2019-11-01T17:04:41-05:00 2019-01-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2018-02-01 421374894 SIOUXLAND COMMUNITY HEALTH CENTER % JAN ANDERSON CFO SIOU 7122522477 1021 NEBRASKA STREET SIOUX CITY IA 51105 MARI KAPTAIN-DAHLEN CEO 2019-06-11 true Krystal K Creach P00422601 4178658701 167.68.126.162 43032920193055000015 2019-11-01 P 92996119D705B961BF1767000FEBD157C9C05609 9ED1AFD43ECA266599EA2022F4AABFE45DA09571 2018 2020-01-14 16:20:31Z MARI KAPTAIN-DAHLEN 1021 NEBRASKA STREET SIOUX CITY IA 51105 31266005 false X WWW.SLANDCHC.COM X 1991 IA TO BE A PATIENT-CENTERED MEDICAL HOME THAT IMPROVES THE PHYSICAL, DENTAL, AND BEHAVIORAL HEALTH OF THE SIOUXLAND COMMUNITY WHILE ELIMINATING ACCESS BARRIERS. 13 13 314 18 0 17025 6185636 6384273 22589917 24592669 103083 225216 48517 63847 28927153 31266005 156713 238275 0 0 16742611 18135861 0 0 0 8381591 10011841 25280915 28385977 3646238 2880028 29215477 31422910 7793855 7042949 21421622 24379961 X WE SERVE OUR COMMUNITY TO BRING HEALING THROUGH OUR COMMITMENT TO CARE. false false 16274704 238275 16207575 PRIMARY AND SPECIALTY MEDICAL SERVICES FOR FYE 2019, SCHC PROVIDED MEDICAL, PRENATAL, AND BEHAVIORAL HEALTH SERVICES FOR 72,813 PATIENT VISITS. SERVICES WERE PROVIDED BY SIX PRIMARY CARE PHYSICIANS, SIX PHYSICIAN ASSISTANTS, FIFTEEN NURSE PRACTITIONERS, AND A VARIETY OF VOLUNTEER SPECIALTY PROVIDERS FROM THE SIOUXLAND COMMUNITY. SPECIALTY CARE VOLUNTEERS PROVIDED THE FOLLOWING CARE: CARDIOVASCULAR, SURGERY, PODIATRY, OPTOMETRY AND NEPHROLOGY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 3187350 5228672 PHARMACY THE SCHC PHARMACY IS AVAILABLE TO ALL PATIENTS RECEIVING HEALTH CARE SERVICES AT THE HEALTH CENTER. THREE PHARMACISTS ARE ONSTAFF TO OFFER MEDICATION COUNSELING FOR PRESCRIPTIONS. IN ADDITION, THE HEALTH CENTER EMPLOYED ONE FULL-TIME CLINICAL PHARMACIST TO ASSIST PATIENTS WITH CHRONIC MEDICAL CONDITIONS. SCHCIS 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. 2838452 3156422 DENTAL CARE - SCHC EMPLOYED FIVE DENTISTS AND FIVE DENTAL HYGIENIST TO PROVIDE ROUTINE DENTAL CARE AND TREATMENT TO PATIENTS AGED INFANTS TO ADULTS. EMERGENCY WALK-IN PATIENTS ARE ACCEPTED DAILY. THE DENTAL DEPARTMENT HAD 17,221 PATIENT VISITS DURING THE YEAR ENDING 1/31/19. 22300506 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 71 0 true 314 true false false false false false false false false false false false false X 13 13 false false false false false false false true true false false true true true true true true true false false X JAN ANDERSON CFO 7122021002 1021 NEBRASKA STREET SIOUX CITY IA 51105 DAVID OLSON PRESIDENT 1.0 0.0 X X 0 0 0 ANDREA BUCKLEY VICE CHAIR 1.0 0.0 X X 0 0 0 DONA PRINCE TREASURER 1.0 0.0 X X 0 0 0 JENNIFER GOMEZ SECRETARY 1.0 0.0 X X 0 0 0 CHAD MARKHAM MEMBER AT LARGE 1.0 0.0 X X 0 0 0 OMAR SUAREZ DIRECTOR 1.0 0.0 X 0 0 0 BIBI GAZNABBI-JAURON DIRECTOR 1.0 0.0 X 0 0 0 KELLEY MCCARTHY DIRECTOR 1.0 0.0 X 0 0 0 JAY ROSENBERG