FURP.ORG / PUBLIC DATA EXPLORER

COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC (EIN 42-1527584)
Tax period
2021-03-01 to 2022-02-28
Filed
2023-01-16
IRS object ID
202300169349300125
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-01-16T10:28:23-06:00ReturnTs
Tax Period End2022-02-28TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FORVIS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1Txt
CitySPRINGFIELDCityNm
State AbbreviationMOStateAbbreviationCd
ZIP658062523ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-03-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN421527584EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWABusinessNameLine1Txt
Business Name Line2INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
In Care Of% ANTONIO FLORESInCareOfNm
Business Name ControlCOMMBusinessNameControlTxt
Phone3197532300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11706 W AGENCY ROADAddressLine1Txt
CityWEST BURLINGTONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52655ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAntonio FloresPersonNm
Person TitleCEOPersonTitleTxt
Phone4178658701PhoneNum
Signature2022-07-11SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstAntonioPersonFirstNm
Person LastFloresPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKRYSTAL K CREACHPreparerPersonNm
PTINP01248198PTIN
Phone4178658701PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-03-07 01:45:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerAntonio FloresPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11706 W AGENCY ROADAddressLine1Txt
CityWEST BURLINGTONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52655ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$29,369,272GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressCHCSEIA.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateIALegalDomicileStateCd
Activity Or MissionCHCSEIA PROVIDES COMPREHENSIVE HEALTH SERVICES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS, AND OTHER HEALTH CARE SERVICES TO RESIDENTS OF THE SE IOWA REGION.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee200TotalEmployeeCnt
Total Volunteers13TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,415,566PYContributionsGrantsAmt
CY Contributions Grants$4,481,022CYContributionsGrantsAmt
PY Program Service Revenue$18,635,495PYProgramServiceRevenueAmt
CY Program Service Revenue$22,564,702CYProgramServiceRevenueAmt
PY Investment Income$46,878PYInvestmentIncomeAmt
CY Investment Income$100,639CYInvestmentIncomeAmt
PY Other Revenue$133,336PYOtherRevenueAmt
CY Other Revenue$2,222,168CYOtherRevenueAmt
PY Total Revenue$24,231,275PYTotalRevenueAmt
CY Total Revenue$29,368,531CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,947,394PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$15,436,928CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,843,788PYOtherExpensesAmt
CY Other Expenses$7,900,109CYOtherExpensesAmt
PY Total Expenses$20,791,182PYTotalExpensesAmt
CY Total Expenses$23,337,037CYTotalExpensesAmt
PY Revenues Less Expenses$3,440,093PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,031,494CYRevenuesLessExpensesAmt
Total Assets BOY$22,692,992TotalAssetsBOYAmt
Total Assets EOY$25,641,167TotalAssetsEOYAmt
Total Liabilities BOY$7,579,594TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,496,275TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,113,398NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$21,144,892NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROVIDE PRIMARY HEALTH CARE TO RESIDENTS OF THE GREATER SE IOWA REGION, ESPECIALLY THOSE INDIVIDUALS/FAMILIES WITH LIMITED RESOURCES OR WITH OTHER BARRIERS TO HEALTH CARE. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$15,839,992ExpenseAmt
Revenue$22,564,702RevenueAmt
DescCOMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA PROVIDES SEVERAL HEALTH SERVICES TO THE COMMUNITY, INCLUDING: COMPREHENSIVE HEALTH SERVICES WITH A VARIETY OF PHYSICIAN SPECIALTIES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS INVOLVING ORAL HEALTH EDUCATION AND DENTAL SCREENING, FAMILY PLANNING, HEALTH SCREENINGS, IMMUNIZATIONS, CASE MANAGEMENT, AND PHARMACIES. DURING THE FISCAL YEAR, THE HEALTH CENTERS HAD APPROXIMATELY 21,300 DENTAL VISITS AND 59,300 MEDICAL VISITS. (INCLUDES BEHAVIORAL HEALTH)Desc
