2021-11-22T16:31:01-06:00 2021-01-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2020-02-01 421374894 SIOUXLAND COMMUNITY HEALTH CENTER % JAN ANDERSON CFO SIOU 7122522477 1021 NEBRASKA ST SIOUX CITY IA 51105 MARI KAPTAIN-EAHLEN CEO 7122522477 2021-11-01 true MARI KAPTAIN-EAHLEN XXX-XX-XXXX Krystal K Creach P01248198 4178658701 2021-11-01 2 2020 2022-09-23 18:48:47Z MARI KAPTAIN-DAHLEN 1021 NEBRASKA ST SIOUX CITY IA 51105 34821220 false X WWW.SLANDCHC.COM X 1991 IA TO BE A PATIENT-CENTERED MEDICAL HOME WHICH IMPROVES THE PHYSICAL, DENTAL, AND BEHAVIORAL HEALTH OF THE SIOUXLAND COMMUNITY WHILE ELIMINATING ACCESS BARRIERS. 14 14 375 16 0 0 6344635 6713145 27273306 27843411 345132 132061 42134 128706 34005207 34817323 305048 329226 0 0 20304865 22359280 0 0 0 11110570 10945934 31720483 33634440 2284724 1182883 33318179 36532590 6692171 8692195 26626008 27840395 X INSPIRING AND EMPOWERING OUR COMMUNITY THROUGH HEALTH EQUITY FOR ALL. true false 19984780 329226 20769676 PRIMARY AND SPECIALTY MEDICAL SERVICES FOR FYE 2021: SCHC PROVIDED MEDICAL, PRENATAL, AND BEHAVIORAL HEALTH SERVICES FOR 94,179 PATIENT VISITS. SERVICES WERE PROVIDED BY SEVEN PRIMARY CARE PHYSICIANS, EIGHT PHYSICIAN ASSISTANTS, AND EIGHTEEN NURSE PRACTITIONERS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 3911759 4064809 PHARMACY: THE SCHC PHARMACY IS AVAILABLE TO ALL PATIENTS RECEIVING HEALTH CARE SERVICES AT THE HEALTH CENTER. THREE PHARMACISTS ARE ON STAFF TO OFFER MEDICATION COUNSELING FOR PRESCRIPTIONS. IN ADDITION, THE HEALTH CENTER EMPLOYED ONE FULL-TIME CLINICAL PHARMACIST TO ASSIST PATIENTS WITH CHRONIC MEDICAL CONDITIONS. SCHC IS A PARTICIPANT IN THE 340B DRUG PRICING PROGRAM AND ALSO OFFERS AN INDIGENT PROGRAM TO PROVIDE PRESCRIPTION ASSISTANCE TO QUALIFYING PATIENTS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 2895633 3008926 DENTAL CARE FOR FYE 2021: SCHC EMPLOYED FIVE DENTISTS AND FIVE DENTAL HYGIENISTS TO PROVIDE ROUTINE DENTAL CARE AND TREATMENT TO PATIENTS AGED INFANTS TO ADULTS. EMERGENCY WALK-IN PATIENTS ARE ACCEPTED DAILY. THE DENTAL DEPARTMENT HAD 12,963 PATIENT VISITS DURING THE YEAR ENDING 1/31/21. 26792172 true true false true false false false false false false true false false false true false true false false false false false false false false false false false true true true false false false false false false false false false false true false false false false false false false false true 74 0 true 375 true false false false false false false false false false false false false X 14 14 false false false false false false false true true false false true true true true true true true false false IA X JAN ANDERSON CFO 7122522477 1021 NEBRASKA STREET SIOUX CITY IA 51105 MICHAEL PIPLANI CMO 40.0 0.0 X 327188 0 21231 DAVID FALDMO QUALITY DIRECTOR 40.0 0.0 X 