DIRECTOR 1.0 0.0 X 0 0 0 FRANK LAMERE DIRECTOR 1.0 0.0 X 0 0 0 AMY SLEVIN DIRECTOR 1.0 0.0 X 0 0 0 JENNIFER BRAVANTE-BURKHART DIRECTOR 1.0 0.0 X 0 0 0 ABDULLAHI URUR DIRECTOR 1.0 0.0 X 0 0 0 JEFFREY DEAN DIRECTOR ENDING 5/2018 1.0 0.0 X 0 0 0 MICHAEL PIPLANI CMO 40.0 0.0 X 300892 0 19575 MARI KAPTAIN-DAHLEN CEO 40.0 0.0 X 209304 0 13089 JAN ANDERSON CFO 40.0 0.0 X 179850 0 27867 BRENDA HAUSMAN-MILLER DENTAL DIRECTOR 40.0 0.0 X 231674 0 32776 DAVID FALDMO PA PA - QUALITY DIRECTOR 40.0 0.0 X 255603 0 41290 KRISTI WALZ PHYSICIAN 40.0 0.0 X 274788 0 35756 GARY HATTAN PHYSICIAN 40.0 0.0 X 262029 0 40646 TYLER WENDEL PHYSICIAN 40.0 0.0 X 259617 0 37240 DYLAN GREENE PHYSICIAN 40.0 0.0 X 241359 0 40629 ANN PICK NURSE PRACTITIONER 40.0 0.0 X 184318 0 27880 2399434 0 316748 35 false true false INCONCERT CARE INC PO BOX 661 SIOUX CITY IA 50322 SOFTWARE SERVICES 559332 SIOUXLAND MEDICAL EDUC FOUNDATION 2501 PIERCE STREET SIOUX CITY IA 51104 PHYSICIANS-PRENATAL 366310 BKD LLP 910 E ST LOUIS ST STE 200 SPRINGFIELD MO 65810 AUDIT/TAX/CONSULTING 108987 3 6285775 98498 656616 6384273 NET PATIENT SERVICE REVENUE 624100 24420107 24420107 OTHER REVENUE 624100 155562 155562 EHR INCENTIVE REVENUE 624100 17000 17000 24592669 220216 220216 0 0 0 0 0 5000 5000 5000 0 0 0 0 0 0 0 0 0 Gain on Equity Investee 900099 63847 63847 63847 31266005 24592669 284063 207 207 238068 238068 0 0 1311920 881810 430110 0 13796774 11495115 2301659 559974 473306 86668 1469275 1117482 351793 997918 821905 176013 0 35406 35406 96529 96529 0 0 0 1555987 1141581 414406 92699 27886 64813 593074 387907 205167 709795 72560 637235 0 347807 280818 66989 16834 11810 5024 0 435466 295062 140404 219621 219621 0 891656 187366 704290 53288 2660 50628 MEDICAL SUPPLIES & DRUGS 3710457 3710457 BAD DEBT 1084202 1084202 LICENSES, DUES, SUBSCRIPTIONS 121177 59365 61812 RECRUITING & RETENTION 31258 10939 20319 16585 16585 28385977 22300506 6085471 0 359225 447555 13713370 16626825 900163 233595 2710680 2727076 0 0 0 0 0 0 208004 209436 115349 446930 17699507 7269711 10955836 10429796 0 0 62850 126697 0 0 0 0 190000 175000 29215477 31422910 2492396 2137086 0 0 0 0 4388705 4031420 0 0 0 0 0 0 0 0 912754 874443 7793855 7042949 X 21282930 24263307 138692 116654 0 0 21421622 24379961 29215477 31422910 2880028 78311 X false true X true true true X 4424315 4731092 5776438 6185636 6384273 27501754 0 0 4424315 4731092 5776438 6185636 6384273 27501754 0 27501754 8401 19427 31233 103083 220216 382360 0 0 27884114 106395331 0.98629 0.97933 X 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 $36,235 TO THE IOWA PRIMARY CARE ASSOCIATION. A PORTION OF THE DUES MAY BE ATTRIBUTABLE TO LOBBYING PURPOSES. 