2020-04-13T11:12:57-05:00 2019-09-30 BKD LLP 201 N Illinois Street Indianapolis IN 46204 990 2018-10-01 351875364 Heart City Health Center Inc % ERNEST SMITH HEAR 5742930052 236 SIMPSON AVENUE ELKHART IN 46516 ESLEEN FULTZ CEO 5742930052 2020-08-15 true NICOLE B FISHBACK P01279475 3173834000 2020-08-15 167.68.126.162 43033020201045000035 2020-04-13 P 0E5A66BCFA8A901678C95AB5123EFFCB93BC0432 9B5ABA5A5A3316C8FEF8FB4057D6A7929F00F476 2018 2021-01-29 14:40:06Z ESLEEN FULTZ 236 SIMPSON AVENUE ELKHART IN 46516 11410340 false X WWW.HEARTCITYHEALTH.ORG X 1993 IN HEART CITY HEALTH CENTER, INC. IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) PROVIDING COMPREHENSIVE PRIMARY HEALTHCARE AND EDUCATION FOR THE ELKHART COMMUNITY. 10 10 138 11 41732 3357530 3423672 5204846 6256877 101419 93271 337872 396342 9001667 10170162 0 0 0 0 6105416 6707957 0 0 3751 2893676 3305516 8999092 10013473 2575 156689 10476339 11279116 659899 1319410 9816440 9959706 X HEART CITY HEALTH CENTER, INC. (HEART CITY) IS A NON-PROFIT, FEDERALLY QUALIFIED HEALTH CENTER (FQHC) PROVIDING AFFORDABLE, HIGH QUALITY, PRIMARY HEALTH, BEHAVIORAL HEALTH, DENTAL AND PHARMACEUTICAL CARE TO RESIDENTS OF ELKHART AND SURROUNDING COUNTIES. (SEE SCH O) false false 6412081 5760936 HEART CITY HEALTH CENTER, INC. (HEART CITY) PROVIDES MEDICAL AND BEHAVIORAL HEALTHCARE IN THE AREA OF ADULTS AND PEDIATRICS TO THE PRIMARILY MEDICARE, MEDICAID, AND UNINSURED POPULATION OF ELKHART COUNTY. DURING THE YEAR ENDED SEPTEMEBER 30, 2019, HEART CITY PROVIDED 33,216 MEDICAL VISITS AND 2,272 BEHAVIORAL HEALTH VISITS TO 11,758 UNDUPLICATED PATIENTS. 835650 495941 HEART CITY HEALTH CENTER, INC.'S (HEART CITY) LICENSED DENTISTS AND HYGIENISTS PROVIDE A LOW-COST OPTION FOR QUALITY GENERAL DENTISTRY SERVICES TO PEOPLE OF ALL AGES, INCOMES AND BACKGROUNDS, BUT PRIMARILY SERVES MEDICAID AND UNINSURED PATIENTS. DURING THE YEAR ENDED SEPTEMBER 30, 2019, HEART CITY SERVED 1,614 UNDUPLICATED PATIENTS PROVIDING 3,785 VISITS. VARIOUS DENTAL SERVICES PROVIDED INCLUDE: EXAMINATIONS; TREATMENT PLANNING; CHILDREN'S DENTISTRY; CLEANING/DENTAL HYGIENE; EXTRACTIONS; FILLINGS; RADIOGRAPHS; AND PATIENT EDUCATION. 396342 HEART CITY HAS AN ONSITE PHARMACY AT OUR SIMPSON STREET LOCATION WHICH PROVIDES CONVENIENT PRESCRIPTION SERVICES TO OUR PATIENTS AND THE COMMUNITY. DURING THE YEAR ENDED SEPTEMBER 30, 2019 THE PHARMACY FILLED 30,316 PRESCRIPTIONS FOR 2,755 PATIENTS. 7247731 true true false false false false false false false false true false false false true true 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 18 0 138 true true true false false false false false false false false false false false X 10 10 false false false false false false false true true false false true true true true true true true false false IN X ERNEST SMITH 5749701448 236 SIMPSON AVENUE ELKHART IN 46516 X DELIA VAZQUEZ BOARD MEMBER 1.0 0.0 X 0 0 0 ANGELIA WASHINGTON TREASURER 1.0 0.0 X X 0 0 0 ROBERT