2024-05-15T17:20:19-05:00 2023-06-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2022-07-01 351362298 FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER INC FOUR 5747225151 401 E 8TH STREET ROCHESTER IN 46975 CARRIE CADWELL CEO 5747225151 2024-05-15 1 CARRIE CADWELL 999009999 0 EMILIE M KNIERIEM CPA P01330194 3176334705 2024-05-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z 4C HEALTH CARRIE CADWELL 401 E 8TH STREET ROCHESTER IN 46975 36364297 0 X WWW.FOURCOUNTY.ORG X 1975 IN TO PROVIDE QUALITY MENTAL HEALTH CARE 9 9 643 10 0 0 7345874 4756500 29536545 30078366 16026 194727 489352 391382 37387797 35420975 55118 69453 0 0 22458391 23149955 0 0 0 6603643 6295911 29117152 29515319 8270645 5905656 50716842 56624406 5395867 5225152 45320975 51399254 X DEDICATED TO HOLISTIC CARE GIVEN WITH COMPASSION, RESPECT, ACCEPTANCE AND HOPE. ACHIEVING EMOTIONAL WELL BEING AND INDEPENDENCE. 0 0 23462873 69453 30467048 THE CENTER PROVIDES COMPREHENSIVE MENTAL HEALTH SERVICES TO THE RESIDENTS OF CARROLL, CASS, CLINTON, FULTON, MIAMI, PULASKI, HOWARD, TIPTON, & WHITE COUNTIES ON BOTH AN INPATIENT AND OUTPATIENT BASIS. CARE IS PROVIDED TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THESE AMOUNTS ARE NOT REPORTED AS NET SERVICE REVENUE. THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE CENTER'S CHARITY CARE POLICY IS $4,111 IN 2023. THE AMOUNT INCLUDES REDUCTIONS IN FEES BASED ON THE CLIENT'S ABILITY TO PAY AND CLIENT SERVICES PERFORMED FREE OF CHARGE. PLEASE CONTACT THE COMMUNITY RELATIONS DEPARTMENT FOR ADDITIONAL DETAILS RELATED TO THE CENTER'S EXEMPT PURPOSE.THE MED CLINIC ASSISTS IN MAINTAINING OUTPATIENT CLIENTS PSYCHIATRIC SYMPTOMS WITH THE LOWEST POSSIBLE DOSE OF MEDICATION AND THE LEAST AMOUNT OF SIDE EFFECTS WHILE OBTAINING AN OPTIMAL LEVEL OF FUNCTIONING. ALL OUTPATIENT CANDIDATES FOR MEDICATION INTERVENTION WILL BE EVALUATED PER STAFF PSYCHIATRIST/APN AND ENCOURAGED TO FOLLOW ALL TREATMENT RECOMMENDATIONS AS PRESCRIBED WITH THE ASSISTANCE OF THE MEDICATION CLINIC RN. 23462873 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 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 0 0 1 45 0 1 643 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IN X DIANA ELLIOTT DIRECTOR OF ACCOUNTING AND HUMAN RESOURCES 5747322410 800 FULTON STREET LOGANSPORT IN 46947 LINDA WEBB PAST PRESIDENT 2.00 0.00 X X 0 0 0 KEITH KOLB PRESIDENT 2.00 0.00 X X 0 0 0 JASON SEE SECRETARY/TREASURER 2.00 0.00 X X 0 0 0 DEAN MCCURDY PRESIDENT ELECT 2.00 0.00 X X 0 0 0 GLORIA CALHOUN BOARD MEMBER 2.00 0.00 X 0 0 0 MARY KAY BOARD MEMBER 2.00 0.00 X 0 0 0 TARA MCVAY BOARD MEMBER 2.00 0.00 X 0 0 0 MICHELLE STARKEY BOARD MEMBER 2.00 0.00 X 0 0 0 LYNNE NESS BOARD MEMBER 2.00 0.00 X 0 0 0 MACKENZIE LEDLEY BOARD MEMBER PARTIAL TERM 2.00 0.00 X 0 0 0 CARRIE CADWELL CHIEF EXECUTIVE OFFICER 40.00 0.00 X 412506 0 61537 JASON CADWELL CHIEF FINANCIAL OFFICER 40.00 0.00 X 338442 0 18720 KATHLEEN MILLER CHIEF MEDICAL OFFICER 40.00 0.00 X 427747 0 59284 NICOLE HIATT-DRANG CHIEF CLINICAL OFFICER 40.00 0.00 X 180138 0 9000 ANDREW HARTLEY CHIEF OPERATING