Total Program Service Expenses$15,839,992TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (true)DeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document39IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee200EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonANTONIO FLORESPersonNm
Phone3197532300PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11706 WEST AGENCY ROADAddressLine1Txt
CityWEST BURLINGTONCityNm
State AbbreviationIAStateAbbreviationCd
ZIP52655ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndOfficerOfficerIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
PATRICK WILLIAMS
PEDIATRICIAN40.00.0Yes (X)$334,799$0$28,602
FRANCES JACKSON
PEDIATRICIAN40.00.0Yes (X)$328,549$0$25,054
WILLIAM DAWS
PEDIATRICIAN40.00.0Yes (X)$336,420$0$2,173
RHEA HARTLEY
CHIEF MEDICAL OFFICER40.00.0$317,283$0$19,071Yes (X)
ERIC BOYUM
PSYCHIATRIST40.00.0Yes (X)$292,083$0$43,529
CATHERINE HANSEN
PHYSICIANS40.00.0Yes (X)$249,057$0$41,671
LUCAS LEMBURG
CHIEF DENTAL OFFICER35.50.0$237,140$0$40,647Yes (X)
DIANE ROUSE
CFO40.00.0$142,334$0$37,608Yes (X)
ANTONIO FLORES
COO END 08/21, CEO BEG 09/2140.00.0$148,008$0$21,038Yes (X)
RONALD KEMP
CEO END 08/2140.00.0$122,400$0$16,839Yes (X)
DAVID WHITAKER
DIRECTOR1.00.0$0$0$0Yes (X)
DAVID SELMON
DIRECTOR BEG 09/211.00.0$0$0$0Yes (X)
ANGELICA CARDENAS
DIRECTOR1.00.0$0$0$0Yes (X)
BARRY CORSON
TREASURER END 01/221.00.0$0$0$0Yes (X)Yes (X)
BILL STAATS
VICE CHAIR1.00.0$0$0$0Yes (X)Yes (X)
CHUCK GRIFFIN
DIRECTOR1.00.0$0$0$0Yes (X)
CINDY SHARPE
DIRECTOR1.00.0$0$0$0Yes (X)
DENISE OSBORN
DIRECTOR END 04/211.00.0$0$0$0Yes (X)
EBONY GRAY
DIRECTOR1.00.0$0$0$0Yes (X)
JASON STRANDBERG
CHAIR1.00.0$0$0$0Yes (X)Yes (X)
JEFF STRAUSE
TREASURER BEG 02/221.00.0$0$0$0Yes (X)Yes (X)
JOANNA SCHNEDEN
DIRECTOR1.00.0$0$0$0Yes (X)
JULIE SCHILLING
SECRETARY1.00.0$0$0$0Yes (X)Yes (X)
SUE SORENSEN
DIRECTOR1.00.0$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,508,073TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$276,232TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K28IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BKD LLP
910 E St Louis StSPRINGFIELDMO65801AUDIT & CONSULT SERV$113,251
PAIN CENTERS OF IOWA
5515 UTICA RIDGE ROAD 600DAVENPORTIA52807HEALTH SERVICES$303,975
NEXTGEN
1811 VON KARMAN AVE STE 800IRVINETX92612SOFTWARE SUPPORT$151,393
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$4,258,383GovernmentGrantsAmt
All Other Contributions$222,639AllOtherContributionsAmt
Noncash Contributions$65,578NoncashContributionsAmt
Total Contributions$4,481,022TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE624100$22,313,520$22,313,520
OTHER REVENUE624100$251,182$251,182
FieldValueIRS element (for citing)
Total Program Service Revenue$22,564,702TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$101,380TotalRevenueColumnAmt
Exclusion$101,380ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$741OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$741OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$741TotalRevenueColumnAmt
Exclusion-$741ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
GAIN ON INV IN EQUITY INVESTEE900099$188,677$188,677
GAIN ON EXTINGUISHMENT OF DEBT900099$2,033,491$2,033,491
FieldValueIRS element (for citing)
Other Revenue Total$2,222,168OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$29,368,531TotalRevenueColumnAmt
Related Or Exempt Func Income$22,564,702RelatedOrExemptFuncIncomeAmt
Exclusion$2,322,807ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,102,368TotalAmt
Program Services$614,141ProgramServicesAmt
Management And General$488,227ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,445,693TotalAmt
Program Services$7,811,844ProgramServicesAmt
Management And General$3,633,849ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$429,027TotalAmt
Program Services$291,218ProgramServicesAmt
Management And General$137,809ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,634,694TotalAmt
Program Services$1,011,380ProgramServicesAmt
Management And General$623,314ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$825,146TotalAmt
Program Services$541,163ProgramServicesAmt
Management And General$283,983ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$60,810TotalAmt
Management And General$60,810ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$103,663TotalAmt
Management And General$103,663ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,300,387TotalAmt