TAYLOR BOARD MEMBER 1.0 0.0 X 0 0 0 MILLIE HERNANDEZ BOARD MEMBER 1.0 0.0 X 0 0 0 ROD ROBERSON BOARD MEMBER (Ended 9/19) 1.0 0.0 X 0 0 0 ANTHONY HUNT VICE-CHAIR 1.0 0.0 X X 0 0 0 TARA MORRIS CHAIRMAN 1.0 0.0 X X 0 0 0 ANA ROSA GARCIA BOARD MEMBER (Ended 10/18) 1.0 0.0 X 0 0 0 ARVIS DAWSON SECRETARY 1.0 0.0 X X 0 0 0 ANTHONY ENGLAND BOARD MEMBER 1.0 0.0 X 0 0 0 ESLEEN FULTZ CHIEF EXECUTIVE OFFICER 40.0 0.0 X 241557 0 13113 PATRICIA KLINGER CFO (Ended 5/19) 40.0 0.0 X 105836 0 17264 DR MARTINA MCGOWAN COO / CMO (Ended 8/19) 40.0 0.0 X 139721 0 9883 DR OMOBOLA OLANIYAN CHIEF MEDICAL OFF.(ENDED 9/18) 40.0 0.0 X 224148 0 11824 ERNEST SMITH CFO (Began 6/19) 40.0 0.0 X 0 0 0 DR MEENAKSHI GUPTA PEDIATRICIAN 40.0 0.0 X 170058 0 4938 DR CHRISTINE DANKWA PEDIATRICIAN 40.0 0.0 X 170357 0 4938 DR DWAYNE JOHNSON PEDIATRICIAN 40.0 0.0 X 158298 0 24906 DR MARY P MCMANMON FAMILY DOCTOR 32.0 0.0 X 165351 0 11942 ESSAM MONTASIR INTERNIST 40.0 0.0 X 202754 0 20397 1578080 0 119205 14 false true false ELKHART GENERAL HOSPITAL PO BOX 1329 ELKHART IN 46515 PHARMACIST CHARGES 167330 TODD ALLEN DESIGN 2812 WARREN STREET ELKHART IN 46516 MARKETING/ADVERTISIN 140437 INDEMAND INTERPRETING PO BOX 675248 DETROIT MI 482675248 INTERPRETING SERVICE 116604 3 63333 2996574 363765 241011 3423672 MEDICAL SERVICES 624100 5750343 5750343 DENTAL SERVICES 624100 495941 495941 MEDICAL RECORDS 900099 5068 5068 MISCELLANEOUS REVENUE 900099 5525 5525 6256877 81784 81784 0 0 0 0 0 211005 199518 11487 11487 11487 0 0 0 0 0 0 1437002 1040660 396342 354610 41732 0 10170162 6611487 41732 93271 0 0 0 0 672615 489699 182916 0 5021842 3673471 1348371 83801 55237 28564 526073 374016 152057 403626 272596 131030 0 31019 31019 10130 10130 0 0 14794 14794 1079704 981692 98012 0 266078 139433 125869 776 612551 544247 68304 378757 105819 272938 0 297168 214757 82411 48238 16882 31356 0 55714 32608 23106 7081 7081 0 217443 151242 66201 51568 36273 15295 DUES & SUBSCRIPTIONS 64750 16200 45575 2975 EMPLOYEE RELATIONS 54578 39946 14632 UNIFORMS 9617 8607 1010 BAD DEBTS 61179 61179 0 45147 26746 18401 10013473 7247731 2761991 3751 1100 1150 4057917 2957930 53523 53524 748269 848658 0 0 0 0 0 0 260566 314948 76136 43793 6968046 1991687 3246607 4976359 2007609 1989337 24612 93417 0 0 0 0 0 0 10476339 11279116 602507 889359 0 0 0 0 0 0 0 0 0 0 0 371296 0 0 57392 58755 659899 1319410 X 9791899 9959706 24541 0 0 0 9816440 9959706 10476339 11279116 X 156689 -14556 1133 X false true X true true true X 2823114 3222231 3181102 3357530 3466172 16050149 6301527 5509601 5794883 5513713 6568987 29688711 8299 10095 5284 0 0 23678 0 0 9132940 8741927 8981269 8871243 10035159 45762538 0 0 0 45762538 37765 50695 52958 77205 81784 300407 0 37765 50695 52958 77205 81784 300407 0 0 9170705 8792622 9034227 8948448 10116943 46062945 0.99348 0.99430 0.00652 0.00570 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 213700 213700 1490772 277904 1212868 4248670 1426925 2821745 638181 