OFFICER 40.00 0.00 X 192000 0 3446 LISA WILLIS-GIDLEY VP OF OPERATIONS SOUTHERN 40.00 0.00 X 157875 0 30538 HOPE KERNS COMPLIANCE OFFICER 40.00 0.00 X 124283 0 44368 DAWN COBURN DIRECTOR OF REVENUE CYCLE 40.00 0.00 X 108594 0 22022 DIANA ELLIOTT DIRECTOR OF BILLING & REIMBURSEMENT 40.00 0.00 X 137572 0 24185 KRISTA CATT DIRECTOR OF COMMUNITY & SCHOOL BAS 40.00 0.00 X 70097 0 41468 JESSICA CRUME DIRECTOR OF COMMUNITY & SCHOOL BAS 40.00 0.00 X 45804 0 2290 BRENT KELLEY DIRECTOR OF CLINIC SERVICE 40.00 0.00 X 16149 0 933 MELISSA ROBERTSON DIRECTOR OF ADULT INTENSIV 40.00 0.00 X 86007 0 31581 ALYSS BLACKBURN DIRECTOR OF COMMUNITY & SCHOOL BAS 40.00 0.00 X 62817 0 4044 LAUREN COOPER DIRECTOR OF COMMUNITY & SCHOOL BAS 40.00 0.00 X 88815 0 6044 BEVERLY GARRETT DIRECTOR OF MOBILE CRISIS & CRIMINAL JUSTICE SERVI 40.00 0.00 X 73444 0 15705 LUCIE INGRAM DIRECTOR OF COMMUNITY & SCHOOL BAS 40.00 0.00 X 59015 0 3174 BRAD KARCH DIRECTOR OF HUMAN RESOURCES 40.00 0.00 X 28785 0 0 DUANNA MCANINCH DIRECTOR OF ADULT INTENSIVE SERVICES 40.00 0.00 X 68880 0 3415 MALLERY NEFF MEDICAL DIRECTOR - INPATIENT 40.00 0.00 X 320272 0 16918 MAREN SHEESE DIRECTOR OF INTEGRATED SERVICES 40.00 0.00 X 72979 0 2432 AMY HERRON-MILLER ADVANCED PRACTICE NURSE 40.00 0.00 X 201486 0 19955 JANE ABBOTT-RIDER ADVANCED PRACTICE NURSE 40.00 0.00 X 162874 0 0 CRYSTAL RIDENOUR ADVANCED PRACTICE NURSE 40.00 0.00 X 152145 0 7988 MATTHEW TANNER ADVANCED PRACTICE NURSE 40.00 0.00 X 150996 0 8838 WONDA ELMORE ADVANCED PRACTICE NURSE 40.00 0.00 X 149775 0 7763 3889497 0 445648 19 0 1 0 7 4574862 181638 4756500 NET PATIENT SERVICE RE 621111 27772147 27772147 MENTAL HEALTH FUNDS RE 621111 2169517 2169517 GROUP HOME RENTAL INCO 531390 136702 136702 30078366 730775 730775 407274 943322 -536048 -536048 -536048 MISCELLANEOUS REVENUE 621110 230884 228184 2700 DISPROPORTIONATE SHARE 621110 160498 160498 391382 35420975 30467048 0 197427 69453 69453 3274742 2662909 611833 16079099 13074978 3004121 415958 338257 77701 2026190 1647698 378492 1353966 1101045 252921 32151 32151 90150 90150 2181922 1366547 815375 67297 46184 21113 196820 135072 61748 390559 268029 122530 580198 398173 182025 557628 536860 20768 57954 57954 909526 739626 169900 279995 192152 87843 HOSPITAL ASSESMENT FEES 557182 557182 DUES & SUBSCRIPTIONS 108627 74548 34079 RECRUITMENT 98417 67541 30876 RECOGNITION EXPENSES 71398 48998 22400 116087 79667 36420 29515319 23462873 6052446 0 267 267 40216649 40962045 74905 3295 1096972 1216082 1791394 1783217 276282 286595 17165301 4792396 7260373 12372905 50716842 56624406 2045546 2171932 1437727 357921 0 2992400 1615493 5395867 5225152 X 45320975 51399254 45320975 51399254 50716842 56624406 5905656 172623 0 X X 0 1 X 1 1 1 X 2363591 3974176 7251515 7345874 4756500 25691656 22715455 24749999 27891503 29393485 30078366 134828808 25079046 28724175 35143018 36739359 34834866 160520464 0 1333911 1611977 1264952 1486978 1809947 7507765 1333911 1611977 1264952 1486978 1809947 7507765 153012699 415221 528249 332678 350592 730775 2357515 415221 528249 332678 350592 730775 2357515 547297 488968 367317 489352 391382 2284316 26041564 29741392 35843013 37579303 35957023 165162295 0.92640 0.92730 0.01430 0.01170 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 547,297. 