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HomeMy WebLinkAboutContract 54502-NC1 Memorandum 54502-N C 1 Date: 10/2/2020 To: JB Strong,Assistant City Attorney Retum to: Tracy Walter—FMS/Vendor Management Re: Mental Health Mental Retardation of Tarrant County to My Health My Resources of Tarrant County-Name Change Request Only Prior Name: Mental Health Mental Retardation of Tarrant County New Name: My Health My Resources of Tarrant County ***CSCO 54502*** TB Stran APPROVED BY:JB Strong(Oct 2,102013:20 CDT) JB Strong,Assistant City Attorney APPROVAL DATE: Oct 2, 2020 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX mhMrtarrant WE CHANGE LIVES October 1, 2020 RE: Change of Name Notification Dear Sir/Madam, Please be advised that the Board of Trustees changed the name of our agency from Mental Health Mental Retardation of Tarrant County to My Health My Resources of Tarrant County ("MHMR"). Today we assist children and adults with all types of health concerns, including substance use disorder, psychiatric disorders, intellectual disabilities and developmental delays. By changing the words for which MHMR stands for, our board has taken an important step to more accurately represent the work we do. MHMR is a unit of local government created by Chapter 534 of the State of Texas Health and Safety Code. As a unit of local government,MHMR does not have to register with the Secretary of State or any other governmental or administrative body; and, an action from its Board of Trustees is all that is needed in order to change its By-Laws or its name. Attached please find: • Board of Trustees Resolution approving the By-Laws showing the new name which became effective on October 25,2016; • Assumed Name Certifications showing that MHMR of Tarrant County and Mental Health Mental Retardation of Tarrant County are now assumed names for My Health My Resources of Tarrant County; • Print out from IRS website showing that the EIN matches My Health My Resources of Tarrant County;and • Letter from IRS confirming the name change and the showing the retention of the same EIN. We will continue using the assumed name of MHMR of Tarrant County for contract purposes. Please update your records to reflect our new name. If you have any questions, do not hesitate to contact me directly,at(817)569-4532 or Aleed.Rivera@mhmrtc.org. Sincerely, Aleed! Rivera General Counsel 3840 Hulen Street Fort Worth,Texas 76107 817-569-4300 www.MHMRtarran(.org MHMR of Tarrant County Mernomudum To: Jim Teague, Board Chair and Members of the Board From: Susan Garnett,Chief Executive Officer Date: October 25,2016 Subject: Approval of the Board Policy Manual 1. Recommendation That the Board pass the following motion Resolved,by the Board of Trustees,that,the Board Policy Manual,as set forth in attachment A including all revisions,is approved. 2. Background The Board ofTrustees and Executive staff review the Board Policy Manual on an annual basis and consider revisions.The Board Policy Manual,including the proposed changes, was distributed to all Board members and reviewed at the Program and Business Committee meetings.Upon approval,a final version of the Board Policy Manual will be distributed to all Board members and made available to staff on the shared-drive of the agency information network. 3. Personnel Implications No personnel implications. A. Facilities Implications No facilities implications. 5. FinanciallmpUcations No financial implications. 6. Anticipated Future Recommendations No anticipate future implications. 7. Approval of Resolution /Jimaguc,Board Chair o[Termut Cou BOARD OFFICERS FY 2016-2017 Jim Teague, Chair Elaine Klos, Vice Chair Lyn Willis, Secretary Board Approved:October 25,2016 MHMR of Tarrant County By-Laws ARTICLE I—THE ORGANIZATION SECTION 1 -NAME The name of the organization is My Health My Resources of Tarrant County, hereafter referred to as MHMR of Tarrant County,MHMR,MHMR Tarrant or the Center. SECTION 2—EXECUTIVE AND ADMINISTRATIVE OFFICE The principal executive and administrative offices of MHMR shall be at such a place in Tarrant County,Texas as may be designated by the Board of Trustees, hereafter referred to as Board. SECTION 3-FISCAL YEAR The fiscal year shall commence on the first day of September in each year. SECTION 4-AUDIT The financial statements of MHMR shall be audited by an independent certified public accounting firm selected by the Board,and a written report thereof shall be submitted to the Board for review in accordance with the Texas Department of State Health Services(DSHS)and the Texas Department of Aging and Disability Services(DADS)Performance Contract requirements. ARTICLE II-PURPOSESIPHILOSOPHY SECTION 1 -PURPOSE/PHILOSOPHY Whereas this Board, acting for the citizens of Tarrant County, affirms their belief in fundamental human rights and in the dignity and worth of every individual, has determined to promote a better standard of life for all citizens, and recognizing that individuals who have mental health disorders, substance use