286859 351322 376724 376724 4976359 0 DRUGS AND PHARMACEUTICALS HELD 58755 58755 11135363 -14556 13937 1041793 1041174 10094189 14794 61179 75973 10170162 10992097 13937 1040660 1054597 9937500 14794 61179 75973 10013473 SCHEDULE D, PART X, LINE 2 FIN 48: 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 OTHER RECONCILING ITEMS: COST OF GOODS SOLD-PHARMACY: $1,040,660 CHANGE IN BENEFICIAL INTEREST AT COMMUNITY FOUNDATION: 1,133 TOTAL: $1,041,793 SCHEDULE D, PART XI & XII, LINE 4B OTHER RECONCILING ITEMS: BAD DEBT: $61,179 SCHEDULE D, PART XII, LINE 2D OTHER RECONCILING ITEMS: COST OF GOODS SOLD-PHARMACY: $1,040,660 X false true X X X true false false false false false false true false ESLEEN FULTZ CHIEF EXECUTIVE OFFICER 211107 0 30450 0 0 0 5202 0 7911 0 254670 0 0 DR OMOBOLA OLANIYAN CHIEF MEDICAL OFF.(ENDED 9/18) 132219 0 0 0 91929 0 5540 0 6284 0 235972 0 0 DR MEENAKSHI GUPTA PEDIATRICIAN 168742 0 1283 0 33 0 4219 0 719 0 174996 0 0 DR CHRISTINE DANKWA PEDIATRICIAN 169041 0 1283 0 33 0 4232 0 706 0 175295 0 0 DR DWAYNE JOHNSON PEDIATRICIAN 156840 0 1354 0 104 0 0 0 24906 0 183204 0 0 DR MARY P MCMANMON FAMILY DOCTOR 164035 0 1283 0 33 0 4165 0 7777 0 177293 0 0 0 ESSAM MONTASIR INTERNIST 201296 0 1354 0 104 0 5175 0 15222 0 223151 0 0 SCHEDULE J, PART I, LINE 1A GROSS-UP PAYMENTS: ESSAM MONTASIR, MEENAKSHI GUPTA, CHRISTINE DANKWA, DWAYNE JOHNSON, MARTINA MCGOWAN, MARY P. MCMANMON, AND PATRICIA KLINGER EACH RECEIVED A TAX GROSS UP ON THE BONUS PAYMENT THEY RECEIVED. THIS WAS INCLUDED ON THEIR W-2. SCHEDULE J, PART I, LINE 4C DR. OLANIYAN SIGNED A SEPARATION AGREEMENT THAT INCLUDED CONTINUATION OF SALARY THROUGH 12/31/18 AND A ONE TIME $5,000 PAYMENT AS SEVERANCE. SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: THE BONUS PAYMENTS ARE BASED ON LENGTH OF SERVICE FOR THE YEAR TO WHICH THE BONUS RELATES AND POSITION HELD. BONUS IS PAID ONLY IF PAYMENT RECEIVED FROM MANAGED CARE ENTITY FOR MEETING TARGETS. THE BOARD OF DIRECTORS DETERMINES WHETHER IT IS TO BE SHARED WITH EMPLOYEES EACH YEAR. THE EXECUTIVE BOARD MEMBERS ALSO DECIDE THE ANNUAL BONUS FOR THE CEO AS PART OF THE PERFORMANCE EVALUATION. THE BONUS IS A PERCENTAGE OF THE EXISTING COMPENSATION, NOT BASED ON THE COMPENSATION WITH RAISE. THE BONUS IS BASED ON NATIONAL COMPENSATION PACKAGE REPORTS AND PERFORMANCE OF THE CEO. OPTIONS FOR THE BONUS ARE LISTED ON THE EVALUATION AS WELL AS AN OPTION FOR NO BONUS. THE EXECUTIVE COMMITTEE AGREE ON THE AMOUNT AND FILE THEIR DECISION WITH EVALUATION AND RAISE INFORMATION WITH HEART CITY HEALTHS ATTORNEY, BARNES & THORNBURG. X 102 248483 MARKET VALUE false true false SCH M, PART I EXPLANATIONS OF REPORTING METHOD FOR NUMBER OF CONTRIBUTIONS: DRUGS AND MEDICAL SUPPLIES ARE REPORTED BY THE NUMBER OF CONTRIBUTIONS FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION: HEART CITY HEALTH CENTER OFFERS A SLIDING FEE SCALE BASED ON INCOME AND FAMILY SIZE FOR THE UNINSURED, UNDER-INSURED AND