2023-01-16T10:28:23-06:00 2022-02-28 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2021-03-01 421527584 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC % ANTONIO FLORES COMM 3197532300 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 Antonio Flores CEO 4178658701 2022-07-11 true Antonio Flores 999009999 KRYSTAL K CREACH P01248198 4178658701 2 2021 2023-03-07 01:45:13Z Antonio Flores 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 29369272 false X CHCSEIA.COM X 2001 IA CHCSEIA PROVIDES COMPREHENSIVE HEALTH SERVICES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS, AND OTHER HEALTH CARE SERVICES TO RESIDENTS OF THE SE IOWA REGION. 12 12 200 13 0 0 5415566 4481022 18635495 22564702 46878 100639 133336 2222168 24231275 29368531 0 0 0 0 13947394 15436928 0 0 0 6843788 7900109 20791182 23337037 3440093 6031494 22692992 25641167 7579594 4496275 15113398 21144892 X TO 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. false false 15839992 22564702 COMMUNITY 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) 15839992 true true false true false false false false false false true false false true true false true false false false false false false false false false false false false true false false false false false false false false true false false false false false false false false true 39 0 true 200 true false false false false false false false false false false false false X 12 12 false false false false false false false true true false false true true true true true true true true false X ANTONIO FLORES 3197532300 1706 WEST AGENCY ROAD WEST BURLINGTON IA 52655 PATRICK WILLIAMS PEDIATRICIAN 40.0 0.0 X 334799 0 28602 FRANCES JACKSON PEDIATRICIAN 40.0 0.0 X 328549 0 25054 WILLIAM DAWS PEDIATRICIAN 40.0 0.0 X 336420 0 2173 RHEA HARTLEY CHIEF MEDICAL OFFICER 40.0 0.0 X 317283 0 19071 ERIC BOYUM PSYCHIATRIST 40.0 0.0 X 292083 0 43529 CATHERINE HANSEN PHYSICIANS 40.0 0.0 X 249057 0 41671 LUCAS LEMBURG CHIEF DENTAL OFFICER 35.5 0.0 X 237140 0 40647 DIANE ROUSE CFO 40.0 0.0 X 142334 0 37608 ANTONIO FLORES COO END 08/21, CEO BEG 09/21 40.0 0.0 X 148008 0 21038 RONALD KEMP CEO END 08/21 40.0 0.0 X 122400 0 16839 DAVID WHITAKER DIRECTOR 1.0 0.0 X 0 0 0 DAVID SELMON DIRECTOR BEG 09/21 1.0 0.0 X 0 0 0 ANGELICA CARDENAS DIRECTOR 1.0 0.0 X 0 0 0 BARRY CORSON TREASURER END 01/22 1.0 0.0 X X 0 0 0 BILL STAATS VICE CHAIR 1.0 0.0 X X 0 0 0 CHUCK GRIFFIN DIRECTOR 1.0 0.0 X 0 0 0 CINDY SHARPE DIRECTOR 1.0 0.0 X 0 0 0 DENISE OSBORN DIRECTOR END 04/21 1.0 0.0 X 0 0 0 EBONY GRAY DIRECTOR 1.0 0.0 X 0 0 0 JASON STRANDBERG CHAIR 1.0 0.0 X X 0 0 0 JEFF STRAUSE TREASURER BEG 02/22 1.0 0.0 X X 0 0 0 JOANNA SCHNEDEN DIRECTOR 1.0 0.0 X 0 0 0 JULIE SCHILLING SECRETARY 1.0 0.0 X X 0 0 0 SUE SORENSEN DIRECTOR 1.0 0.0 X 0 0 0 2508073 0 276232 28 false true false BKD LLP 910 E St Louis St SPRINGFIELD MO 65801 AUDIT & CONSULT SERV 113251 PAIN CENTERS OF IOWA 5515 UTICA RIDGE ROAD 600 DAVENPORT IA 52807 HEALTH SERVICES 303975 NEXTGEN 1811 VON KARMAN AVE STE 800 IRVINE TX 92612 SOFTWARE SUPPORT 151393 3 4258383 222639 65578 4481022 NET PATIENT SERVICE REVENUE 624100 22313520 22313520 OTHER REVENUE 624100 251182 251182 22564702 101380 101380 0 0 0 0 0 741 -741 -741 -741 0 0 0 0 0 0 0 0 0 GAIN ON INV IN EQUITY INVESTEE 900099 188677 188677 GAIN ON EXTINGUISHMENT OF DEBT 900099 2033491 2033491 2222168 29368531 22564702 2322807 0 0 0 0 1102368 614141 488227 0 11445693 