2019 AMOUNT: $ 488,968. 2020 AMOUNT: $ 367,317. 2021 AMOUNT: $ 489,352. 2022 AMOUNT: $ 391,382. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3634 3634 0 SCHEDULE C, PART II-B, LINE 1I: 10.77% OF DUES PAID TO IN COUNCIL OF COMMUNITY MENTAL HEALTH CENTERS AND 10.78% OF DUES PAID TO INDIANA HOSPITAL ASSOCIATION WERE ATTRIBUTABLE TO LOBBYING DURING THE FISCAL YEAR. 0 0 650300 650300 14713430 3696415 11017015 1801571 1095981 705590 12372905 ESTIMATED THIRD PARTY SETTLEMENTS 1615493 1615493 X 35593598 172623 172623 35420975 0 35420975 29515319 0 29515319 0 29515319 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY 4C HEALTH AND RECOGNIZE A TAX LIABILITY IF 4C HEALTH 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 4C HEALTH, AND HAS CONCLUDED THAT AS OF JUNE 30, 2023 AND 2022, 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. 4C HEALTH HAS FILED ITS FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH JUNE 30, 2022 AND IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS. AS OF THE DATE THE FINANCIAL STATEMENTS WERE AVAILABLE TO BE ISSUED, THERE WERE NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). 1 LIVING ALLOTMENT - SUPERVISED GROUP LIVING 29 28063 EDUCATION ASSISTANCE PROGRAM 25 35397 PART I, LINE 2: FOUR COUNTY MAKES ASSISTANCE AVAILABLE TO ELIGIBLE PERSONS TO FURTHER THE HEALTHCARE IN THE COMMUNITY. X 0 0 0 0 0 0 0 0 0 KATHLEEN MILLER CHIEF MEDICAL OFFICER 403257 0 23699 0 791 0 15916 0 43368 0 487031 0 0 0 CARRIE CADWELL CHIEF EXECUTIVE OFFICER 307991 0 97500 0 7015 0 16119 0 45418 0 474043 0 0 0 JASON CADWELL CHIEF FINANCIAL OFFICER 269602 0 68750 0 90 0 15870 0 2850 0 357162 0 0 0 MALLERY NEFF MEDICAL DIRECTOR - INPATIENT 301772 0 18500 0 0 0 0 0 16918 0 337190 0 0 0 AMY HERRON-MILLER ADVANCED PRACTICE NURSE 192340 0 8750 0 396 0 10104 0 9851 0 221441 0 0 0 ANDREW HARTLEY CHIEF OPERATING OFFICER 160000 0 32000 0 0 0 3446 0 0 0 195446 0 0 0 NICOLE HIATT-DRANG CHIEF CLINICAL OFFICER 150000 0 30000 0 138 0 9000 0 0 0 189138 0 0 0 LISA WILLIS-GIDLEY VP OF OPERATIONS SOUTHERN 130821 0 27000 0 54 0 8100 0 22438 0 188413 0 0 0 HOPE KERNS COMPLIANCE OFFICER 102228 0 22000 0 55 0 6600 0 37768 0 168651 0 0 0 JANE ABBOTT-RIDER ADVANCED PRACTICE NURSE 149874 0 7000 0 6000 0 0 0 0 0 162874 0 0 0 DIANA ELLIOTT DIRECTOR OF BILLING & REIMBURSEMENT 112469 0 25000 0 103 0 7230 0 16955 0 161757 0 0 0 CRYSTAL RIDENOUR ADVANCED PRACTICE NURSE 130768 0 13739 0 7638 0 7604 0 384 0 160133 0 0 0 MATTHEW TANNER ADVANCED PRACTICE NURSE 132496 0 11000 0 7500 0 7970 0 868 0 159834 0 0 0 WONDA ELMORE ADVANCED PRACTICE NURSE 134525 0 11250 0 4000 0 7763 0 0 0 157538 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 TWO OFFICERS AT FOUR COUNTY, JASON CADWELL, CFO AND CARRIE CADWELL, CEO HAVE A FAMILIAL RELATIONSHIP. CARRIE CADWELL REPORTS DIRECTLY TO THE PRESIDENT OF THE BOARD OF DIRECTORS AND JASON CADWELL REPORTS DIRECTLY TO THE