2020-10-14T21:32:57-05:00 2019-11-30 410746749 CLIFTONLARSONALLEN LLP 1301 WEST 22ND STREET SUITE 1100 OAK BROOK IL 60523 990 2018-12-01 391908462 COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA COMM 6414462383 302 NE 14TH STREET LEON IA 50144 SAMANTHA CANNON CEO 6414462383 2020-10-13 1 CHRIS MANDERFIELD P01238973 6305738600 2020-10-12 67.137.57.251 2020-10-13 14:05:12 CD P 818A38AF944F766214C5223DB74141538F6091E6 DBDBF52EAC2BB495685EFE5302A3527750B2664D 2018 2021-01-29 14:40:06Z SAMANTHA CANNON 302 NE 14TH STREET LEON IA 50144 13874065 0 X WWW.CHCSI.ORG X 1997 IA CHCSI PROVIDES ACCESSIBLE, HIGH-QUALITY HEALTH CARE TO EVERYONE IN OUR REGION. 12 12 143 0 0 0 2274727 4261131 8841536 9384243 -9347 -7028 112716 1201 11219632 13639547 4162 0 0 0 6690537 8297608 0 0 0 3339386 3771723 10034085 12069331 1185547 1570216 5902536 8027120 2180008 2687099 3722528 5340021 X CHCSI PROVIDES ACCESSIBLE, HIGH-QUALITY HEALTH CARE TO EVERYONE IN OUR REGION. 0 0 4084897 4007639 COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA (CHCSI) WAS FUNDED AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) IN DECATUR COUNTY, IOWA, IN 2005. TODAY, CHCSI MANAGES TEN LOCATIONS, TWO OF WHICH PROVIDE PRIMARY AND PREVENTIVE HEALTH CARE SERVICES. THE REGION SERVED IS INCREDIBLY RURAL, AND ACCESSIBILITY CAN OFTEN PRESENT A BARRIER TO HEALTH CARE. THE COMMUNITIES SERVED ARE IN GREAT NEED OF THE ACCESSIBLE, AFFORDABLE PRIMARY AND PREVENTIVE HEALTH CARE, AND THE ORGANIZATION IS COMMITTED TO ENSURING THAT THE COMMUNITIES' NEEDS ARE MET. THE ORGANIZATION CURRENTLY SERVES 10,000 UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 23,000 VISITS ARE FOR MEDICAL SERVICES. THE ORGANIZATION CURRENTLY HAS 7 FTE MEDICAL PROVIDERS. 3832053 3759577 COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA IS THE ONLY FQHC IN THE STATE OF IOWA THAT HAS ALSO RECEIVED THE DESIGNATION OF BEING A COMMUNITY MENTAL HEALTH CENTER (CMHC). CHCSI CURRENTLY PROVIDES MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES IN THE IOWA COUNTIES OF APPANOOSE, LUCAS, MONROE, WAYNE, AND DECATUR. TELEMEDICINE SERVICES ARE PROVIDED IN FIVE OF THE SIX LOCATIONS. THE ORGANIZATION CURRENTLY SERVES 10,000 UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 25,000 VISITS ARE FOR BEHAVIORAL HEALTH SERVICES AND 2,000 ARE FOR SUBSTANCE ABUSE SERVICES. THE ORGANIZATION CURRENTLY HAS 25 FTE BEHAVIORAL PROVDERS AND 4 FTE SUBSTANCE ABUSE PROVIDERS. 508506 498889 DENTAL SERVICES: COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA BEGAN PROVIDING ORAL HEALTH SERVICES IN THE LEON, IOWA FACILITY IN JANUARY 2011. THE ORGANIZATION CURRENTLY SERVES 10,000, UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 3,000 VISITS ARE FOR DENTAL SERVICES. THE ORGANIZATION CURRENTLY HAS 3 FTE DENTAL PROVIDERS. 47461 46563 COMMUNITY HEALTH CENTERS OF SOUTHERN IOWA BEGAN PROVIDING VISION SERVICES IN 2016. THE ORGANIZATION CURRENTLY SERVES APPROXIMATELY 10,000 UNIQUE PATIENTS, CONDUCTING APPROXIMATELY 54,000 PATIENT VISITS ANNUALLY (2019 UDS). OF THESE, APPROXIMATELY 300 ARE FOR VISION SERVICES. THE ORGANIZATION CURRENTLY HAS .07 FTE VISION PROVIDERS. 