SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
SOUTHWEST IOWA MENTAL HEALTH CENTER
 
Employer identification number

42-0928938
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR, BUSINESS OFFICE MANAGER, AND GOVERNING BOARD PRIOR TO FILING THE FORM WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST DECLARATION EACH YEAR. THE DECLARATIONS ARE REVIEWED BY THE EXECUTIVE DIRECTOR, BUSINESS OFFICE MANAGER AND GOVERNING BOARD FOR ANY POTENTIAL CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR ADMINISTRATION, MANAGERS, AND SUPERVISORS OPERATING UNDER CASS COUNTY HEALTH SYSTEM (WHICH INCLUDES CASS COUNTY MEMORIAL HOSPITAL AND SOUTHWEST IOWA MENTAL HEALTH CENTER) IS CALCULATED BY: ATTAINMENT OF FORMALIZED GOALS RELATED TO DEPARTMENTAL AND ORGANIZATIONAL OUTCOMES, PERSONAL WORK PERFORMANCE (MERIT INCREASES), AND BEHAVIORS IN ACCORDANCE WITH THE FORMALIZED STANDARDS OF BEHAVIOR. CASS COUNTY MEMORIAL HOSPITAL'S HUMAN RESOURCE DEPARTMENT ALSO USES COMPARATIVE DATA FROM SIMILAR ORGANIZATIONS TO MAKE SURE THAT COMPENSATION IS COMPETITIVE WITH OTHER AGENCIES. THE CASS COUNTY MEMORIAL HOSPITAL'S CEO EVALUATES AND CALCULATES THE SOUTHWEST IOWA MENTAL HEALTH CENTER'S EXECUTIVE DIRECTOR'S ANNUAL COMPENSATION ADJUSTMENTS, WHICH THE BOARD APPROVES.
FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST OF THE ORGANIZATION.
FORM 990, PART IX, LINE 11G CONTRACTED STAFF: PROGRAM SERVICE EXPENSES 1,309,081. MANAGEMENT AND GENERAL EXPENSES 375. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,309,456.
FORM 990, PART XI, LINE 9: CHANGE IN PRIOR YEAR UNRECOGNIZED PENSION COSTS -65,747.
FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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