TREASURER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A THE COUNTY COMMISSIONERS OR COUNTY COUNCIL OF FULTON COUNTY SELECTS ONE MEMBER TO SERVE ON THE BOARD OF DIRECTORS WHILE THE OTHER MEMBERS ARE ELECTED BY THE EXISTING MEMBERS AT THE ANNUAL MEETING OF THE ORGANIZATION. VACANCIES CAN BE FILLED BY REMAINING DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW OF THE FORM 990 BY THE ORGANIZATION'S CEO, CFO AND ACCOUNTING PERSONNEL. THE FINAL FORM INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, IS PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE IS ENFORCED BY THE BOARD PRESIDENT. THE SCOPE OF THIS POLICY INCLUDES ALL DIRECTORS, OFFICERS, AND ASSOCIATES. THE POLICY IS IN PLACE TO ASSIST FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER DIRECTORS, OFFICERS, ASSOCIATES, AND AGENTS WHO GOVERN AND ADMINISTER FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER AFFAIRS TO RESOLVE SITUATIONS THAT INVOLVE A DUAL INTEREST OR THAT MAY BE INTERPRETED AS A CONFLICT OF INTEREST AND TO DEFINE CONFLICT OF INTEREST SITUATIONS AND PROCEDURES TO FOLLOW ONCE THEY ARE DISCLOSED. THE COVERED PERSONS ARE HELD TO A STRICT RULE OF HONEST AND FAIR DEALING BETWEEN THEMSELVES AND THE ORGANIZATION. THEY SHALL NOT USE THEIR POSITIONS, OR KNOWLEDGE GAINED THEREFROM, IN SUCH A WAY THAT A CONFLICT MIGHT ARISE BETWEEN THE INTEREST IN THE ORGANIZATION AND THAT OF THE INDIVIDUAL. A SELF DISCLOSURE FROM COVERED PERSONS TO OTHER BOARD MEMBERS IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. ANY DIRECTOR HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHOULD NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER, AND HE OR SHE SHOULD NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHOULD REFLECT: A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THAT A QUORUM WAS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATIONS OF FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC.'S CEO ARE MADE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. IN DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO, THE PROCESS INCLUDED ANALYZING THE INDIANA COUNCIL SALARY SURVEY, LOCAL RECRUITING INFORMATION, AND MARKET RATES RELEVANT TO FOUR COUNTY'S RURAL AREA TO HELP ASSIST IN THE DECISION MAKING PROCESS. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THE FINAL COMPENSATION AMOUNTS, AND DOCUMENTATION OF THIS WAS PRESENTED TO THE FULL BOARD FOR APPROVAL AND RECORDED IN THE BOARD MINUTES. THE CEO IS NOT PRESENT DURING THESE MEETINGS DISCUSSIONS AND APPROVALS. COMPENSATION DETERMINATIONS OF FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC.'S CFO ARE MADE BY THE INTERNAL AFFAIRS COMMITTEE. THE CFO IS NOT PRESENT DURING DISCUSSIONS OR APPROVALS OF THEIR COMPENSATION. COMPENSATION DETERMINATIONS OF FOUR COUNTY COMPREHENSIVE MENTAL HEALTH CENTER, INC.'S OTHER OFFICERS OR KEY EMPLOYEES WERE MADE BY THE CEO. OTHER OFFICERS AND KEY EMPLOYEES ARE NOT PRESENT DURING DISCUSSIONS OR APPROVALS OF THEIR COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C: OVERSIGHT OF AUDIT THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.