2017-11-06T16:21:25-06:00 2016-12-31 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2016-01-01 460418932 COMMUNITY HEALTH CENTER OF THE BLACK HILLS COMM 6057218939 350 PINE STREET RAPID CITY SD 57701 Tim Trithart CHief Executive officer 6057218939 2017-11-07 1 deidre budahl cpa P01273830 6053481930 2017-11-06 65.153.235.186 2017-11-06 16:17:01 MS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 45B7F4684595822E7290ABD736E8533D4E2025B3 2016 2018-03-14 21:41:22Z Tim Trithart 350 PINE STREET RAPID CITY SD 57701 8224392 0 X www.chcbh.com X 1992 SD TO PROVIDE QUALITY MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR THE COMMUNITY. 11 11 108 11 0 0 4484980 2783596 4684397 4233914 74844 151784 4314 273367 9248535 7442661 0 0 0 0 4953678 5471590 0 0 0 2585597 2328471 7539275 7800061 1709260 -357400 7803273 7587032 2144676 2285835 5658597 5301197 To provide quality medical, dental, and mental health care for the community. 0 0 4901643 3850297 Community Health Center of the Black Hills, Inc. had 33,453 patient visits during 2016 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. 1080154 656984 Community Health Center of the Black Hills, Inc. had 6,585 patient visits during 2016 in the Oral Health facility. We provide general dentistry by appointment and acute walk-in visits. 71959 0 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. PERFORMS COMMUNITY AWARENESS CAMPAIGNS THROUGHOUT THE YEAR. 6053756 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 5 0 1 108 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X The Organization 6057218939 350 PINE STREET RAPID CITY SD 57701 RON REED PRESIDENT 1.00 0.25 X X 0 0 0 MARY CORBINE VICE PRESIDENT 1.00 X X 9000 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 TAMMY MISSELT DIRECTOR 1.00 X 0 0 0 STAN ADELSTEIN DIRECTOR 1.00 X 0 0 0 TODD KENNER DIRECTOR 1.00 X 0 0 0 REBECCA MANN DIRECTOR 1.00 X 0 0 0 DAVID KLOCKE DIRECTOR 1.00 X 0 0 0 ANTHONY ROBINSON DIRECTOR 1.00 X 0 0 0 DAVID GOEHRING DIRECTOR 1.00 X 0 0 0 TIM TRITHART CEO 39.00 1.00 X 107548 0 9983 LAURA JONES FORMER CFO 39.00 1.00 X 46918 0 7136 JAMIE DAHLMAN FINANCE DIRECTOR 39.00 1.00 X 38236 0 1632 JOAN BARKER MEDICAL DIRECTOR 40.00 X 209275 0 20221 JACQUELINE VAN EGERAAT PROVIDER 35.00 X 146021 0 20221 TIMOTHY KELLY DENTIST 40.00 X 155000 0 18674 DOUGLAS LEHMANN PROVIDER 40.00 X 209306 0 20221 DONALD BLOWER PROVIDER 28.00 X 127483 0 0 AMANDA DIEHL PROVIDER 27.00 X 135199 0 9825 1183986 0 107913 9 0 1 0 GREENWAY PO Box 203658 DALLAS TX 75320 MAINTENANCE OF ELECTRONIC MEDIAL RECORDS 137880 KT CONNECTIONS 829 QUINCY ST STE A RAPID CITY SD 57701 IT CONSULTING 115062 LABCORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 OUTSOURCED LAB SERVICES 107405 DR MARK GARRY 1141 CREEKSIDE VIEW LANE RAPID CITY SD 57701 BEHAVIORAL HEALTH SERVICES 103338 PATTERSON DENTAL 12008 PORTAL RD SUITE 102 LA VISTA NE 68128 PURCHASE OF DENTAL EQUIPMENT/SUPPLIES 100881 5 45970 2548604 189022 2783596 PATIENT SERVICES 621110 4026983 4026983 WIC Contract Revenue 621110 178136 178136 Family Planning Revenue 621110 28795 28795 4233914 163728 163728 11944 -11944 -11944 -11944 1036647 769787 266860 266860 Medical Records 621110 6507 6507 6507 7442661 4507281 0 151784 449949 229496 220453 4029326 3504702 524624 670120 564266 105854 322195 272663 49532 73 73 23320 23320 759805 359914 399891 30852 30852 405276 199619 205657 558356 533935 24421 73061 73061 237174 235429 1745 14459 14353 106 Medical Supplies & Equi 146974 110171 36803 Education & recruiting 39374 29208 10166 BAD DEBTS 26868 26868 Collections 12879 12879 7800061 6053756 1746305 0 212613 476089 904446 411166 447328 368386 332069 348082 4247632 4247632 75021 154393 28916 31735 1942904 678353 1284522 1264551 270726 284998 7803273 7587032 508202 525870 1626176 1516127 10298 243838 2144676 2285835 X 5164034 4949333 494563 351864 5658597 5301197 7803273 7587032 -357400 0 X X 0 1 X 1 1 1 X 2746835 3699489 2748108 4802350 2783596 16780378 2746835 3699489 2748108 4802350 2783596 16780378 659046 16121332 275 457 102859 163728 267319 17047697 20801773 0.94570 0.95230 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 49285 4572 44713 1893619 673781 1219838 1264551 ACCRUED INTEREST EXPENSE 13196 AMOUNT DUE TO RELATED PARTY 22998 LEASE PAYABLE DUE TO ESCALATING LEASE PAYMENTS 207644 243838 X Part X, Line 2: As of December 31, 2016, 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 2013. 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 JOAN BARKER MEDICAL DIRECTOR 209275 0 0 0 0 0 0 0 20221 0 229496 0 0 0 JACQUELINE VAN EGERAAT PROVIDER 146021 0 0 0 0 0 0 0 20221 0 166242 0 0 0 TIMOTHY KELLY DENTIST 155000 0 0 0 0 0 0 0 18674 0 173674 0 0 0 DOUGLAS LEHMANN PROVIDER 209306 0 0 0 0 0 0 0 20221 0 229527 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 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 CHCBH QALICB INC K 480642 STRAIGHT-LINE LEASE EXPENSE