DAYMARK RECOVERY SERVICES, INC.

Annual Report for Fiscal Year 2010-2011

This report is intended to serve as a snapshot of the people we serve and select demographic and treatment information. It also describes some of our key accomplishments during the past fiscal year and identifies important goals for the coming fiscal year as determined during our recent strategic planning retreat. The following is divided into several categories to facilitate the review of this report. From these categories, our administration and Board Members can ascertain if we are holding true to our mission, meeting the needs of the communities we serve, and remaining on the cutting edge of providing cost effective and evidenced based treatment.

Billy R. West, Jr.

Billy R. West, Jr., MSW, LCSW, Executive Director Mission Statement: Daymark Recovery Services, Inc. is a mission driven, comprehensive community provider of culturally sensitive mental health and substance abuse services. The Daymark goal is for skilled medical and behavioral healthcare professionals to support citizens of all ages and their families with the greatest opportunity for recovery, independence and the highest quality of life. We are committed to using the most current best practices and effective, research-based treatment programs to assist all citizens working toward achieving optimum health and recovery. Values Statement: Daymark Recovery Services, Inc. serves those with the greatest needs and facing the greatest challenges with a coordinated effort of services. Services are culturally sensitive, strength based and delivered in congruence with natural community supports and each consumer's personal support system. Services will promote safety and recovery while always respecting the rights of self-determination. MAJOR ACCOMPLISHMENTS DURING FISCAL YEAR 2010-11 Maintained National CARF Accreditation. Successful in lobbying for provisionally licensed employees to be permitted to continue to practice individual and group therapy in the State of North Carolina Cont. on next page

2 MAJOR ACCOMPLISHMENTS DURING FISCAL YEAR 2010-11 Expanded fully operational services to Guilford, Wake and Vance Counties in North Carolina Provides psychiatric services to rural areas in Western North Carolina through telemedicine. Services provided by DAYMARK are considered best practice and/or are literature based. Serves as the main portal of entry for mental health and substance abuse consumers all counties we serve and subsequently there is no wait list for entering mental health and substance abuse outpatient services in any of our counties. Provided care to over 37,000 patients in FY 2010-2011. Leading public provider of telemedicine psychiatric services in the State of North Carolina with over 20 locations linked together to pool the skills of over 25 psychiatrists for those we serve in a more timely fashion and in some cases on demand when needed. Provides access for walk-in crisis services to over 3,500 individuals per quarter that keeps people from going to their local emergency room for emergent psychiatric care. Provides Mobile Crisis Services in eight counties to better respond to acute psychiatric crisis in the community and keep patients out of the psychiatric hospitals when possible. Clinics operate as an assessment site for first commitment evaluations and is successful in diverting almost half of our citizens evaluated from psychiatric hospitalization. Our business model sustained multiple budget and rate reductions this year without significant decrease in services to the indigent and in some areas we grew. Added three service locations in three different counties without adding to our administrative overhead. Our information technology platform was certified for Meaningful Use to comply with the Recovery Act

SERVICE LOCATION Lexington, NC Davidson County

SERVICES PROVIDED Walk-in Crisis Mobile Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Intensive Substance Abuse Treatment Outpatient individual and group treatment Walk-in Crisis Mobile Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Intensive Substance Abuse Treatment Outpatient individual and group treatment

Salisbury, NC Rowan County

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

3 SERVICE LOCATION Concord, NC Cabarrus County SERVICES PROVIDED Walk-in Crisis Mobile Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Intensive Substance Abuse Treatment Outpatient individual and group treatment Facility Based Crisis and Detox (Kannapolis) Peer Support Walk-in Crisis Mobile Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Intensive Substance Abuse Treatment Outpatient individual and group treatment Walk-in Crisis Mobile Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Intensive Substance Abuse Treatment Outpatient individual and group treatment Facility Based Crisis and Detox Walk-in Crisis Psychiatric Services (also telemedicine) Intensive Substance Abuse Group Peer Support Outpatient individual and group treatment Mobile Crisis Targeted Case Management Mobile Crisis Access to all other services in the Forsyth Office Mobile Crisis Access to all other services in the Forsyth Office Mobile Crisis Psychiatry Services (also telemedicine) Walk-in Crisis Psychosocial Club House Assertive Community Treatment Team\ Indigent Medication Program Intensive Substance Abuse Treatment Outpatient individual and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual, group treatment and community support

Albemarle, NC Stanly County

Monroe, NC Union County

Winston-Salem, NC Forsyth County

Mocksville, NC Davie County King and Danbury, NC Stokes County Reidsville, NC Rockingham County