292632 0 46576 GARY HATTAN PHYSICIAN 40.0 0.0 X 290021 0 44182 KRISTI WALZ PHYSICIAN 40.0 0.0 X 291052 0 42114 TYLER WENDEL PHYSICIAN 40.0 0.0 X 283151 0 39379 DYLAN GREENE PHYSICIAN 40.0 0.0 X 267592 0 46311 BRENDA HAUSMAN-MILLER DENTAL DIRECTOR 40.0 0.0 X 256963 0 39179 KELLY RYDER PHYSICIAN 40.0 0.0 X 269495 0 14200 MARI KAPTAIN-DAHLEN CEO 40.0 0.0 X 219684 0 30155 JAN ANDERSON CFO 40.0 0.0 X 201865 0 33025 ABDULLAHI URUR MEMBER AT LARGE 1.0 0.0 X 0 0 0 AMY SLEVIN TREASURER 1.0 0.0 X X 0 0 0 ANDREA BUCKLEY CHAIR 1.0 0.0 X X 0 0 0 KELLY MCCARTHY MEMBER AT LARGE 1.0 0.0 X 0 0 0 DAVID OLSON MEMBER AT LARGE 1.0 0.0 X 0 0 0 CHAD MARKHAM MMR AT LAR END 08/20/SECRETARY 1.0 0.0 X X 0 0 0 DR DONA PRINCE VICE CHAIR 1.0 0.0 X X 0 0 0 JAY ROSENBERG MEMBER OF LARGE 1.0 0.0 X 0 0 0 JENNIFER BRAVANTE-BURKHART MEMBER AT LARGE 1.0 0.0 X 0 0 0 TREYLA LEE MEMBER AT LARGE 1.0 0.0 X 0 0 0 REVATHI TRUONG MEMBER AT LARGE 1.0 0.0 X 0 0 0 MONA ZUFFANTE MEMBER AT LARGE 1.0 0.0 X 0 0 0 TIM DAUGHERTY MEMBER AT LARGE BEG 10/20 1.0 0.0 X 0 0 0 WILLIE SUAREZ MEMBER AT LARGE BEG 10/20 1.0 0.0 X 0 0 0 BIBI GAZNABBI-JAURON MEMBER AT LARGE END 08/20 1.0 0.0 X 0 0 0 JENNIFER GOMEZ SECRETARY END 08/20 1.0 0.0 X X 0 0 0 2699643 0 356352 41 false true false HR CONSTRUCTION 307 E 39TH STREET SOUTH SIOUX CITY NE 68776 BUILDING CONSTRUCTIO 2704160 SIOUXLAND OBGYN 2730 PIERCE STREET 201 SIOUX CITY IA 51104 OBSTETRICAL SERVICES 724374 INCONCERT CARE 500 SW 7TH ST STE 300 DES MOINES IA 50309 SOFTWARE SUPPORT 714024 BKD LLP 910 E ST LOUIS ST STE 200 SPRINGFIELD MO 65810 AUDIT/TAX/CONSULTING 126812 4 11544 6466880 234721 736184 6713145 NET PATIENT SERVICE REVENUE 624100 27703678 27703678 OTHER REVENUE 624100 139733 139733 27843411 134708 134708 0 0 0 0 0 1250 3897 -2647 -2647 -2647 0 0 0 0 0 0 0 0 0 Gain on Equity Investee 900099 128706 128706 128706 34817323 27843411 260767 0 329226 329226 0 0 1468498 983769 484729 0 17242392 14388887 2853505 670702 572955 97747 1743851 1378645 365206 1233837 974639 259198 0 22910 22910 125718 125718 0 0 0 2538275 2120170 418105 139942 68079 71863 663339 391311 272028 967559 128756 838803 0 384516 317313 67203 8809 6389 2420 0 267168 202288 64880 5067 5067 0 913641 169032 744609 54012 6057 47955 MEDICAL SUPPLIES & DRUGS 4671563 4671563 LICENSES, DUES, SUBSCRIPTIONS 152760 83093 69667 RECRUITING & RETENTION 24690 24690 MISCELLANEOUS EXPENSE 5965 5965 33634440 26792172 6842268 0 178450 122183 17745753 17447329 542836 837127 3476841 3517444 0 0 0 0 0 0 191413 251860 265929 232931 22279583 8698404 10568126 13581179 0 0 168831 297537 0 0 0 0 180000 245000 33318179 36532590 2073457 2461856 0 0 0 0 3655594 3260293 0 0 0 0 0 2292430 0 0 963120 677616 6692171 8692195 X 26404810 27660662 221198 179733 26626008 27840395 33318179 36532590 1182883 31504 X false true X true true true X 5776438 