UNITED COMMUNITY HEALTH CENTER INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- UNITED COMMUNITY HEALTH CENTER INC (EIN 30-0225826)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202103199349327220
- Schema version
- 2020v4.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-15T17:41:16-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 WEST 22ND STREET SUITE 1100 | AddressLine1Txt |
| City | OAK BROOK | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 300225826 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNITED COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIT | BusinessNameControlTxt |
| Phone | 7122130109 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 W MILWAUKEE AVE | AddressLine1Txt |
| City | STORM LAKE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50588 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEVE CAMPBELL | PersonNm |
| Person Title | BOARD TREASURER | PersonTitleTxt |
| Phone | 7122130109 | PhoneNum |
| Signature | 2021-10-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | STEVE | PersonFirstNm |
| Person Last | CAMPBELL | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CHRIS MANDERFIELD | PreparerPersonNm |
| PTIN | P01238973 | PTIN |
| Phone | 6305738600 | PhoneNum |
| Preparation | 2021-10-25 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICH GEHRIG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 W MILWAUKEE AVE | AddressLine1Txt |
| City | STORM LAKE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50588 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,733,566 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UCHCSL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | IA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE COMPREHENSIVE PRIMARY AND PREVENTIVE CARE TO THE UNINSURED, UNDERINSURED, AND UNDERSERVED | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 53 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,768,014 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,575,186 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,796,478 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,113,454 | CYProgramServiceRevenueAmt |
| PY Investment Income | $887 | PYInvestmentIncomeAmt |
| CY Investment Income | -$1,850 | CYInvestmentIncomeAmt |
| PY Other Revenue | $247 | PYOtherRevenueAmt |
| CY Other Revenue | $43,693 | CYOtherRevenueAmt |
| PY Total Revenue | $4,565,626 | PYTotalRevenueAmt |
| CY Total Revenue | $4,730,483 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,779,013 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,035,287 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,397,022 | PYOtherExpensesAmt |
| CY Other Expenses | $1,487,654 | CYOtherExpensesAmt |
| PY Total Expenses | $4,176,035 | PYTotalExpensesAmt |
| CY Total Expenses | $4,522,941 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $389,591 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $207,542 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,959,673 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,094,475 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,281,489 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,208,749 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,678,184 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,885,726 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | IT IS THE MISSION OF UNITED COMMUNITY HEALTH CENTER TO PROVIDE COMPREHENSIVE PRIMARY AND PREVENTIVE CARE TO THE UNINSURED, UNDERINSURED, AND UNDERSERVED OF BUENA VISTA AND SAC COUNTIES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,985,515 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,269,109 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES PRIMARY AND PREVENTIVE CARE TO A WIDE RANGE OF PATIENTS IN 2020. UNITED COMMUNITY HEALTH CENTER (UCHC) SERVED 4412 PATIENTS FROM OVER 115 DIFFERENT ZIP CODES THROUGH 13,050 CLINIC VISITS. 49% OF THE PATIENTS SERVED HAVE INCOME UNDER THE 200% FEDERAL POVERTY LINE AND 21% OF PATIENTS ARE UNINSURED. 45% OF PATIENTS ARE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. 54% OF PATIENTS CONSIDER THEMSELVES HISPANIC OR LATINO. 5% ARE AFRICAN AMERICAN, 9% ARE ASIAN, 79% ARE CAUCASIAN, AND 4% ARE OTHER PACIFIC ISLANDER. COMMUNITY OUTREACH ACTIVITIES IN 2020 WERE VERY LIMITED DUE TO THE COVID PANDEMIC. IN OUR MEDICAL CLINIC ELIGIBLE CHILDREN ARE GIVEN FREE VACCINES THROUGH OUR PARTICIPATION IN THE FEDERAL VFC PROGRAM, ALONG WITH LIMITED ADULT FEE FLU SHOTS PROCURED THRU A PROGRAM WITH THE STATE OF IOWA. UCHC OFFERS PRIMARY AND PREVENTIVE MEDICAL CARE, LABORATORY SERVICES. WE ALSO CAN GIVE REFERRALS FOR REDUCED FEE MAMMOGRAMS WITH BUENA VISTA REGIONAL MEDICAL CENTER, AND WORK WITH THE IOWA DEPARTMENT OF PUBLIC HEALTH TO PROVIDE FREE BREAST & CERVICAL CANCER SCREENS, AS WELL AS SCREENS FOR HEART DISEASE. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $889,864 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $538,588 | RevenueAmt |