Wadesboro, NC Anson County

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

4 SERVICE LOCATION Buies Creek, NC Harnett County SERVICES PROVIDED Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted case management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual, group and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted Case Management Walk-in Crisis Psychiatry Services (also telemedicine) Indigent Medication Program Outpatient individual and group treatment Targeted Case Management Substance Abuse Outpatient Services Substance Abuse Residential Treatment (30, 60, 90 days) Psychiatric Assessment, Evaluation and Medication Administration Note: This is a new service area and will not be in the 2011 data

Raeford, NC Hoke County

Sanford, NC Lee County

Troy, NC Montgomery County

Pinehurst, NC Moore County

Asheboro, NC Randolph County

Archdale, NC Randolph County

Rockingham, NC Richmond County

Greensboro, NC Guilford County High Point, NC Guilford County Henderson, NC Vance County

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

5 SERVICE LOCATION Raleigh, NC Wake County SERVICES PROVIDED Facility Based Crisis and Detox Services Note: This is a new service area and will not be in the 2011 data

Services and Fiscal Information

Information regarding Daymark Recovery Services, Inc. (DAYMARK) consumers served, services provided, and revenues is described in the following tables. Information is typically identified by catchment area as follows: Piedmont Behavioral Healthcare (PBH) catchment area consisting of Davidson, Union, Cabarrus, Rowan and Stanly Counties. CenterPoint Human Services (CPHS) catchment area consisting of Forsyth, Stokes, Davie and Rockingham Counties. Sandhills catchment area consisting of Anson, Harnett, Hoke, Lee, Montgomery, Moore, RandolphAsheboro, Randolph-Archdale, and Richmond Counties. Guilford catchment area consisting of Guilford County. Catchment Area PBH CPHS Sandhills Guilford CONSUMERS SERVED FY 2010-11 Unduplicated Consumers Unduplicated Services 16,812 158,855 9,354 73,829 10,724 88,059 256 6,919

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

NUMBER OF CONSUMERS SERVED AND SERVICE STATISTICS FOR FISCAL YEARS 2009-10 AND 2010-11
Catchment Area Unduplicated Consumers FY 2009-10 Unduplicated Consumers FY 2010-11 Percent Increase/ (Decrease) Unduplicated Services FY 2009-10 Unduplicated Services FY 2010-11 Percent Increase/ (Decrease)

PBH CPHS Sandhills Guilford

17,129 9,318 10,443 n/a

16,812 9,354 10,724 256

-1.85% 0.39% 2.69% n/a

163,685 66,153 70,312 n/a

158,855 73,829 88,059 6,919

-2.95% 11.60% 25.24% n/a

A review of this table reveals that the number of persons served during the last two fiscal years fluctuated between catchment areas. Some factors to consider as possible causes in the fluctuations are below: The number of DAYMARK therapist in the PBH Region decreased during this FY due to budget reductions. This resulted in less individual therapy sessions offered and more group oriented treatments. This is our second year in this region offering primarily group treatment but it was our first full year of doing so. We assume this contributed to the 317 less patients seen and 4,830 less services being delivered. Our patient satisfaction scores gave some validity to this theory with some patients wanting more individual services and not choosing group as reported in their survey. There was a slight increase in the number of persons seen in the CPHS Area. This area experienced no budget cuts and several other providers in the area going out of business. We attribute these factors to our increase. We did not see an increase but a decrease in services. We attribute this to a stagnant budget causing no new hires in the past three years yet a continually slight to moderate increase in patients. This causes appointments to become less frequent resulting in more declined or missed appointments. Vacancies in staff leaving and finding qualified applicants to fill clinical positions have also contributed to the slight service decrease. While the staffing pattern at Sandhills remained stagnant we saw an increase in the number of patients and services. We contribute this to the maturation of programming in this book of business that is less than three years old.

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

7 Guilford County Residential program saw a significant number of people receive residential treatment. While the program can be up to 90 days we are able to treat a significant number of people because the service design is based on a medical necessity model and not entitlement model. In short, when someone can be discharged to a higher or lower level of care they are discharged. This allows more people to access this care throughout the year.

