2018-08-30T16:41:29-05:00 2017-12-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2017-01-01 460418932 COMMUNITY HEALTH CENTER OF THE BLACK HILLS COMM 6057218939 350 PINE STREET RAPID CITY SD 57701 TIM TRITHART CHIEF EXECUTIVE OFFICER 6057218939 2018-08-30 1 DEIDRE BUDAHL CPA P01273830 6053481930 2018-08-30 2017 2022-09-23 18:48:47Z TIM TRITHART 350 PINE STREET RAPID CITY SD 57701 8384277 0 X WWW.CHCBH.COM X 1992 SD TO PROVIDE QUALITY MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR THE COMMUNITY. 12 12 108 12 0 0 2783596 3205938 4233914 4154600 151784 146742 273367 480314 7442661 7987594 0 0 0 0 5471590 5476610 0 0 0 2328471 2504044 7800061 7980654 -357400 6940 7587032 7632803 2285835 2269385 5301197 5363418 TO PROVIDE QUALITY MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR THE COMMUNITY. 0 0 4403100 3888664 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. HAD 29,018 PATIENT VISITS DURING 2017 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. 1337054 746250 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. HAD 7,045 PATIENT VISITS DURING 2017 IN THE ORAL HEALTH FACILITY. WE PROVIDE GENERAL DENTISTRY BY APPOINTMENT AND ACUTE WALK-IN VISITS. 58930 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. PERFORMS COMMUNITY AWARENESS CAMPAIGNS THROUGHOUT THE YEAR. 5799084 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 5 0 1 108 1 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 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 DAVID GOEHRING 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 PAWLEWSKI DIRECTOR 1.00 X 0 0 0 JEANNE GALBRAITH DIRECTOR 1.00 X 0 0 0 ROGER CORNELIUS DIRECTOR 1.00 X 0 0 0 TIM TRITHART CEO 39.00 1.00 X 107548 0 25495 JAMIE DAHLMAN FINANCE DIRECTOR 39.00 1.00 X 71784 0 11324 DOUGLAS LEHMANN PROVIDER 40.00 X 207766 0 28837 THOMAS BENJAMIN DENTIST 40.00 X 172093 0 10955 TIMOTHY KELLY DENTIST 40.00 X 161269 0 21058 JOAN BARKER MEDICAL DIRECTOR 40.00 X 145043 0 20221 AMANDA DIEHL PROVIDER 29.00 X 145078 0 16400 1010581 0 134290 13 0 1 0 GREENWAY PO BOX 203658 DALLAS TX 75320 MAINTENANCE OF ELECTRONIC MEDIAL RECORDS 136603 DR MARK GARRY 1141 CREEKSIDE VIEW LANE RAPID CITY SD 57701 BEHAVIORAL HEALTH SERVICES 136524 LABCORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 OUTSOURCED LAB SERVICES 127051 KT CONNECTIONS 829 QUINCY ST STE A RAPID CITY SD 57701 IT CONSULTING 119976 4 45996 3155577 4365 3205938 PATIENT SERVICES 621110 3908198 3908198 WIC CONTRACT REVENUE 621110 176469 176469 FAMILY PLANNING REVENU 621110 69933 69933 4154600 149373 149373 2631 -2631 -2631 -2631 872376 394052 478324 478324 MEDICAL RECORDS 621110 1990 1990 1990 7987594 4634914 0 146742 216149 216149 3933791 3408800 524991 996846 533095 463751 329824 265278 64546 15356 15356 47404 47404 729791 391775 338016 43283 43283 357239 163881 193358 603845 574078 29767 69514 69514 217580 214427 3153 23709 23365 344 MEDICAL SUPPLIES & EQUI 186633 169324 17309 BAD DEBTS 102178 102178 EDUCATION & RECRUITING 71952 55061 16891 COLLECTIONS 26819 26819 8741 8741 7980654 5799084 2181570 0 476089 584251 411166 329112 368386 274990 348082 365462 4247632 4247632 154393 325590 31735 41670 1955902 882387 1264551 1073515 284998 390581 7587032 7632803 525870 448656 1516127 1375246 243838 445483 2285835 2269385 X 4949333 5123720 351864 239698 5301197 5363418 7587032 7632803 6940 -39228 94509 0 X X 0 1 X 1 1 1 X 3699489 2748108 4802350 2783596 3205938 17239481 3699489 2748108 4802350 2783596 3205938 17239481 646877 16592604 275 457 102859 163728 149373 416692 17656173 21637983 0.93980 0.94570 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 55634 11242 44392 1900268 871145 1029123 1073515 OTHER RECEIVABLES 180286 ACCRUED INTEREST RECEIVABLE 32499 RECEIVABLE FROM CHCBH QALICB 177796 390581 ACCRUED INTEREST EXPENSE 12000 AMOUNT DUE TO RELATED PARTY 62498 LEASE PAYABLE DUE TO ESCALATING LEASE PAYMENTS 370985 445483 X PART X, LINE 2: AS OF DECEMBER 31, 2017, 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 2014. 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 207766 0 0 0 0 0 0 0 28837 0 236603 0 0 0 THOMAS BENJAMIN DENTIST 172093 0 0 0 0 0 0 0 10955 0 183048 0 0 0 TIMOTHY KELLY DENTIST 161269 0 0 0 0 0 0 0 21058 0 182327 0 0 0 JOAN BARKER MEDICAL DIRECTOR 145043 0 0 0 0 0 0 0 20221 0 165264 0 0 0 AMANDA DIEHL PROVIDER 145078 0 0 0 0 0 0 0 16400 0 161478 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 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 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 CHCBH QALICB INC K 524794 STRAIGHT-LINE LEASE EXPENSE CHCBH QALICB INC D 177796 LOAN PAYMENTS ON BEHALF OF QALICB