| Desc | OUR DENTAL SERVICES PROGRAM SERVED 1479 PATIENTS IN 3178 DENTAL ENCOUNTERS IN 2020. DENTAL SERVICES OFFERED INCLUDE THE FOLLOWING: DENTAL EXAMINATIONS AND X-RAYS; DENTAL TREATMENTS, FILLINGS, AND EXTRACTIONS; EMERGENCY TREATMENT FOR PAIN, SWELLING, BROKEN TEETH, ETC.; PARTIALS AND DENTURES; ROOT CANAL TREATMENT FOR DISEASES OF THE PULP. THESE ENCOUNTERS WERE VERY LIMITED DURING THE COVID PANDEMIC. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $125,497 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $75,957 | RevenueAmt |
| Desc | PATIENTS ARE ASSISTED TO OBTAIN LOW COST MEDICATION RANGING FROM 20-80% DISCOUNT THROUGH THE FEDERAL 340B DRUG PROGRAM. PRESCRIPTIONS WERE FILLED THROUGH THIS PROGRAM AT OUR CONTRACT PHARMACIES, HY-VEE AND WALGREENS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $379,679 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $229,800 | RevenueAmt |
| Desc | OUR BEHAVIOR HEALTH CLINIC SERVED 174 PATIENTS IN 1249 VISITS, WITH 708 OF THOSE BEING DONE VIA TELEHEALTH. THE USE OF TELEHEALTH IN BEHAVIOR HEALTH INCREASED DRAMATICALLY DUE TO THE COVID PANDEMIC IN 2020. SERVICES INCLUDE A COMPREHENSIVE PSYCHIATRIC EVALUATION, DIAGNOSIS, AND DISCUSSION ON INDIVIDUALIZED EVIDENCE-BASED TREATMENT OPTIONS. WE OFFER TREATMENT TO PATIENTS AND FAMILIES FROM CHILDREN TO ADULTS AND TREAT A WIDE RANGE OF CONDITIONS, INCLUDING ANXIETY, DEPRESSION, ADHD, TRAUMA, BIPOLAR DISORDER, SCHIZOPHRENIA, PERSONALITY DISORDERS, AND OTHER BEHAVIORAL HEALTH CONCERNS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $379,679 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $229,800 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $3,380,555 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 53 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHELLE ANDERSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7122130109 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 W MILWAUKEE AVE | AddressLine1Txt |
| City | STORM LAKE | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 50588 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| ROBERT WHITMORE MD | |||||||
| CO-MEDICAL DIRECTOR | 40.00 | Yes (X) | $241,370 | $0 | $43,591 | ||
| BRIAN SMITH DDS | |||||||
| DENTAL DIRECTOR | 40.00 | Yes (X) | $171,359 | $0 | $22,807 | ||
| NATALIE SCHALLER DO | |||||||
| CO-MEDICAL DIRECTOR | 24.00 | Yes (X) | $201,658 | $0 | $38,988 | ||
| RICH GEHRIG | |||||||
| CEO | 40.00 | $112,278 | $0 | $25,001 | Yes (X) | ||
| MICHELLE ANDERSON | |||||||
| CFO | 40.00 | $87,346 | $0 | $21,159 | Yes (X) | ||
| CLARK FORT | |||||||
| CHAIRPERSON | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MATT RICKLEFFS | |||||||
| VICE CHAIRPERSON | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| STEVE CAMPBELL | |||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LORINDA PETERSON | |||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MATT BROSTAD | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JAY DAHLHAUSER | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DI DANIELS | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| JACKIE DUFFY | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| RENATO JIMENEZ | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $814,011 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $151,546 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WOODRUFF CONSTRUCTION LLC | |||||
| 1890 KOUNTRY LANE | FT DODGE | IA | 50501 | CONSTRUCTION | $953,095 |
| REBNORD TECHNOLOGIES | |||||
| 210 SALE BARN ROAD | STORM LAKE | IA | 50588 | IT SERVICE AGREEMENT | $161,602 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $2,561,366 | GovernmentGrantsAmt |
| All Other Contributions | $13,820 | AllOtherContributionsAmt |