6185636 6384273 6344635 6713145 31404127 0 0 5776438 6185636 6384273 6344635 6713145 31404127 0 31404127 31233 103083 220216 353248 134708 842488 0 0 32246615 123764989 0.97387 0.97588 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 PAID DUES OF $20,000 TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND $43,644 TO THE IOWA PRIMARY CARE ASSOCIATION. A PORTION OF THE DUES MAY BE ATTRIBUTABLE TO LOBBYING PURPOSES. 1271327 1271327 14478454 5905171 8573283 4849258 2793233 2056025 1680544 1680544 13581179 0 INTEREST RATE SWAP 391616 EST. DUE TO THIRD PARTIES 286000 677616 34895989 31504 3050 213456 248010 34647979 169344 169344 34817323 33640137 3050 2647 5697 33634440 33634440 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 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $ 213,456 NET ASSETS RELEASED FROM RESTRICTION SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 171,991 TEMPORARILY RESTRICTED CONTRIBUTIONS (2,647) LOSS ON DISPOSAL OF ASSET ------------- $ 169,344 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON FORM 990, PART VII, LINE 2D, BUT NOT ON LINE 1: $ 2,647 LOSS ON ASSET DISPOSAL true RENTAL ASSISTANCE PROGRAM 49 197620 CO-PAY ASSISTANCE PROGRAM 85 73570 FOOD ASSISTANCE PROGRAM 117 28000 UTILITIES ASSISTANCE PROGRAM 48 30036 SCHEDULE I, PART I, LINE 2 MONITORING OF GRANT FUNDS: PATIENTS WITHIN THE HIV PROGRAM MAY QUALIFY FOR THE FOLLOWING PROGRAMS: RENTAL ASSISTANCE, MEDICAL/DENTAL CO-PAY ASSISTANCE, FOOD ASSISTANCE, AND UTILITIES ASSISTANCE. INDIVIDUALS MUST DEMONSTRATE A NEED FOR FINANCIAL ASSISTANCE AND THEY MUST FOLLOW-UP REGULARLY WITH THE STAFF AT THE CLINIC. X X X X false false false false false false false true false MICHAEL PIPLANI CMO 319945 0 1250 0 5993 0 14250 0 6981 0 348419 0 0 0 MARI KAPTAIN-DAHLEN CEO 217348 0 1250 0 1086 0 10887 0 19268 0 249839 0 0 0 JAN ANDERSON CFO 192077 0 1250 0 8538 0 10482 0 22543 0 234890 0 0 0 KRISTI WALZ PHYSICIAN 285994 0 4800 0 258 0 13875 0 28239 0 333166 0 0 0 GARY HATTAN PHYSICIAN 287535 0 1400 0 1086 0 14250 0 29932 0 334203 0 0 0 TYLER WENDEL PHYSICIAN 271295 0 2880 0 8976 0 14250 0 25129 0 322530 0 0 0 DYLAN GREENE PHYSICIAN 257707 0 5600 0 4285 0 13178 0 33133 0 313903 0 0 0 KELLY RYDER PHYSICIAN 257264 0 3620 0 8611 0 12991 0 1209 0 283695 0 0 0 DAVID FALDMO QUALITY DIRECTOR 245412 0 26750 0 20470 0 14250 0 32326 0 339208 0 0 0 BRENDA HAUSMAN-MILLER DENTAL DIRECTOR 245795 0 5300 0 5868 0 9204 0 29975 0 296142 0 0 0 SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: MONTHLY INCENTIVE PAYMENTS BASED ON PRODUCTION ARE PAID TO EMPLOYEES SUBJECT TO THE DISCRETION OF THE BOARD OF DIRECTORS. A WOODBURY COUNTY IOWA 426005221 2007-09-25 7000000 CONSTRUCTION OF NEW FACILITY false false false A 3705852 0 7000000 0 0 0 100000 0 6900000 0 0 0 2009 false false true true A false false false false 0 true false false true A false false false true true true WELLS FARGO 20. false false false 0 false false A true SCHEDULE K, PART IV, LINE 2C NO REBATE DUE: THE COMPUTATION WAS PERFORMED AS OF 11/02/2017. X 2 697827 FMV X PPE 3 38357 FMV false true false SCHEDULE M, PART I, LINE 20, COLUMN (B) NUMBER OF CONTRIBUTIONS: THE NUMBERS ENTERED IN COLUMN B REPRESENT THE NUMBER OF DONORS WHO CONTRIBUTED THESE ITEMS DURING THE YEAR. FORM 990, PART III, LINE 2 SIGNIFICANT PROGRAM SERVICES: DUE TO THE COVID-19 PANDEMIC, THE HEALTH CENTER BEGAN OFFERING TELEHEALTH SERVICES AND MOBILE HEALTH SERVICES. FORM 990, PART III, LINE 4 PROGRAM SERVICES: SIOUXLAND COMMUNITY HEALTH CENTER (SCHC) IS DEDICATED TO MEETING THE HEALTHCARE NEEDS OF THE SIOUXLAND AREA AND IS A LEVEL THREE PATIENT CENTERED MEDICAL HOME. SCHC OFFERS THE FOLLOWING SERVICES: PRIMARY AND SPECIALTY MEDICAL SERVICES, FAMILY PLANNING SERVICES PRENATAL SERVICES, LABORATORY, RADIOLOGY, HIV/AIDS AND HEPATITIS CARE, BEHAVIORAL HEALTH, PHARMACY, AND DENTAL SERVICES. SCHC PROVIDES FINANCIAL ASSISTANCE TO THE UNINSURED AND UNDERINSURED TO ELIMINATE ACCESS BARRIERS. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACTIVITY #1: LABORATORY SIOUXLAND COMMUNITY HEALTH CENTER CURRENTLY CONDUCTS APPROXIMATELY 96% OF ITS LABORATORY TESTS ONSITE AND IS A MODERATE COMPLEX LABORATORY. FOR THOSE TESTS NOT PERFORMED ONSITE, THEY ARE SENT TO A REFERENCE LABORATORY WHERE THE MAJORITY OF TEST RESULTS ARE RETURNED WITHIN 24-72 HOURS. CONDUCTING THE MAJORITY OF TESTS ONSITE ENSURES RAPID TURNAROUND FOR DIAGNOSIS AND MONITORING OF CHRONIC MEDICAL CONDITIONS. THE LABORATORY WAS ACCREDITED BY CLIA FOR THE YEAR ENDING 1/31/21, THE LABORATORY PERFORMED 610,112 TESTS. RADIOLOGY SCHC ALSO CONDUCTS RADIOLOGY SERVICES. IT PERFORMED 4,590 EXAMS FOR THE YEAR ENDING 1/31/21. SCHC ALSO STARTED PROVIDING ULTRASOUND SERVICES ON 3/1/20 AND PERFORMED 1,642 EXAMS FOR THE YEAR ENDING 1/31/21. HIV/AIDS AND HEPATITIS THE HIV TEAM SERVES THE TRI-STATE SIOUXLAND AREA, AS WELL AS 20 NORTHWEST IOWA COUNTIES, 6 COUNTIES IN NEBRASKA, AND 3 COUNTIES IN SOUTH DAKOTA. APPROXIMATELY 48% OF PATIENTS RECEIVING HIV/AIDS CARE LIVE IN RURAL AREAS. IN ADDITION TO MEDICAL CARE, THE HIV TEAM COORDINATES DENTAL CARE, CASE MANAGEMENT, TRANSPORTATION, AND HOUSING ASSISTANCE. FOR THE FISCAL YEAR ENDING 1/31/21, THE HIV TEAM SERVED 214 PATIENTS. FINANCIAL SERVICES TO ENSURE PATIENTS HAVE ACCESS TO CARE AT AN AFFORDABLE RATE, SCHC OFFERS A SLIDING FEE DISCOUNT TO PATIENTS BASED ON INCOME ELIGIBILITY AND ACCEPTS MEDICAID (TITLE 19), MEDICARE (TITLE 18), HAWK-I (STATE CHIP) AND MOST PRIVATE INSURANCES. FOR FISCAL YEAR ENDING 1/31/21, 15% OF PATIENTS RECEIVING CARE WERE UNINSURED, 43% HAD COVERAGE BY MEDICAID/HAWK-I, 9% HAD MEDICARE COVERAGE, AND 33% HAD COVERAGE BY