BUDGET BY PAYER BILLED State Dollars (Indigent Care) Medicaid Medicare, Commercial Insurance, Grants, Health Choice, County Dollars, Donations, etc. TOTAL BUDGET FY 2010-2011

AGENCY-WIDE FY 10-11 65% 18% 17%

$30,215,866.00

As noted in the above table and graph, the percent of revenues per payer source demonstrates DAYMARKs commitment to provide care to those persons most in need of services. This is evidenced by the percent of funds received for consumers who are indigent (IPRS funded) and eligible for entitlement funding (Medicaid). Indigent Medication and Emergency Medication Programs DAYMARK understands that access to medications is an important key to recovery. With a high number of indigent consumers and increased cost of medication, DAYMARK has developed and/or supported programs that enable persons served to obtain their medications. It is important to point out that each of our Local Management Entities provide strong monetary support to make sure we are successful in linking person to their needed medications. These include the following:

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

8 In the CPHS catchment area (Davie, Forsyth, Stokes, and Rockingham Counties), CPHS provides assistance through their indigent medication program and through the Forsyth County Government, to provide an on-site pharmacy in Forsyth County. These resources provide the much needed medications to persons served at little or no cost to consumers and no additional cost to DAYMARK. DAYMARK also provides some sample and Medication Access and Review Program (MARP) services to Rockingham County Residents. In the PBH catchment area (Cabarrus, Davidson, Rowan, Stanly, and Union Counties), PBH provides monetary support for DAYMARK clinics to offer sample medication to indigent persons served. This medication is often made available for emergency needs and/or while waiting for a consumer to become eligible for coverage through an indigent or entitlement funding source. MARP is an automated program that permits consumers that cannot afford their medication, to receive medicine on an ongoing basis at no cost. It is also important to note that PBH monetarily supports our agency purchasing medications for those patients that receive care in our two Facility Based Crisis Units (32 total beds). In our Sandhills catchment area (Harnett, Lee, Montgomery, Anson, Randolph, Moore, Richmond, and Hoke Counties), we have sample medication programs for persons coming out of inpatient units in need of medication immediately. We also have an indigent medication program that is funded through the Sandhills LME. This allows our most high risk patients to receive the medication they need. In our Guilford Residential Services indigent patients receive their medication through a variety of community and county sponsored programs. What we are unable to obtain from natural community supports and other programming is purchased at a reduced cost through a wholesale pharmacy and reimbursed by Guilford County during our budgeting process. In our Wake County Facility Based Crisis Services Wake County provides a pharmacy service where we can purchase medications a reduced cost and those cost are reimbursed by the Wake County Local Management Entity. In our Vance County Clinic the Five County Local Management Entity monetarily supports nursing services over and above reimbursable cost in order for medical staff to obtain sample and indigent medication programs.

In short, our Local Management Entities make providing medication to our indigent possible through a variety of programs. To illustrate the cost savings and impact of these funded programs we have included a snap shot of our MARP Program in the PBH Area below:

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

Daymark Recovery Services

Medication Access and Review Program (MARP) Site Activity Report

7/1/2010 - 6/30/2011 Patients * Active Patients: ** Inactive Patients: Total Patients: 1,244 748 1,992 Requests * Patient Requests: ** Patient Medications: Average Meds/Request:
generated during the specified time frame.

Average Wholesale Price (AWP) 883 * Average AWP: 3,518 3.98 *Average Wholesale Price for medications
requested during the specified time frame.

$1,674.77 $5,891,833.51

** Total AWP:

*Number of Patients with Active status. **Number of Patients with Inactive status.

*Number of Patients for whom requests were **Number of Medications requested during
the specified time frame.

**Total Wholesale Price for medications

requested during the specified time frame.

PATIENTS BY COUNTY:
Rowan Cabarrus Davidson 471 359 436 Grand Total: 1,992 Stanly Union 391 335

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

10 CONSUMERS SERVED BY LOCATION PBH CATCHMENT AREA County Consumers Served Cabarrus County 3,845 Davidson County 4,056 Rowan County 3,257 Stanly County 1,947 Union County 3,707 CPHS CATCHMENT AREA County Consumers Served Davie County 108 Forsyth County 5,725 Rockingham 3,432 Stokes County 89 Sandhills CATCHMENT AREA County Consumers Served Anson County 742 Harnett County 1,630 Hoke County 591 Lee County 1,361 Montgomery County 747 Moore County 1,190 Randolph (Asheboro) County 2,710 Randolph (Archdale) County 781 Richmond County 972 Guilford CATCHMENT AREA County Consumers Served Guilford County 256

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

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CONSUMERS SERVED BY GENDER Female 19,003 Male 18,143

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

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CONSUMERS BY CULTURE NUMBER OF POPULATION SERVED White 25,011 African-American 9,153 Hispanic 1,053 Native (American or Alaskan) 413 Asian 151 Multi-racial 243 Other (did not list, aboriginal Canadians, 362 native Hawaiian, Pacific Islander, Cambodian) Unknown (due to incomplete information 760 taken during crisis intervention) CULTURE