ALSO ACCEPT MEDICAID, MEDICARE AND SOME PRIVATE INSURANCES. HEART CITY IS COMMITTED TO REDUCING HEALTH DISPARITIES AMONG RESIDENTS BY PROVIDING PROFESSIONAL AND RESPECTFUL SERVICE TO ELKHART AND SURROUNDING COUNTIES THROUGH EDUCATION AND HIGH QUALITY PRIMARY MEDICAL CARE FOR THOSE IN NEED AND EXPERIENCING BARRIERS TO TRADITIONAL HEALTH CARE. THE MAJORITY OF HEART CITY'S PATIENTS ARE AT 100% OR BELOW THE FEDERAL POVERTY GUIDELINES, AND ALMOST 50% OF PATIENTS ARE UNDER THE AGE OF 18. HEART CITY IS ONE OF THE FEW SITES IN THE ELKHART AREA THAT PROVIDES SERVICES TO MEDICAID PATIENTS AND THE UNINSURED POPULATION. FORM 990, PART VI, LINE 1A DELEGATE BROAD AUTHORITY TO A COMMITTEE: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE FOLLOWING OFFICERS OF THE CORPORATION, ALL OF WHOM SHALL HAVE THE RIGHT TO VOTE: CHAIRPERSON, VICE CHAIR, SECRETARY AND TREASURER. THE CHIEF EXECUTIVE OFFICER SHALL BE A NON-VOTING MEMBER OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE THE FOLLOWING GENERAL AUTHORITY; THE EXECUTIVE COMMITTEE SHALL BE COMPROMISED EXCLUSIVELY OF BOARD MEMBERS AND SHALL ACT FOR THE CORPORATION IN THE INTERIM PERIODS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS ONLY WITH RESPECT TO MATTERS OF AN URGENT NATURE AND THEN TO THE MAXIMUM EXTENT FEASIBLE, IN COMPLIANCE WITH THE ESTABLISHED POLICIES AND EXPRESSED POSITIONS OF THE BOARD. ANY SUCH ACTIONS BY THE EXECUTIVE COMMITTEE ON BEHALF OF THE CORPORATION SHALL REQUIRE RATIFICATION AT THE FOLLOWING REGULAR OR SPECIAL MEETING WHERE A QUORUM IS PRESENT. THE CHAIRPERSON OF THE BOARD OF DIRECTORS OR ANY THREE (3) EXECUTIVE COMMITTEE MEMBERS CONVENES. SAID WRITTEN NOTICE SHALL BE DELIVERED TO THE REMAINING MEMBERS OF THE EXECUTIVE COMMITTEE. A MAJORITY OF THE OFFICERS PRESENT AND IN PERSON, SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF EXECUTIVE COMMITTEE BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY: THE ORGANIZATION'S FORM 990 IS REVIEWED IN DETAIL BY THE EXECUTIVE MANAGEMENT. A BOARD MEETING IS THEN HELD TO PRESENT AND REVIEW A FINAL DRAFT OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES; EACH BOARD MEMBER IS PROVIDED A COPY OF THE RETURN AT THE BOARD MEETING AND IS ALLOWED TO ASK ANY QUESTIONS THEY MAY HAVE. ONCE ALL QUESTIONS ARE ANSWERED, THE BOARD VOTES TO APPROVE SUBMISSION BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: AN ANNUAL CONFLICT OF INTEREST FORM IS FILLED OUT BY EACH BOARD MEMBER. ALL OTHER EMPLOYEES SIGN THE CODE OF CONDUCT POLICY AT THE TIME OF HIRE WHICH COVERS CONFLICTS OF INTEREST. THE CEO AND THE BOARD LIAISON REVIEW THE CONFLICT OF INTEREST FORMS TO DETERMINE IF ANY POTENTIAL CONFLICT OF INTEREST EXISTS. IF A POTENTIAL CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE CEO AND EXECUTIVE COMMITTEE OF THE BOARD, CONSISTING OF THE CHAIR, VICE CHAIR, SECRETARY AND TREASURER, MEET TO DISCUSS WHETHER ANY ACTUAL CONFLICTS OF INTEREST EXIST. ALTHOUGH NO CONFLICTS HAVE BEEN NOTED