Program Services$1,815,934ProgramServicesAmt
Management And General$484,453ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$44,796TotalAmt
Program Services$14,921ProgramServicesAmt
Management And General$29,875ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$598,940TotalAmt
Program Services$264,400ProgramServicesAmt
Management And General$334,540ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$687,840TotalAmt
Program Services$17,317ProgramServicesAmt
Management And General$670,523ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$38,587TotalAmt
Program Services$18,004ProgramServicesAmt
Management And General$20,583ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$39,409TotalAmt
Program Services$29,704ProgramServicesAmt
Management And General$9,705ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$115,469TotalAmt
Program Services$17,101ProgramServicesAmt
Management And General$98,368ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$575,755TotalAmt
Program Services$232,587ProgramServicesAmt
Management And General$343,168ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$108,724TotalAmt
Program Services$47,894ProgramServicesAmt
Management And General$60,830ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES & DRUGS$2,887,072$2,887,072
LICENSES, DUES, SUBSCRIPTIONS$131,027$52,898$78,129
RECRUITING & RETENTION$207,630$172,414$35,216
REPAIRS AND MAINTENANCE$0

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$23,337,037TotalAmt
Program Services$15,839,992ProgramServicesAmt
Management And General$7,497,045ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Joint Costs TotalJointCostsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$80,211BOYAmt
EOY$749,903EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,492,765BOYAmt
EOY$8,343,659EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,382,493BOYAmt
EOY$36,190EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,307,688BOYAmt
EOY$3,421,422EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$386,999BOYAmt
EOY$361,862EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$279,162BOYAmt
EOY$93,779EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,838,856LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,896,159LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$7,210,377BOYAmt
EOY$6,942,697EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$306,662BOYAmt
EOY$495,339EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$644,435BOYAmt
EOY$578,900EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$4,602,200BOYAmt
EOY$4,617,416EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$22,692,992BOYAmt
EOY$25,641,167EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,317,995BOYAmt
EOY$1,746,641EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$279,092EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,045,850BOYAmt
EOY$1,928,725EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$2,419,607BOYAmt
EOY$281,461EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$796,142BOYAmt
EOY$260,356EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,579,594BOYAmt
EOY$4,496,275EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,113,398BOYAmt
EOY$21,121,326EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$23,566EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,113,398BOYAmt
EOY$21,144,892EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$22,692,992BOYAmt
EOY$25,641,167EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$6,031,494ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,916,957CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,213,276CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,299,706CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,415,566CurrentTaxYearMinus1YearAmt
Current Tax Year$4,481,022CurrentTaxYearAmt
Total$20,326,527TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,916,957CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,213,276CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,299,706CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,415,566CurrentTaxYearMinus1YearAmt
Current Tax Year$4,481,022CurrentTaxYearAmt
Total$20,326,527TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$20,326,527PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$4,053CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,069CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$28,523CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$61,533CurrentTaxYearMinus1YearAmt
Current Tax Year$101,380CurrentTaxYearAmt
Total$200,558TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$20,527,085TotalSupportAmt
Gross Receipts Rltd Activities$84,377,510GrossReceiptsRltdActivitiesAmt
Public Support CY1700.99023PublicSupportCY170Pct
Public Support PY1700.99440PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1(I)FormAndLineReferenceDesc
ExplanationOTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC), THE IOWA PRIMARY CARE ASSOCIATION (IAPCA), AND THE ILLINOIS PRIMARY HEALTHCARE ASSOCIATION (ILPHCA). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$223,943OtherCostOrOtherBasisAmt
Book Value$223,943BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,230,540OtherCostOrOtherBasisAmt
Depreciation$2,572,688DepreciationAmt
Book Value$5,657,852BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$505,753OtherCostOrOtherBasisAmt
Depreciation$257,478DepreciationAmt
Book Value$248,275BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,085,233OtherCostOrOtherBasisAmt
Depreciation$1,477,183DepreciationAmt
Book Value$608,050BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$793,387OtherCostOrOtherBasisAmt
Depreciation$588,810DepreciationAmt
Book Value$204,577BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,942,697TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
DUE FROM THIRD PARTY PAYERS$4,225,000
OTHER RECEIVABLES$132,060
457(B) ASSETS$260,356
FieldValueIRS element (for citing)
Total Book Value Other Assets$4,617,416TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
Desc457(B) PLAN PAYABLEDesc
Amt$260,356Amt
FieldValueIRS element (for citing)
Total Liability$260,356TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$29,381,706TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts$36,000DonatedServicesAndUseFcltsAmt
Revenue Not Reported$36,000RevenueNotReportedAmt
Revenue Subtotal$29,345,706RevenueSubtotalAmt
Other Revenues Not Included$22,825OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$22,825RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$29,368,531TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$23,373,778TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts$36,000DonatedServicesUseFcltsAmt
Other Expenses Included$741OtherExpensesIncludedAmt
Expenses Not Reported$36,741ExpensesNotReportedAmt
Expenses Subtotal$23,337,037ExpensesSubtotalAmt
Total Expenses Per Form990$23,337,037TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART X, LINE 2UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 4BAMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 23,566 CONTRIBUTIONS WITH DONOR RESTRICTIONS (741) LOSS ON SALE OF PROPERTY AND EQUIPMENT ---------- $ 22,825
SCHEDULE D, PART XII, LINE 2DAMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990 PART IX, LINE 25: $ 741 LOSS ON SALE OF PROPERTY AND EQUIPMENT

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DIANE ROUSE
CFO$128,264$0$5,967$0$8,103$0$7,482$0$30,126$0$179,942$0$0$0
ANTONIO FLORES
COO END 08/21, CEO BEG 09/21$137,266$0$10,742$0$0$0$7,522$0$13,516$0$169,046$0$0$0
LUCAS LEMBURG
CHIEF DENTAL OFFICER$218,602$0$5,574$0$12,964$0$11,488$0$29,159$0$277,787$0$0$0
RHEA HARTLEY
CHIEF MEDICAL OFFICER$304,413$0$12,870$0$0$0$6,265$0$12,806$0$336,354$0$0$0
CATHERINE HANSEN
PHYSICIANS$244,066$0$4,991$0$0$0$9,655$0$32,016$0$290,728$0$0$0
ERIC BOYUM
PSYCHIATRIST$276,669$0$15,414$0$0$0$14,891$0$28,638$0$335,612$0$0$0
FRANCES JACKSON
PEDIATRICIAN$290,551$0$37,998$0$0$0$0$0$25,054$0$353,603$0$0$0
PATRICK WILLIAMS
PEDIATRICIAN$290,135$0$44,664$0$0$0$0$0$28,602$363,401$0$0$0
WILLIAM DAWS
PEDIATRICIAN$295,384$0$41,036$0$0$0$0$0$2,173$0$338,593$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1AHEALTH OR SOCIAL CLUB DUES: THE ORGANIZATION OFFERS A WELLNESS PROGRAM TO ITS EMPLOYEES WHICH PROVIDES DIRECT REIMBURSEMENT OF UP TO $25 PER MONTH AFTER THE EMPLOYEES HAVE USED THE GYM OR WEIGHT WATCHERS PROGRAM THREE TIMES DURING THE MONTH. EMPLOYEE MUST SHOW DOCUMENTATION OF PAYMENT OF FEES AND ATTENDANCE. IF ATTENDANCE IS LESS THAN THREE TIMES A MONTH, NO PAYMENT IS MADE.
SCHEDULE J, PART I, LINE 7NON-FIXED PAYMENTS: BONUS AMOUNTS PAID ARE BASED ON PRODUCTION LEVELS AND QUALITY MEASURES.