disorders, intellectual and developmental disabilities (1DD), and/or early childhood developmental delays need special safeguards and care, therefore, resolves that MHMR, as established under Vernon's Texas Codes Annotated, Health and Safety Code, §534.001 and under the sponsorship of the Tarrant County Commissioners Court, shall use all public and private re- sources available to provide for the special needs of persons who have mental health disorders, substance use disorders, 1DD, and/or early childhood developmental delays. In this regard, to the best of its ability,MHMR shall: (a) Plan, monitor and coordinate its activities in relation to the efficient use of its resources in cooperation with the citizens of Tarrant County, its service providers and public and private agencies,and shall account to the public for its use of such resources; 9 Board Approved. October 25,2016 •r' 's MARY LOUISE GARCIA 200 Taylor St.,Suite 301 Fort Worth,TX 76196 COUNTY CLERK PHONE(817)884-1550 Certificate of Assumed Name Fite#A216016598 I, MARY LOUISE GARCIA, County Clerk of the County of TARRANT COUNTY, do hereby certify that MY HEALTH MY RESOURCES OF TARRANY COUNTY,SUSAN GARNETT,CEO has fled In the office of the County Clerk on 12/28/2016 a certificate setting forth the name of MENTAL HEALTH MENTAL RETARDATION OF TARRANT COUNTY 3840 HULEN STREET,FORT WORTH TX 76107 under which business is to be conducted or transacted, together with the true full name of each person conducting such business: MY HEALTH MY RESOURCES OF TARRANY COUNTY,SUSAN GARNETT,CEO 3840 HULEN STREET FORT WORTH TX 76107 Wi �`tn"s%ffi bhdtvd sea]of office, this day: 12/28/2016 ' r MARY LOUISE GARCIA County Clerk of TAR T CO NTY,TX %�y''•�� fi�•••'gQ; 9Y ' Deputy rruitHtt��`��```, MARY LOUISE GARCIA 200 Taylor St.,Suite 301 Fort Worth,TX 75196 COUNTY CLERK PHONE(817)884-1550 Certificate of Assumed Name File#A216016604 I,MARY LOUISE GARCIA, County Clerk of the County of TARRANT COUNTY,do hereby certify that MY HEALTH MY RESOURCES OF TARRANT COUNTY, SUSAN GARNET, CEO has tiled In the office of the County Clerk on 1212812016 a certificate setting forth the name of MHMR OF TARRANT COUNTY 3840 HULEN STREET,FORT WORTH TX 76107 under which business Is to be conducted or transacted, together with the true full name of each person conducting such business: NamefsL• MY HEALTH MY RESOURCES OF TARRANT COUNTY,SUSAN GARNET,CEO 3840 HULEN STREET FORT WORTH TX 76107 Witnessifnyfignd and seal of office, this day: 1212812016 . S MARY LOUISE GARCIA �o- County Clerk of TARRANT F02UNT TX BY , Deputy till 1100�`�\`` OIRS e-services Online Tutorials Mailbox Sign out Contact Us Interactive TIN Session:Interactive Results This screen provides you with the results of your TIN Match request.The Watch rrxbcator'displays a code next to the TIN and name combination Use the codes below to interpret your results 0=TIN and Name combination matches IRS records. 1=TIN was missing or TIN not 9-d git numeric 2=TIN entered is not currently issued. 3=TIN and Name combination does not match IRS records 4=Invalid TIN Matching request. 5=Duplicate TIN Matchuig request. 6=TIN and Name combination matches IRS SSN records. 7=TIN and Name combination matches IRS EIN records. 8=TIN and Name combination matches IRS SSN and EIN records Important:Before leaving this screen,you may want to do a Print Screen of the results.Once you exit this screen,the interactive results will no longer be available for viewing. Using the TIN Matching system allows you to verity the accuracy of taxpayer TIN and name information prior to submitting information to IRS.Internal Revenue Code 6724 provides any penalties under Section 6721 may be waned if the filer shows the failure to file a correct TIN on an information return was due to reasonable cause and not willful neglect Filers may prove due diligence and receive a waiver from proposed penalties if they prove the TIN and name combination they submitted matched IRS records.Providing a copy of the Print Screen of your Interactive Results will be considered proof of due diligence. ID TIN Type TIN Name Result Code 1 Unknown 751249456 My Health My Resources of Tarrant County 7 You may do either of the following: • Select Another Tin Matching Request to check more TIN and Name combinations • Select Done to return to the TIN Matching home page ANOTH ER TIN MATCHING REQUEST IRS Privacy Policy I Privacy Notice IRSDopmintenl of lllr Treasury Internal Revenue Service OGOEN UT 84201-0046 032753.619619.411966.3216 1 AB 0.403 699 IIIII I III hI1-1111111to11l1rlll111111111111111l 11111111 MY HEALTH MY RESOURCES OF TARRANT POO BOX Y2603 FORT WORTH TX 76113-2603 12753 CUT OUT AND RETURN THE VOUCHER AT THE BOTTOM OF THIS PAGE IF YOU ARE MAKING A PAYMENT, EVEN IF YOU ALSO HAVE AN INQUIRY. 