| Total Contributions | $2,575,186 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CLINIC PROGRAMS | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $2,113,454 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,113,454 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,113,454 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $754 | TotalRevenueColumnAmt |
| Exclusion | $754 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $479 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $3,083 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$2,604 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$2,604 | TotalRevenueColumnAmt |
| Exclusion | -$2,604 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $43,693 | TotalRevenueColumnAmt |
| Exclusion | $43,693 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $43,693 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,730,483 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,113,454 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $41,843 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,785 | TotalAmt |
| Management And General | $245,785 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,062,688 | TotalAmt |
| Program Services | $1,728,945 | ProgramServicesAmt |
| Management And General | $333,743 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $571,465 | TotalAmt |
| Program Services | $367,465 | ProgramServicesAmt |
| Management And General | $204,000 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,349 | TotalAmt |
| Program Services | $113,177 | ProgramServicesAmt |
| Management And General | $42,172 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,701 | TotalAmt |
| Program Services | $91 | ProgramServicesAmt |
| Management And General | $3,610 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,844 | TotalAmt |
| Program Services | $871 | ProgramServicesAmt |
| Management And General | $35,973 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $417,272 | TotalAmt |
| Program Services | $335,490 | ProgramServicesAmt |
| Management And General | $81,782 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,928 | TotalAmt |
| Program Services | $12,744 | ProgramServicesAmt |
| Management And General | $24,184 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,692 | TotalAmt |
| Program Services | $51,245 | ProgramServicesAmt |
| Management And General | $51,447 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,780 | TotalAmt |
| Program Services | $20,021 | ProgramServicesAmt |
| Management And General | $11,759 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258,879 | TotalAmt |
| Program Services | $197,075 | ProgramServicesAmt |
| Management And General | $61,804 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,291 | TotalAmt |
| Program Services | $14,673 | ProgramServicesAmt |
| Management And General | $8,618 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL EXPENSES | $308,835 | $308,835 | |
| BAD DEBT | $151,815 | $151,815 | |
| LICENSES AND DUES | $55,795 | $36,517 | $19,278 |
| RECRUITMENT | $47,547 | $40,734 | $6,813 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,275 | TotalAmt |
| Program Services | $857 | ProgramServicesAmt |
| Management And General | $11,418 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,522,941 | TotalAmt |
| Program Services | $3,380,555 | ProgramServicesAmt |
| Management And General | $1,142,386 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $739,397 | BOYAmt |
| EOY | $1,436,601 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $318,573 | BOYAmt |
| EOY | $315,630 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $82,007 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $357,259 | BOYAmt |
| EOY | $330,830 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,096 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,465 | BOYAmt |
| EOY | $55,753 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,756,242 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,049,924 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,068,870 | BOYAmt |
| EOY | $3,706,318 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $407,013 | BOYAmt |
| EOY | $167,336 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,959,673 | BOYAmt |
| EOY | $6,094,475 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $713,487 | BOYAmt |
