2020-11-16T09:34:37-06:00 2019-12-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST STE 101 RAPID CITY SD 57701 990 2019-01-01 460418932 COMMUNITY HEALTH CENTER OF THE BLACK HILLS COMM 6057218939 350 PINE STREET RAPID CITY SD 57701 TIM TRITHART CHIEF EXECUTIVE OFFICER 6057218939 2020-11-13 1 DEIDRE BUDAHL CPA P01273830 6053481930 2020-11-16 208.117.102.74 2020-11-16 09:33:20 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4209FC10985E69F276120298B2790CCA229C60DB 2019 2021-01-29 14:40:06Z TIM TRITHART 350 PINE STREET RAPID CITY SD 57701 9179455 0 X WWW.CHCBH.COM X 1992 SD TO PROVIDE QUALITY MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR THE COMMUNITY. 13 13 108 13 0 0 3255406 3710933 3685944 3477069 149609 171703 549372 1439834 7640331 8799539 0 0 0 0 5595052 5798228 0 0 95976 2531968 2460926 8127020 8259154 -486689 540385 6909575 7546540 2078399 2218225 4831176 5328315 TO PROVIDE QUALITY MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR THE COMMUNITY. 0 0 5707651 4587429 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. HAD 26,665 PATIENT VISITS DURING 2019 IN ITS HEALTHCARE CLINICS. WE PROVIDED PRIMARY PREVENTATIVE HEALTH CARE TO PEDIATRICS AND ADULTS. SERVICES INCLUDE FAMILY PLANNING, WOMEN'S HEALTH, MENTAL HEALTH, ACUTE WALK-IN CLINIC, PEDIATRICS, AN OUTREACH CLINIC FOR THE HOMELESS, AND A SCHOOL-BASED CLINIC. 970110 329474 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. HAD 3,930 PATIENT VISITS DURING 2019 IN THE ORAL HEALTH FACILITY. WE PROVIDE GENERAL DENTISTRY BY APPOINTMENT AND ACUTE WALK-IN VISITS. 64866 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. PERFORMS COMMUNITY AWARENESS CAMPAIGNS THROUGHOUT THE YEAR. 6742627 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 0 0 0 1 3 0 1 108 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X THE ORGANIZATION 6057218939 350 PINE STREET RAPID CITY SD 57701 MARY CORBINE PRESIDENT 1.00 X X 0 0 0 REBECCA MANN VICE PRESIDENT 1.00 X X 0 0 0 S ROY DISHMAN CPA TREASURER 1.00 0.25 X X 0 0 0 LOIS AMES SECRETARY 1.00 X X 0 0 0 RON REED DIRECTOR 1.00 0.25 X 0 0 0 ANTHONY ROBINSON DIRECTOR 1.00 X 0 0 0 TAMMY MISSELT DIRECTOR 1.00 X 0 0 0 TODD KENNER DIRECTOR 1.00 X 0 0 0 MATTHEW PAWELSKI DIRECTOR 1.00 X 0 0 0 JEANNE GALBRAITH DIRECTOR 1.00 X 0 0 0 LLOYD LACROIX DIRECTOR 1.00 X 0 0 0 LORI LARSON DIRECTOR 1.00 X 0 0 0 RICK STRACQUALURSI DIRECTOR 1.00 X 0 0 0 TIM TRITHART CEO 37.00 1.00 X 114782 0 25967 JAMIE DAHLMAN FINANCE DIRECTOR 36.00 1.00 X 79900 0 10497 DOUGLAS LEHMANN PROVIDER 35.00 X 208506 0 28911 THOMAS BENJAMIN DENTIST 34.00 X 183335 0 16281 GARY MEYERS PHARMACY DIRECTOR 38.00 X 133822 0 27245 SHIELA SZYMONSKI PEDIATRIC NURSE PRACTITIONER 36.00 X 127203 0 9561 JENNIFER SOBOLIK NURSE PRACTITIONER 36.00 X 110253 0 12727 957801 0 131189 8 0 1 0 KT CONNECTIONS 829 QUINCY ST STE A RAPID CITY SD 57701 IT CONSULTING 342091 RCS CONSTRUCTION PO BOX 9337 RAPID CITY SD 57709 CONSTRUCTION BEH HEALTH POD 309690 LABCORP OF AMERICA PO BOX 12140 BURLINGTON NC 272162140 OUTSOURCED LAB SERVICES 146611 MARK GARRY 1141 CREEDSIDE VIEW RAPID CITY SD 57701 PHYSICIAN CONTRACT 112738 GREENWAY PO BOX 203658 DALLAS TX 75320 MAINTENANCE OF ELECTRONIC MEDIAL RECORDS 108923 5 44768 3625104 41061 3710933 PATIENT SERVICES 621110 3157269 3157269 WIC CONTRACT REVENUE 621110 205898 205898 FAMILY PLANNING REVENUE 621110 113902 113902 3477069 171703 171703 1819658 379916 1439742 1439742 MEDICAL RECORDS 621110 92 92 92 8799539 4916903 