1271327 1271327 12663468 4950720 7712748 3722866 2318991 1403875 41846 41846 10429796 0 INTEREST RATE SWAP 384443 EST. DUE TO THIRD PARTIES 490000 874443 30282727 78311 5575 -425142 -341256 30623983 642022 642022 31266005 27302350 5575 -5000 575 27301775 1084202 1084202 28385977 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: $ (1,084,202) BAD DEBT EXPENSE 659,060 NET ASSETS RELEASED FROM RESTRICTION ------------- $ (425,142) SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 637,022 TEMPORARILY RESTRICTED CONTRIBUTIONS 5,000 GAIN ON DISPOSAL OF ASSET ------------- $ 642,022 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON FORM 990, PART VII, LINE 2D, BUT NOT ON LINE 1: $ 5,000 GAIN ON ASSET DISPOSAL SCHEDULE D, PART XII, LINE 4D AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 1,084,202 BAD DEBT EXPENSE true RENTAL ASSISTANCE PROGRAM 73 174583 CO-PAY ASSISTANCE PROGRAM 76 35405 FOOD ASSISTANCE PROGRAM 72 9475 UTILITIES ASSISTANCE PROGRAM 49 18605 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 285579 0 1160 0 14153 0 13750 0 5825 0 320467 0 0 0 MARI KAPTAIN-DAHLEN CEO 198858 0 1000 0 9446 0 10444 0 2645 0 222393 0 0 0 JAN ANDERSON CFO 170267 0 1000 0 8583 0 9313 0 18554 0 207717 0 0 0 KRISTI WALZ PHYSICIAN 254303 0 6340 0 14145 0 11062 0 24694 0 310544 0 0 0 GARY HATTAN PHYSICIAN 258986 0 1260 0 1783 0 13465 0 27181 0 302675 0 0 0 TYLER WENDEL PHYSICIAN 240548 0 17104 0 1965 0 13376 0 23864 0 296857 0 0 0 DYLAN GREENE PHYSICIAN 228743 0 5850 0 6766 0 12673 0 27956 0 281988 0 0 0 ANN PICK NURSE PRACTITIONER 170317 0 13110 0 891 0 9120 0 18760 0 212198 0 0 0 BRENDA HAUSMAN-MILLER DENTAL DIRECTOR 222344 0 5300 0 4030 0 7412 0 25364 0 264450 0 0 0 DAVID FALDMO PA PA - QUALITY DIRECTOR 216831 0 35710 0 3062 0 13339 0 27951 0 296893 0 0 0 SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: MONTHLY OR QUARTERLY 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 2968580 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 09/25/2017. X 5 656616 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 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 1/31/19, THE LABORATORY PERFORMED 598,183 TESTS. RADIOLOGY SCHC ALSO CONDUCTS RADIOLOGY SERVICES. IT PERFORMED 4,008 EXAMS FOR THE YEAR ENDING 1/31/19. HIV/AIDS AND HEPATITIS THE HIV TEAM SERVES THE TRI-STATE SIOUXLAND AREA, AS WELL AS 18 NORTHWEST IOWA COUNTIES, 4 COUNTIES IN NEBRASKA, AND 3 COUNTIES IN SOUTH DAKOTA. APPROXIMATELY 48% OF PATIENTS RECEIVING HIV/AIDS CARE LIVE IN RURAL AREAS. ADDITION TO MEDICAL CARE, THE HIV TEAM COORDINATES DENTAL CARE, CASE MANAGEMENT, TRANSPORTATION, AND HOUSING ASSISTANCE. FOR THE FISCAL YEAR ENDING 1/31/19, THE HIV TEAM SERVED 175 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 1/31/19, 14% OF PATIENTS RECEIVING CARE WERE UNINSURED, 48% HAD COVERAGE BY MEDICAID/HAWK-I, 13% HAD MEDICARE COVERAGE, AND 25% HAD COVERAGE BY OTHER SCHC EMPLOYED FOUR 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 2018 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 MUTUALLYNAGREED UPON OBJECTIVES FOR THE FISCAL YEAR BEING REVIEWED. THE HRNDIRECTOR 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 2018 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.