| EOY | $542,451 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $568,002 | BOYAmt |
| EOY | $1,666,298 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,281,489 | BOYAmt |
| EOY | $2,208,749 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,678,184 | BOYAmt |
| EOY | $3,885,726 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,678,184 | BOYAmt |
| EOY | $3,885,726 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,959,673 | BOYAmt |
| EOY | $6,094,475 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $207,542 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,247,568 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,208,801 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,347,960 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,768,014 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,575,186 | CurrentTaxYearAmt |
| Total | $8,147,529 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,247,568 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,208,801 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,347,960 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,768,014 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,575,186 | CurrentTaxYearAmt |
| Total | $8,147,529 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $8,147,529 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $282 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $405 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $651 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $887 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $754 | CurrentTaxYearAmt |
| Total | $2,979 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $59,227 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $90,311 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $107 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $240 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $43,693 | CurrentTaxYearAmt |
| Total | $193,578 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $8,344,086 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $10,820,485 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97640 | PublicSupportCY170Pct |
| Public Support PY170 | 0.97510 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | Yes (1) | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (1) | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Total Lobbying Expenditures | $0 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS DUES TO THE IOWA PRIMARY CARE ASSOCIATION. A PORTION OF THESE DUES MAY BE ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $281,494 | OtherCostOrOtherBasisAmt |
| Book Value | $281,494 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,136,518 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,123,136 | DepreciationAmt |
| Book Value | $3,013,382 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,338,230 | OtherCostOrOtherBasisAmt |
| Depreciation | $926,788 | DepreciationAmt |
| Book Value | $411,442 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,706,318 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $4,578,668 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$151,815 | OtherRevenueAmt |
| Revenue Not Reported | -$151,815 | RevenueNotReportedAmt |
| Revenue Subtotal | $4,730,483 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $4,730,483 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,371,126 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$151,815 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$151,815 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,522,941 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,522,941 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)3 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE ORGANIZATION AS A RESULT OF THIS STANDARD. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -151,815. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -151,815. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (1) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | 0 | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT WHITMORE MD | ||||||||||||||
| CO-MEDICAL DIRECTOR | $237,485 | $0 | $3,885 | $0 | $0 | $0 | $23,016 | $0 | $20,575 | $0 | $284,961 | $0 | $0 | $0 |
| BRIAN SMITH DDS | ||||||||||||||