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

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Disabilities SERVED Diagnoses* TOTAL CONSUMERS Mental Health (MH) only 22,300 Substance Abuse (SA) only 1,088 Both MH & SA 13,376 Other (not primary MH or SA but those with developmental disabilities, dementia or other medical complications 382
Note: Does not account for co-occurring disorders but only primary diagnosis

AGE 0-5 6-17 18-40 41-65 66-85 86+

CONSUMERS SERVED BY AGE CONSUMERS SERVED 240 4,686 17,379 13,840 951 50

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

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Patient Satisfaction and Outcomes Executive Summary: Below is an executive summary of the outcome of the survey for each service location this fiscal year (FY) and longitudinally over the past two years. Numbers indicate the overall patient satisfaction. Taken from 10% sample of all persons scheduled to be seen at each location for the month. Patient Satisfaction Questions include, but not limited to, their overall satisfaction of services and being able to be in better control of their symptoms and life. CUMULATIVE AVERAGES FOR EACH PROGRAM SITE BY CALENDAR YEAR PROGRAM SITE AND NUMBER PARTICIPATING DURING CY CY CY CY CY 2011 SURVEY sample of 10% of appointments scheduled for clinics 2007 2008 2009 2010
and 100% of the patients in residential and day programs

CY 2011 100% 99% 98% 98% 98% 97% 96% 96% 96% 96% 96% 96% 96% 96% 95% 95% 94% 94% 93% 96%

CRC Kannapolis Richmond Stanly Cabarrus CRC Union Anson Guilford Residential Montgomery Rowan Lee Union Forsyth Rockingham Davidson Moore Harnett New Bridge Academy (2007-2010 formerly Expeditions) Randolph Hoke CUMULATIVE AVERAGE

97% 95% 92%

96% 94% 93%

98% 96% 94%

98% 93% 96% 92% 86% 95% 99% 95% 94% 93% 92% 92% 92% 97% 95% 100% 97% 93% 94%

92% 94% 90% 96%

94% 91% 91% 94%

95% 93% 89% 90%

95%

98%

90%

94%

94%

93%

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

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Executive Findings and Comments: The consistency of the survey over a four year period give indications the survey is valid The scores indicate that consumers have been overall very satisfied with their services

GOALS FOR FISCAL YEAR 2011-2012 Expand to other counties that value professional care to both provide good care and spread out overhead cost. This allows more money to be allocated to direct care. Retain National Accreditation. Build continuums of care for persons served in each county and increase the number of services each of our consumers receive when medically necessary. Add other books of business to meet community needs as CABHA rules decrease providers of case management, day treatment and intensive in-home services. Increase the number of Medicaid eligible consumers in service and the number of services delivered to them. Expand our co-location of behavioral health and traditional healthcare service programs. Hold true to our mission of serving the neediest in our communities with the best treatments available. Improve on and build peer support services. Remain cutting edge on Evidenced Based Treatments and research grants. Comply with the Recovery Act and be successful in our Meaningful Use endeavors

DAYMARK RECOVERY SERVICES, INC. BOARD OF DIRECTORS

Mr. Tim Childs, Board Chairperson Mr. Jim Cook, Board Vice-Chairperson Mr. Dwight Wilhelm, Secretary/Treasurer Ms. Debora Pershing Ms. Sharon Scott Ms. Brenda Trott Ms. Barbara Davis Ms. Linda Lowder Mr. Larry Johnson Dr. Tom Appenzeller Mr. Tom Harman Hartsell and Williams, Board Attorney Ms. Erin Cornelius, Board Clerk

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011

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DAYMARK RECOVERY SERVICES, INC. EXECUTIVE STAFF Billy R. West, Jr., MSW, LCSW, Executive Director Philip Nofal, MD, JD, Medical Director Elizabeth Pekarek, MD, Medical Director Dr. Robert Werstlein, Training Director Dr. Lisa Brandyberry, Clinical Director Jerold Greer, Information Systems Director Larry Elmore, MSW, LCSW, MPH, Quality Improvement Director Bonnie Miller, RHIT, Quality Assurance Director Jerry Smith, Finance Officer Cathy Shoaf, CPUC, AIM, Human Resources Director CONTACT Billy R. West, Jr., MSW, LCSW Executive Director DAYMARK Recovery Services, Inc. 220 East First Avenue Ext. Suite 10 Lexington, NC 27292 Phone: 336-242-2411 bwest@daymarkrecovery.org www.daymarkrecovery.org

Daymark Recovery Services, Inc. Annual Report for Fiscal Year 2010-2011