'The IRS address must appear in the window. Use for payments 0423674590 Letter Number : LTR0252C HODCD-TE Letter Date : 2017-06-21 Tax Period 000000 *751249456* MY HEALTH MY RESOURCES OF TARRANT INTERNAL REVENUE SERVICE COUNTY PO BOX 2603 OGDEN !! UT]] 8421I01-0046 }} IItt FORT WORTH TX 76113-2603 I�1IIi1Ir11111111�11t111�1�Irll�lr lrr'1 l�ti�Illllill 751244456 AV MENT 00 2 000000 670 00000000000 IRSDopattment of the Treasury 1 S Internal Revenue Service In reply refer to: 0423674590 OGDEN UT 84201-OD46 June 21 , 2017 LTR 252C 0 75-1249456 00D000 00 00008997 BODC: TE MY HEALTH MY RESOURCES OF TARRANT COUNTY PO BOX 2603 FORT WORTH TX 76113-2603 12753 Taxpayer Identification Number : 75-1249456 Dear Taxpayer : Thank you for the inquiry dated Apr. 27, 2017. We have changed the name on your account as requested . The number shown above is valid for use on all tax documents. If you need forms , schedules, or publications, you may get them by visiting the IRS website at www. irs .gov or by calling toll-free at 1-800-TAX-FORM ( 1-800-829-3676) . If you have any questions, please call us toll free at 1-800-829-0115. If you prefer, you may write to us at the address shown at the top of the first page of this letter. Whenever you write , please include this letter and, in the spaces below, give us your telephone number with the hours we can reach you . Also, you may want to keep a copy of this letter for your records . Telephone Number ( ) Hours Sincerely yours, Shane M. Painter Enclosure(s) : Dept . Manager, Entity Copy of this letter e`q IR Duparmient or the Treasury �N1 IRS Interne! Revenue Service In reply refer to : 0423674590 OGDEN UT 84201-0046 June 21 , 2017 LTR 252C 0 75-1249456 000000 00 00008997 BODC: TE MY HEALTH MY RESOURCES OF TARRANT COUNTY PO BOX 2603 > FORT WORTH TX 76113-2603 12753 Taxpayer Identification Number : 75-1249456 Dear Taxpayer : Thank you for the inquiry dated Apr . 27, 2017. We have changed the name on your account as requested. The number shown above is valid for use on all tax documents. If you need forms , schedules , or publications , you may get them by visiting the IRS website at www. irs .gov or by calling toll-free at 1-800-TAX-FORM ( 1-800-829-3676) . If you have any questions, please call us tall free at 1-800-829-0115. If you prefer, you may write to us at the address shown at the top of the first page of this letter . Whenever you write , please include this letter and, in the spaces below, give us your telephone number with the hours we can reach you. Also, you may want to keep a copy of this letter for your records. Telephone Number ( ) Hours Sincerely yours, Shane M. Painter Enclosure(s) : Dept . Manager, Entity Copy of this letter Request for Taxpayer Farm �� (five Form to the (Rev.October2018) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to www.Irs.gor/FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name is required on thls line;do not leave this line blank. My Health My Resources Of Tarrant Count 2 Business name/disregardad entity name,if different from above MHMR of Tarrant Count appropriate 3 Check a ro box for federal tax classification of the � PP p� parson whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to m following seven boxes. certain entities,not individuals;see °- instructions on page 3): p ❑ Individuai/sole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate m single-member LLC Exempt ( y) o p payee code d an 3 y ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► `o Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting 6 N LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any) -= c another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. ✓❑ Other(see instructions)► Government Entity; State and Local V4DP*5 f••ceounts MAin*wa owraNe m•U.S.) 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) 3840 Hulen Street 6 City,state,and ZIP code Fort Worth TX 76107 7 Ust account numbers)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup when,sole For individuals,this is generally your social security number ISSN).However,fora _M resident alien,sole proprietor,or disregarded entity,see the instructions for Part 1,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see Now to get a U11 TIN,later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and I Employer Identification number Number To Give the Requester for guidelines on whose number to enter. Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S,citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(f any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your lax return.For real estate transactions,item 2 does not apply,For mortgage interest paid, acquisition or abandonment of secured pro gf tion of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you a.ref equir to n the certification,but you must provide your correct TIN.See the instructions for Part 11,later. Sign Signature of -t Here U.S.person Date 1 d13il General instr tions a Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross noted, proceeds) Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to wwwJrs.gov1FormM. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Foram W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(AMN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.102SIX Form W-9(Rev.10-2018)