| DENTAL DIRECTOR | $168,253 | $0 | $1,468 | $0 | $1,638 | $0 | $16,059 | $0 | $6,748 | $0 | $194,166 | $0 | $0 | $0 |
| NATALIE SCHALLER DO | ||||||||||||||
| CO-MEDICAL DIRECTOR | $189,916 | $0 | $4,168 | $0 | $7,574 | $0 | $18,413 | $0 | $20,575 | $0 | $240,646 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE HEALTH CENTER COMPENSATION AND BENEFITS REPORT FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE COMPENSATION AND BENEFITS SURVEY FROM THE IOWA PRIMARY CARE ASSOCIATION ARE THE RESOURCES USED FOR COMPARABILITY DATA AND SUBSTANTIATION OF THE DELIBERATION AND DECISION. THIS PROCESS IS USED FOR ALL OFFICERS AND KEY EMPLOYEES. THE FINANCE COMMITTEE AND BOARD REVIEWS THE COMPENSATION FOR THE CFO EACH YEAR, INCLUDING 2020. THE CEO'S SALARY WAS APPROVED IN 2009 AS PART OF THE INITIAL CONTRACT. THESE SALARIES ARE ALL APPROVED AS PART OF THE ANNUAL BUDGET BY THE BOARD OF DIRECTORS. |
| PART I, LINE 7 | MEDICAL DIRECTORS CAN EARN BONUS FOR HITTING PRODUCTIVITY MARKS AS SPECFIED IN EMPLOYMENT CONTRACT. |
| PART I, LINE 8 | DENTAL DIRECTOR WAS PAID A SIGN-ON BONUS AS ACCORDING TO EMPLOYEMENT CONTRACT. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| RICH GEHRIG | |||
| CEO | $23,401 | CEO'S DAUGHTER IS AN EMPLOYEE OF THE ORGANIZATION | 0 |
| MATT RICKLEFS | |||
| VICE CHAIR | $17,100 | TREASURER'S WIFE DOES THE SOCIAL MEDIA POSTINGS | 0 |
| MATT RICKLEFS | |||
| VICE CHAIR | TREASURER DOES SOME WEBSITE MAINTENANCE | 0 | |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MATT RICKLEFS AND AND RENATO JIMINEZ - FAMILY RELATIONSHIP - BOARD MEMBERS ARE FAMILY MEMBERS MATT RICKLEFS - BUSINESS RELATIONSHIP - EMPLOYEE OF CENTRAL BANK CLARK FORT - BUSINESS RELATIONSHIP - EMPLOYEE OF STILLE, PIERCE AND PERZBORN STEVE CAMPBELL - BUSINESS RELATIONSHIP - EMPLOYEE OF HUNZELMAN PUTZIER, CPA LLC |
| FORM 990, PART VI, SECTION A, LINE 8B | NO COMMITTEES HAVE THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | 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. ONCE A DRAFT IS PREPARED, THE 990 IS INTERNALLY REVIEWED BY THE CEO AND CFO. AFTER THIS REVIEW, THE 990 IS PRESENTED AT THE BOARD MEETING AND TIME IS GIVEN AFTER THE MEETING TO ALLOW FOR BOARD MEMBERS TO ASK QUESTIONS OR MAKE CHANGES TO THE 990 BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE EMPLOYEES, BOARD, AND OFFICERS ("BOARD MEMBERS") ARE TO AVOID EVEN THE APPEARANCE OF A CONFLICT OF INTEREST. ALL BOARD MEMBERS SHALL DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST AT THE EARLIEST PRACTICABLE TIME. NO BOARD MEMBER SHALL VOTE ON ANY MATTER UNDER CONSIDERATION AT A BOARD OR COMMITTEE MEETING IN WHICH SUCH A BOARD MEMBER HAS A CONFLICT OF INTEREST. THE MINUTES OF SUCH MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE AND THAT THE BOARD MEMBER HAVING A CONFLICT OF INTEREST ABSTAINED FROM VOTING. ANY DISCLOSURE OF A PERSON'S INTEREST SHALL APPEAR IN THE MINUTES OF THE MEETING OF THE BOARD OF DIRECTORS OR COMMITTEE THEREOF. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO, ADDRESSED ANNUALLY AT THE JANUARY BOARD MEETING AND WHEN ALL NEW BOARD MEMBERS JOIN. A BOARD MEMBER WHO HAS A CONFLICT OF INTEREST SHALL NOT TAKE PART IN THE DISCUSSION OF SUCH MATTERS UNLESS ALL PERSONS INTEREST IN SUCH CONTRACT OR TRANSACTION SHALL ALSO HAVE THE RIGHT TO TAKE PART IN THE SAME DISCUSSION OF SUCH MATTER. THE BOARD MEMBERS' PARTICIPATION IN THE DISCUSSION SHALL BE LIMITED TO STATEMENTS CONCERNING THE FAIRNESS AND REASONABLENESS OF SUCH CONTRACT OR TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HEALTH CENTER COMPENSATION AND BENEFITS REPORT FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE COMPENSTAION AND BENEFITS SURVEY FROM THE IOWA PRIMARY CARE ASSOCIATION ARE THE RESOURCES USED FOR COMPARABILITY DATA AND SUBSTANTIATION OF THE DELIBERATION AND DECISION. THIS PROCESS IS USED FOR ALL OFFICERS AND KEY EMPLOYEES. THE FINANCE COMMITTEE AND BOARD REVIEWS THE COMPENSATION FOR THE CEO EACH YEAR, INCLUDING 2020. THE CFO'S SALARY WAS APPROVED IN 2009 AS PART OF THE INITIAL CONTRACT. THESE SALARIES ARE ALL APPROVED AS PART OF THE ANNUAL BUDGET BY THE BOARD OF DIRECTORS WITHIN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO BE VIEWED AT THE ADIMINISTRATIVE OFFICE AT 715 WEST MILWAUKEE AVE UPON WRITTEN REQUEST. |
| FORM 990, PART XII, LINE 2C: | NO CHANGE FROM PRIOR YEAR |
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