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArtGrp
Art Historical TreasuresArtHistoricalTreasuresGrp
Art Fractional InterestArtFractionalInterestGrp
Books And PublicationsBooksAndPublicationsGrp
Clothing And Household GoodsClothingAndHouseholdGoodsGrp
Cars And Other VehiclesCarsAndOtherVehiclesGrp
Boats And PlanesBoatsAndPlanesGrp
Intellectual PropertyIntellectualPropertyGrp
Securities Publicly TradedSecuritiesPubliclyTradedGrp
Securities Closely Held StockSecuritiesCloselyHeldStockGrp
Secur Prtnrshp Trust IntrstsSecurPrtnrshpTrustIntrstsGrp
Securities MiscellaneousSecuritiesMiscellaneousGrp
Qualified Contrib Hist StructQualifiedContribHistStructGrp
Qualified Contrib OtherQualifiedContribOtherGrp
Real Estate ResidentialRealEstateResidentialGrp
Real Estate CommercialRealEstateCommercialGrp
Real Estate OtherRealEstateOtherGrp
CollectiblesCollectiblesGrp
Food InventoryFoodInventoryGrp

Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution2ContributionCnt
Noncash Contributions Rpt F990$65,578NoncashContributionsRptF990Amt
Method Of Determining RevenuesFMVMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
TaxidermyTaxidermyGrp
Historical ArtifactsHistoricalArtifactsGrp
Scientific SpecimensScientificSpecimensGrp
Archaeological ArtifactsArchaeologicalArtifactsGrp
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (true)ReviewProcessUnusualNCGiftsInd
Third Parties UsedfalseThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE M, PART I, COLUMN BFormAndLineReferenceDesc
ExplanationNUMBER OF CONTRIBUTIONS: THE NUMBER IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 6VOLUNTEERS: THE ORGANIZATION'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD
FORM 990, PART III, LINE 1ORGANIZATION'S MISSION: CHCSEIA IS A FEDERALLY QUALIFIED HEALTH CENTER WHOSE MISSION IS TO PROVIDE AFFORDABLE, COMPREHENSIVE, CULTURALLY APPROPRIATE, COST EFFECTIVE HEALTH CARE TO RESIDENTS OF THE GREATER SOUTHEASTERN IOWA REGION IN ORDER TO IMPROVE THEIR OVERALL HEALTH STATUS. THE MAIN PURPOSES OF THE ORGANIZATION ARE THE FOLLOWING: -PROVIDE PRIMARY MEDICAL CARE, GENERAL DENTAL SERVICES, AND INTEGRATED BEHAVIORAL HEALTH SERVICES -CREATE NEW HEALTH CARE RESOURCES AND HEALTH CARE ARRANGEMENTS TO OFFER TO THE COMMUNITIES SERVED BY THE CORPORATION -EXPAND ACCESS TO HEALTH CARE TO THOSE INDIVIDUALS UNABLE TO OBTAIN ADEQUATE HEALTH CARE -REDUCE UNNECESSARY DUPLICATION OF SERVICES, TECHNOLOGY AND FACILITIES BY COORDINATING THE DELIVERY OF HEALTH CARE SERVICES ON A COST-EFFECTIVE BASIS -CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED OR THE PROMOTION OR HEALTH WHICH MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS OR OTHER REQUIREMENTS THAT ARE OR CAN BE MADE AVAILABLE -PROMOTE AND CARRY ON SPECIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED INSOFAR AS SAID RESEARCH CAN BE CARRIED ON, OR IN CONNECTION WITH, THE FACILITIES AND PROGRAMS OPERATED BY THIS CORPORATION -TAKE AND HOLD BY BEQUEST, DEVISE, GIFT, GRANT, PURCHASE, LEASE OR OTHERWISE ANY PROPERTY, REAL, PERSONAL, TANGIBLE OR INTANGIBLE, OR ANY UNDIVIDED INTEREST THEREIN, WITHOUT LIMITATION AS TO AMOUNT OR VALUE -SELL, CONVEY OR TO OTHER DISPOSE OF ANY SAID PROPERTY AND INVEST, REINVEST, OR DEAL WITH THE PRINCIPAL OR THE INCOME THEREOF IN SAID MANNER AS, IN THE JUDGEMENT OF THE DIRECTORS OF THIS CORPORATION, WILL BEST PROMOTE THE PURPOSES OF THE CORPORATION WITHOUT LIMITATION, EXCEPT SUCH LIMITATIONS, IF ANY AS MAY BE CONTAINED IN THE INCORPORATION, THE BYLAWS OF THE CORPORATION, OR ANY OTHER LAWS THERETO APPLICABLE. -RAISE GIFTS, BEQUESTS, DONATIONS, AND OTHER FUNDS FROM THE PUBLIC AND FROM ALL OTHER SOURCES AVAILABLE, RECEIVE AND MAINTAIN SUCH FUNDS AND EXPEND PRINCIPAL AND INCOME THERE FROM IN SUPPORT OF OR IN FURTHERANCE OF THE CHARITABLE PURPOSES OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11BFORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO BEING FILED, THE RETURN IS REVIEWED BY THE ORGANIZATION'S CEO AND CFO. IT IS THEN PROVIDED TO THE BOARD FOR APPROVAL.
