN 120682 0 0 0 6000 0 0 0 10451 0 137133 0 6000 0 PART I, LINE 4B JAMES J. JORDAN - TAXABLE DISTRIBUTION FROM 457(B) PLAN - $6,000 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 FORM 990 WAS REVIEWED BY THE FINANCE COMMITTEE CHAIR AND SENT TO EACH MEMBER OF THE FINANCE COMMITTEE PRIOR TO FILING. 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 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 ISSUES 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 PROCESS WAS LAST UNDERTAKEN FOR THE CHIEF OPERATING OFFICER, S. DWYER IN 2009. THE PROCESS FOR DETERMINING OTHER OFFICERS' COMPENSATION INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, CONTEMPORANEOUS SUBSTANTIATION, AND A REVIEW BY THE FINANCE COMMITTEE WITH THE CHIEF OPERATING OFFICER AND THE BOARD PRESIDENT. THE PROCESS WAS LAST UNDERTAKEN FOR THE CONTROLLER, R. BOURMAN IN 2008; AND MEDICAL DIRECTOR, R. NESHEIM IN 2010. 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: 9,610. CHANGE IN VALUE OF DONOR DESIGNATED FUND 4,970. CHANGE IN LONG-TERM PENSION OBLIGATION 176,835. TOTAL TO FORM 990, PART XI, LINE 5: 191,415.