7811844 3633849 429027 291218 137809 1634694 1011380 623314 825146 541163 283983 0 60810 60810 103663 103663 0 0 0 2300387 1815934 484453 44796 14921 29875 598940 264400 334540 0 0 687840 17317 670523 38587 18004 20583 0 39409 29704 9705 115469 17101 98368 0 575755 232587 343168 108724 47894 60830 MEDICAL SUPPLIES & DRUGS 2887072 2887072 LICENSES, DUES, SUBSCRIPTIONS 131027 52898 78129 RECRUITING & RETENTION 207630 172414 35216 REPAIRS AND MAINTENANCE 0 23337037 15839992 7497045 0 0 0 0 0 80211 749903 4492765 8343659 2382493 36190 2307688 3421422 0 0 0 0 0 0 386999 361862 279162 93779 11838856 4896159 7210377 6942697 0 0 0 0 306662 495339 644435 578900 4602200 4617416 22692992 25641167 2317995 1746641 0 0 0 279092 0 0 0 0 0 0 2045850 1928725 2419607 281461 796142 260356 7579594 4496275 X 15113398 21121326 0 23566 15113398 21144892 22692992 25641167 6031494 X false true X true true true X 3916957 3213276 3299706 5415566 4481022 20326527 0 0 3916957 3213276 3299706 5415566 4481022 20326527 0 20326527 4053 5069 28523 61533 101380 200558 0 0 20527085 84377510 0.99023 0.99440 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true false SCHEDULE C, PART II-B, LINE 1(I) OTHER 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. 223943 223943 8230540 2572688 5657852 505753 257478 248275 2085233 1477183 608050 793387 588810 204577 6942697 DUE FROM THIRD PARTY PAYERS 4225000 OTHER RECEIVABLES 132060 457(B) ASSETS 260356 4617416 0 457(B) PLAN PAYABLE 260356 260356 29381706 36000 36000 29345706 22825 22825 29368531 23373778 36000 741 36741 23337037 23337037 SCHEDULE D, PART X, LINE 2 UNCERTAIN 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 4B AMOUNTS 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 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990 PART IX, LINE 25: $ 741 LOSS ON SALE OF PROPERTY AND EQUIPMENT X true true X X X false false false false false false false true false DIANE ROUSE CFO 128264 0 5967 0 8103 0 7482 0 30126 0 179942 0 0 0 ANTONIO FLORES COO END 08/21, CEO BEG 09/21 137266 0 10742 0 0 0 7522 0 13516 0 169046 0 0 0 LUCAS LEMBURG CHIEF DENTAL OFFICER 218602 0 5574 0 12964 0 11488 0 29159 0 277787 0 0 0 RHEA HARTLEY CHIEF MEDICAL OFFICER 304413 0 12870 0 0 0 6265 0 12806 0 336354 0 0 0 CATHERINE HANSEN PHYSICIANS 244066 0 4991 0 0 0 9655 0 32016 0 290728 0 0 0 ERIC BOYUM PSYCHIATRIST 276669 0 15414 0 0 0 14891 0 28638 0 335612 0 0 0 FRANCES JACKSON PEDIATRICIAN 290551 0 37998 0 0 0 0 0 25054 0 353603 0 0 0 PATRICK WILLIAMS PEDIATRICIAN 290135 0 44664 0 0 0 0 0 28602 363401 0 0 0 WILLIAM DAWS PEDIATRICIAN 295384 0 41036 0 0 0 0 0 2173 0 338593 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH 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 7 NON-FIXED PAYMENTS: BONUS AMOUNTS PAID ARE BASED ON PRODUCTION LEVELS AND QUALITY MEASURES. X 2 65578 FMV false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTIONS: THE NUMBER IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART I, LINE 6 VOLUNTEERS: THE ORGANIZATION'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD FORM 990, PART III, LINE 1 ORGANIZATION'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 11B FORM 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 12C CONFLICT 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 15B COMPENSATION 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 19 DOCUMENT 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.