0 171703 231146 231146 4160995 3795017 293097 72881 1051651 915200 136451 354436 304258 44603 5575 1974 1974 32557 32557 745430 379322 348588 17520 33744 33744 231328 114557 116771 605631 536423 69208 40650 40650 229711 225765 3946 44242 44242 MEDICAL SUPPLIES & EQUI 410626 389831 20795 EDUCATION & RECRUITING 52052 41604 10448 COLLECTIONS 32981 32981 8259154 6742627 1420551 95976 685748 907552 200 28050 204445 175840 414393 512996 4247632 4247632 219852 233645 31807 69481 2632288 1292250 963907 1340038 141591 31306 6909575 7546540 596629 595402 931711 915320 550059 707503 2078399 2218225 X 4646079 5260373 185097 67942 4831176 5328315 6909575 7546540 540385 -43246 0 X X 0 1 X 1 1 1 X 4802350 2783596 3205938 3255406 3710933 17758223 4802350 2783596 3205938 3255406 3710933 17758223 380085 17378138 102859 163728 149373 149873 171703 737536 18495759 23337699 0.93960 0.94420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32466 108 32358 393615 50004 343611 2049105 1242138 806967 157102 157102 1340038 ACCRUED INTEREST EXPENSE 9837 LEASE PAYABLE DUE TO ESCALATING LEASE PAYMENTS 697666 707503 X PART X, LINE 2: AS OF DECEMBER 31, 2019, CHCBH HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. CHCBH'S INCOME TAX FILINGS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES. CHCBH IS NO LONGER SUBJECT TO FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR YEARS BEFORE 2016. MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATION, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. CHCBH BELIEVES ITS ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. INTEREST AND PENALTIES ASSESSED BY INCOME TAXING AUTHORITIES, IF ANY, ARE INCLUDED IN INTEREST EXPENSE. X X X 0 0 0 0 0 0 0 0 0 DOUGLAS LEHMANN PROVIDER 208506 0 0 0 0 0 0 0 28911 0 237417 0 0 0 THOMAS BENJAMIN DENTIST 183335 0 0 0 0 0 0 0 16281 0 199616 0 0 0 GARY MEYERS PHARMACY DIRECTOR 133822 0 0 0 0 0 0 0 27245 0 161067 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE FORM 990 WAS PROVIDED TO MANAGEMENT AND THE FINANCE COMMITTEE. MANAGEMENT REVIEWED THE DRAFT AND SUGGESTED CHANGES TO THE PREPARER. THE FINANCE COMMITTEE REVIEWED AND APPROVED THE FINAL DRAFT. THE FINANCE COMMITTEE REPORTED TO THE FULL BOARD THAT A REVIEW AND APPROVAL OF THE 990 HAD BEEN PERFORMED. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND DIRECTORS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST ANNUALLY. MANAGEMENT REVIEWS ALL CONFLICT OF INTEREST STATEMENTS ANNUALLY TO ENSURE THAT ALL APPLICABLE PERSONS HAVE COMPLETED THE STATEMENTS AND THAT THE ORGANIZATION IS NOT ENGAGED IN ACTIVITIES THAT MAY CAUSE A CONFLICT OF INTEREST. AT THE BEGINNING OF EACH BOARD MEETING, ALL DIRECTORS ARE ASKED TO IDENTIFY ANY CONFLICTS WITH THE AGENDA. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD DETERMINES THE ANNUAL SALARY OF THE CEO BASED ON SALARY INFORMATION AVAILABLE FOR COMMUNITY HEALTH CENTERS. THE APPROVAL OF THE CEO'S SALARY IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PART XII, LINE 2C THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR HIRING AN INDEPENDENT ACCOUNTANT AND OVERSEEING THE AUDIT PROCESS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CHCBH QALICB INC 350 PINE STREET RAPID CITY SD 57701 472820304 SUPPORTING THE ACTIVITIES OF COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC SD 503(C)(3) 509(A)(3) 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 CHCBH QALICB INC K 524337 STRAIGHT-LINE LEASE EXPENSE