IN THE PAST, IF A CONFLICT OF INTEREST WAS TO ARISE, RESTRICTIONS WOULD BE IMPOSED AND THE BOARD MEMBER WOULD BE REQUIRED TO EXCUSE THEMSELVES FROM ANY DISCUSSIONS AND/OR VOTES RELATED TO THE CONFLICTING ISSUE. FORM 990, PART VI, SECTION B, LINE 15A PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL: COMPENSATION FOR THE ORGANIZATION'S CEO IS DETERMINED BY THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE BASED ON A PERFORMANCE EVALUATION AND INTERVIEW WITH THE CEO. EACH EXECUTIVE BOARD MEMBER COMPLETES AN EVALUATION, AND THEN THE EXECUTIVE COMMITTEE REPORTS THE FINDINGS AND ANY CHANGES IN COMPENSATION TO THE CEO AND IT IS SENT TO THE HEART CITY HEALTH'S ATTORNEY. ANY CHANGES IN COMPENSATION ARE BASED ON COMPILED NATIONAL BENCHMARKING SALARY REPORTS. THIS PROCESS HAS BEEN PERFORMED ANNUALLY IN THE PAST. HOWEVER A REVIEW AND COMPENSATION CHANGE HAS NOT OCCURRED SINCE THE LAST ONE ON SEPTEMBER OF 2018. THE EVALUATION AND REVIEW PROCESS IS SIGNED BY THE EXECUTIVE BOARD COMMITTEE AND IS DOCUMENTED AND ON FILE WITH HEART CITY HEALTH'S ATTORNEY, BARNES & THORNBURG FORM 990, PART VI, LINE 15B PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES: THE ORGANIZATION'S CEO COMPLETES AN ANNUAL PERFORMANCE EVALUATION FOR THE CFO; BASED ON THE OUTCOME OF THE PERFORMANCE EVALUATION AND THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) SALARY SURVEYS, THE CFO'S COMPENSATION IS REVIEWED AND ADJUSTED AS NECESSARY. THE ORGANIZATION'S CEO ALSO COMPLETES AN ANNUAL PERFORMANCE EVALUATION FOR THE CMO; BASED ON THE OUTCOME OF THE PERFORMANCE EVALUATION AND GENERAL COMPENSATION GUIDELINES SET BY THE BOARD, THE CMO'S EMPLOYMENT CONTRACT IS UPDATED AS NECESSARY. THESE PERFORMANCE EVALUATIONS AND COMPENSATION/EMPLOYMENT CONTRACT UPDATES WERE LAST COMPLETED DURING THE FISCAL YEAR ENDED 10/01/2018. FORM 990, PART VI, SECTION C, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: CHANGE IN BENEFICIAL INTEREST AT COMMUNITY FOUNDATION - $1,133 FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:11410 FORM 990 PART IX LINE 11G DESCRIPTION:DENTAL LABS TOTAL FEES:3430 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - BEHAVIOR TOTAL FEES:133360 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - MEDICAL TOTAL FEES:80200 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - EHR / PM TOTAL FEES:520583 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - SECURITY TOTAL FEES:60391 FORM 990 PART IX LINE 11G DESCRIPTION:INTERPRETING SERVICES TOTAL FEES:89348 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - CONSULTING TOTAL FEES:43105 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - PAYROLL TOTAL FEES:21987 FORM 990 PART IX LINE 11G DESCRIPTION:TELEPHONE SERVICE TOTAL FEES:95011 FORM 990 PART IX LINE 11G DESCRIPTION:ANSWERING SERVICE TOTAL FEES:7850 FORM 990 PART IX LINE 11G DESCRIPTION:CLAIMS PROCESSING TOTAL FEES:3860 FORM 990 PART IX LINE 11G DESCRIPTION:INTERNET SERVICE TOTAL FEES:9169