OTHER SOURCES. SCHC EMPLOYED SIX CERTIFIED APPLICATION COUNSELORS TO ASSIST INDIVIDUALS WITH ENROLLMENT IN THE HEALTH INSURANCE EXCHANGE. FORM 990, PART III, LINE 4B PROGRAM SERVICE ACTIVITY #2: THE SCHC PHARMACY ALSO PARTICIPATES IN OTHER PHARMACEUTICAL ASSISTANCE PROGRAMS TO ENSURE PATIENTS HAVE ACCESS TO NEEDED PRESCRIPTION DRUGS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE FORM 990: 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. THE CEO AND CFO REVIEW THE RETURN BEFORE IT IS PRESENTED TO THE FINANCE COMMITTEE. THE FINANCE COMMITTEE APPROVES THE RETURN, AND THE FINANCE COMMITTEE CHAIR MAKES A RECOMMENDATION TO THE BOARD FOR APPROVAL OF THE FORM 990 FOR FILING WITH THE IRS. BOARD MEMBERS RECEIVE THE FORM 990 AS HARD COPIES (MAILED OR HAND-DELIVERED) OR ELECTRONIC FILES (SENT VIA E-MAIL). FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: A CONFLICT OF INTEREST POLICY IS STATED IN THE EMPLOYEE HANDBOOK. PER THE BYLAWS, IF A QUESTION CONCERNING A CONFLICT OF INTEREST FOR ANY DIRECTOR IS RAISED, A WRITTEN SECRET BALLOT MAY BE USED BY THE REMAINING DIRECTORS TO DETERMINE IF SUCH CONFLICT OF INTEREST EXISTS. SHOULD A CONFLICT OF INTEREST, PECUNIARY OR OTHERWISE, BE DETERMINED FOR ANY DIRECTOR, SUCH DIRECTOR SHALL BE EXCLUDED FROM VOTING ON THAT SUBJECT MATTER. A SIMPLE, AFFIRMATIVE MAJORITY OF THOSE PRESENT SHALL RULE. IN ALL EVENTS, A DIRECTOR SHALL DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A CEO COMPENSATION REVIEW: THE CEO'S COMPENSATION WAS EVALUATED IN 2020 BY THE EXECUTIVE BOARD OF DIRECTORS USING A COMPREHENSIVE CEO PERFORMANCE EVALUATION TOOL. THE EXECUTIVE BOARD ASSESSED THE CEO'S INDIVIDUAL PERFORMANCE, THE ORGANIZATION'S PERFORMANCE, AND WHETHER THE CEO ACCOMPLISHED THE MUTUALLY-AGREED UPON OBJECTIVES FOR THE FISCAL YEAR BEING REVIEWED. THE HR DIRECTOR CONDUCTS AN IN-DEPTH SALARY ANALYSIS ON A BI-ANNUAL BASIS WITH A CURSORY ANALYSIS DURING THE ALTERNATE YEARS. THE DATA USED IS OBTAINED LOCALLY, REGIONALLY, AND NATIONALLY. THIS ANALYSIS IS COMPILED AND A RECOMMENDATION IS TAKEN TO THE EXECUTIVE BOARD. THE CEO'S ANNUAL PERFORMANCE EVALUATION IS CALCULATED BY THE EXECUTIVE BOARD TO DETERMINE THE CURRENT YEAR SALARY, AND THE SALARY ANALYSIS IS COMPARED TO ENSURE THAT THE SALARY IS APPROPRIATE FOR THE POSITION AND PERFORMANCE. FORM 990, PART VI, SECTION B, LINE 15B OTHER OFFICER COMPENSATION REVIEW: THE CFO'S AND THE CMO'S COMPENSATION WAS EVALUATED IN 2019 BY THE CEO USING A COMPREHENSIVE PERFORMANCE EVALUATION TOOL. THE CEO ASSESSED THE CFO'S AND THE CMO'S INDIVIDUAL PERFORMANCE, THE ORGANIZATION'S PERFORMANCE, AND WHETHER THE CFO AND THE CMO ACCOMPLISHED THE MUTUALLY AGREED UPON OBJECTIVES FOR THE FISCAL YEAR BEING REVIEWED. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS WILL BE PROVIDED TO INQUIRING PARTIES UPON REQUEST.