FORM 990, PART VI, SECTION B, LINE 12CCONFLICT OF INTEREST POLICY: A. GENERAL PRINCIPLES PROHIBITING CONFLICTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR MEMBER OF THE BOARD OF DIRECTORS OF CHC/SEIA WILL PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT (SUPPORTED BY FEDERAL FUNDS) IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER, OR ANY MEMBER OF HIS OR HER IMMEDIATE FAMILY, HIS OR HER PARTNER, OR AN ORGANIZATION WHICH EMPLOYS OR IS ABOUT TO EMPLOY ANY OF THE PARTIES INDICATED HEREIN, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD. B. CONFLICTS OF INTEREST AND DISCLOSURE REQUIREMENTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER WILL HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST IN, OR RECEIVE ANY COMPENSATION OR OTHER BENEFITS AS A RESULT OF, TRANSACTIONS BETWEEN CHC/SEIA AND ANY INDIVIDUAL OR BUSINESS FIRM WITHOUT DISCLOSING THE CONFLICT OF INTEREST. NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS MAY PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT IN WHICH FEDERAL FUNDS ARE USED, IF THEY HAVE A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD WITHOUT DISCLOSING THE CONFLICT OF INTEREST. IF AN EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS BELIEVES THAT ONE OF THE AFOREMENTIONED CONFLICTS ACTUALLY OR POTENTIALLY EXISTS, HE OR SHE MUST IMMEDIATELY DISCLOSE THIS INFORMATION IN WRITING TO THE CEO. DISCLOSURES BY MEMBERS OF THE BOARD OF DIRECTORS MUST ALSO BE MADE TO THE CHAIR OF THE BOARD OF DIRECTORS (AND IF IT IS THE CEO OR THE CHAIR WHO HAS SUCH A FINANCIAL INTEREST, HE OR SHE MUST MAKE DISCLOSURE TO THE CHAIR OR VICE CHAIR, RESPECTIVELY). THE CHC/SEIA REQUIRES THAT ALL EMPLOYEES, CONTRACTORS, AGENTS, OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS AND CANDIDATES FOR BOARD MEMBERSHIP DISCLOSE IN WRITING (AND UPDATE AT LEAST ANNUALLY) AT OR AROUND THEIR JANUARY MEETING: - ALL BUSINESS AND FAMILY RELATIONSHIPS WHICH CREATE AN ACTUAL OR POTENTIAL A CONFLICT OF INTEREST, AND - WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. TO FACILITATE DISCLOSURE, CHC/SEIA REQUIRES EMPLOYEES, CONTRACTORS, AGENTS) OFFICERS AND BOARD MEMBERS TO COMPLETE A CHC/SEIA CONFLICT OF INTEREST FORM. COMPLETION THE FORM DOES NOT RELIEVE INDIVIDUALS OF THE OBLIGATION TO NOTIFY THE CEO OR BOARD CHAIR IF CHANGES OCCUR SINCE FILING OF THE FORM REGARDING A NEW CONFLICT OF INTEREST. NO MEMBER OF THE BOARD OF DIRECTORS MAY VOTE ON ANY MATTER WHICH MAY DIRECTLY OR INDIRECTLY RESULT IN FINANCIAL OR OTHER GAIN TO THAT MEMBER, OR WHICH MAY CONFLICT WITH THAT MEMBER'S OBLIGATIONS TO ANOTHER ORGANIZATION'S BOARD OF DIRECTORS OR TO HIS OR HER EMPLOYER. PROVIDED THAT THE MEMBER OF THE BOARD OF DIRECTORS HAS FIRST DISCLOSED A CONFLICT OR POTENTIAL CONFLICT) AND ABSTAINS FROM VOTING IN THAT REGARD, HE OR SHE MAY PARTICIPATE IN DISCUSSIONS RELATING TO THAT MATTER.
FORM 990, PART VI, SECTION B, LINE 15A AND 15BCOMPENSATION REVIEW: ANNUALLY PAY RANGES ARE REVIEWED AS PART OF THE BUDGETING PROCESS. COMPARABILITY DATA IS USED FROM FQHC SALARY SURVEY RESULTS FROM NACHC, IOWA PRIMARY CARE ASSOCIATION AND ILLINOIS PRIMARY CARE ASSOCIATION. IOWA WORKFORCE DEVELOPMENT SURVEY RESULTS FOR THE REGION ARE ALSO COMPARED. ANY PROPOSED CHANGES ARE TAKEN TO CHCSEIA'S PERSONNEL COMMITTEE, FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR REVIEW AND APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC EXCEPT IN CASES WHERE IT IS REQUIRED BY LAW. FINANCIAL STATEMENTS ARE ONLY RELEASED FOR ACTIVITIES THAT ARE DEEMED NECESSARY FOR BONA FIDE BUSINESS PURPOSES, SUCH AS LOANS, OR IN CASES WHERE IT IS REQUIRED BY LAW.