1084486 1063975 CHCSI BEGAN PROVIDING IN HOUSE PHARMACY SERVICES IN THE LEON, IOWA FACILITY IN 2017. THE ORGANIZATION CURRENTLY HAS 2.25 FTE PHARMACISTS. IN 2019, APPROXIMATELY 20,500 PRESCRIPTIONS WERE DISPENSED. 1131947 1110538 9557403 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 43 0 143 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X SAMANTHA CANNON 6414462383 302 NE 14TH STREET LEON IA 50144 SHIRLEY KESSEL BOARD PRESIDENT 1.00 X X 0 0 0 SHARON SOUTH BOARD VICE PRESIDENT 1.00 X X 0 0 0 MARCY BIESEMEYER BOARD MEMBER 1.00 X 0 0 0 LINDA BAYNES BOARD MEMBER 1.00 X 0 0 0 JUSTIN AKERS BOARD TREASURER 1.00 X X 0 0 0 DIEN JUDGE BOARD MEMBER 1.00 X 0 0 0 ALAN WILSON AT-LARGE 1.00 X 0 0 0 MARK WAITS BOARD MEMBER 1.00 X 0 0 0 ALAN DYKENS BOARD MEMBER 1.00 X 0 0 0 PATRICIA MAGLE LEFT 819 BOARD MEMBER 1.00 X 0 0 0 BILL MORAIN SECRETARY 1.00 X X 0 0 0 JONATHAN ERB 1019 BOARD MEMBER 1.00 X 0 0 0 RACHEL CECIL 519 BOARD MEMBER 1.00 X 0 0 0 SAMANTHA CANNON CEO 40.00 X 134116 0 5965 JANEEN EDDY CCO 40.00 X 86751 0 4070 JANELLE ANDERS CFO 40.00 X 11055 0 1042 DR ROSHAN DASARI PSYCHIATRIST 40.00 X 313590 0 13144 DR LARRY RICHARD MD 40.00 X 229001 0 9760 DR NATHAN ALLEN DO 40.00 X 209849 0 8994 DR MARK EASTER DO 40.00 X 210004 0 9000 JENNIFER SPOERL ARNP 40.00 X 164912 0 7196 1359278 0 59171 8 0 1 0 INTEGRATED TELEHEALTH PARTNERS 318 5TH STREET WEST DES MOINES IA 50265 TELEHEALTH SERVICES 415386 JAMES BROOKS PO BOX 1030 KALAHEO HI 96741 CONTRACT DOCTOR 183240 BKD LLP 910 E ST LOUIS STREET SUITE 400 SPRINGFIELD MO 65806 ACCOUNTING 130883 3 4170675 90456 4261131 PATIENT REVENUE 621400 9202960 9202960 OTHER REVENUE 621400 181283 181283 9384243 572 572 1201 0 1201 1201 1201 226918 234518 -7600 -7600 -7600 13639547 9376643 0 1773 243000 243000 6564767 5125163 1439604 163012 117528 45484 811992 585430 226562 514837 393558 121279 16770 16770 23639 23639 937887 664870 273017 66041 66041 196165 132888 63277 404654 404654 171647 171647 127219 85728 41491 95025 95025 48369 39453 8916 460850 411552 49298 62819 62819 MEDICAL SUPPLIES, DRUGS 890956 890956 REPAIRS AND MAINTENANCE 117061 117061 DUES AND SUBSCRIPTIONS 80804 80804 MISCELLANEOUS EXPENSES 61445 61445 10372 10372 12069331 9557403 2511928 0 130499 81703 72304 105973 55703 192763 761108 742803 217644 264900 63128 54421 8910767 2492346 4483289 6418421 118861 166136 5902536 8027120 1015362 1929620 1164646 757479 2180008 2687099 X 3710110 5252603 12418 87418 3722528 5340021 5902536 8027120 1570216 47277 0 X X 0 1 X 1 1 1 X 1272808 2728503 2335002 2274727 4261131 12872171 1272808 2728503 2335002 2274727 4261131 12872171 12872171 1613 3217 2439 1533 1773 10575 12882746 0.99920 0.99200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 19440 19440 4757839 1258249 3499590 83045 28297 54748 1782564 1205800 576764 2267879 2267879 6418421 X 13639547 0 13639547 0 13639547 12069331 0 12069331 0 12069331 PART X, LINE 2: THE ORGANIZATION IS TAX-EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND NOT A PRIVATE FOUNDATION AS DESCRIBED IN SECTION 509(A) FOR FEDERAL PURPOSES. THE ORGANIZATION IS ALSO TAX-EXEMPT UNDER IOWA STATUTES FOR STATE PURPOSES. CONSEQUENTLY, THE ORGANIZATION RECORDS NO PROVISION FOR INCOME TAXES. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. AS A RESULT OF THE APPLICATION OF THE STANDARD, THE ORGANIZATION HAS RECOGNIZED NO LIABILITY FOR UNRECOGNIZED TAX BENFITS. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. SCHEDULE D, PARTI VI, LINE 1E THE $2,267,879 OTHER LAND, BUILDING AND EQUIPMENT ASSET REPRERESNTS THE CURRENT COST OF A NEW FACILITY UNDER CONSTRUCTION. X X X 0 0 0 0 0 0 0 0 0 DR ROSHAN DASARI PSYCHIATRIST 250240 0 63350 0 0 0 12544 0 600 0 326734 0 0 0 DR LARRY RICHARD MD 219401 0 9600 0 0 0 9160 0 600 0 238761 0 0 0 DR NATHAN ALLEN DO 205849 0 4000 0 0 0 8394 0 600 0 218843 0 0 0 DR MARK EASTER DO 206004 0 4000 0 0 0 8400 0 600 0 219004 0 0 0 JENNIFER SPOERL ARNP 160912 0 4000 0 0 0 6596 0 600 0 172108 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE ELECTED BY THE FULL BOARD OF DIRECTORS AND SHALL CONSIST OF THE CHAIRPERSON, VICE-CHAIRPERSON, SECRETARY, TREASURER, IMMEDIATED PAST CHAIRPERSON, AND ONE AT-LARGE MEMBER ELECTED BY THE BOARD. BETWEEN MEETING OF THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE SHALL, EXCEPT AS OTHERWISE PROVIDED BY LAW OR THE BYLAWS, HAVE THE POWER OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE MAY ALSO MEET IN PLACE OF THE BOARD OF DIRECTORS IF DEEMED APPROPRIATE BY MAJORITY VOTE OF THE BOARD. THE COMMITTEE SHALL PROVIDE GENERAL OVERSIGHT AND SHALL PROVIDE ADVICE AND COUNSEL TO THE CHIEF EXECUTIVE OFFICER. THE COMMITTEE WILL REVIEW BYLAWS OF THE CORPORATION, AND SHALL MAKE RECOMMENDATIONS TO THE BOARD CONCERNING REVISIONS OR AMENDMENTS TO THE SAME. ACTIONS SHALL BE EXCERCISED BY A MAJORITY VOTE OF THE EXECUTIVE COMMITTEE. 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 ORGANIZATIONS. PRIOR TO FILING, A DRAFT OF THE RETURN IS REVIEWED BY THE CEO. ONCE ANY UPDATES ARE MADE, A FINAL COPY IS PROVIDED TO THE FULL BOARD OF DIRECTORS FOR COMMENTS BEFORE THE RETURN IS FILED WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY INQUIRES INTO POTENTIAL CONFLICTS OF INTEREST AMONG INTERESTED PERSONS AND BETWEEN INTERESTED PERSONS AND THE ORGANIZATION. CONFLICTS SHOULD BE DISCLOSED PRIOR TO SPECIFIC BOARD DISCUSSIONS THAT MAY BE SENSITIVE TO ALLEGATIONS OF CONFLICT. IF A CONFLICT EXISTS, THE INTERESTED PERSON WILL REFRAIN FROM VOTING ON OR MAKING DECISIONS RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE CEO SALARY IS REVIEWED BY THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. THEY USE COMPARABLE DATA FROM SALARY WEBSITES AND THE SALARY AND WAGE SURVEY DONE BY OUR STATE PRIMARY CARE ASSOCIATION. HER REVIEW AND ANNUAL INCREASE IS BASED ON HER PERFORMANCE AND WORKPLACE QUESTIONAIRE THAT IS DONE ON AN ANNUAL BASIS. THE CEO REVIEWS AND DETERMINES THE OTHER OFFICERS AND KEY EMPLOYEES SALARY AND WAGES. THE SALARY AND WAGES ARE COMPARED TO SALARY AND WAGE SURVEY DONE BY OUR STATE PRIMARY CARE ASSOCIATION AND THE INCREASE IS FROM THEIR FORMAL REVIEW. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST