2017-01-16T13:53:40-06:00 2016-02-29 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2015-03-01 421527584 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC % RONALD KEMP COMM 3197532300 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 RONALD KEMP CEO 3197532300 2016-10-04 true Brian D Todd P00422601 4178658701 2015 2021-01-29 14:40:06Z RONALD KEMP 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 12169998 false X CHCSEIA.COM X 2001 IA CHCSEIA PROVIDES COMPREHENSIVE HEALTH SERVICES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS, AND OTHER HEALTHCARE SERVICES TO THE RESIDENTS OF THE SE IOWA REGION. 11 11 120 15 0 2793614 2187729 8271319 9971936 3414 2501 0 7832 11068347 12169998 0 0 0 0 3915079 6490654 0 0 0 6355529 4905301 10270608 11395955 797739 774043 8059297 8206400 2634478 2007538 5424819 6198862 X TO PROVIDE PRIMARY HEALTH CARE TO RESIDENTS OF THE GREATER SE IOWA REGION, ESPECIALLY THOSE INDIVIDUALS/FAMILIES WITH LIMITED RESOURCES OR WITH OTHER BARRIERS TO HEALTH CARE. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false false 7687109 9971936 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA PROVIDES SEVERAL HEALTH SERVICES TO THE COMMUNITY, INCLUDING: COMPREHENSIVE HEALTH SERVICES WITH A VARIETY OF PHYSICIAN SPECIALTIES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS INVOLVING ORAL HEALTH EDUCATION AND DENTAL SCREENING, FAMILY PLANNING, HEALTH SCREENINGS, IMMUNIZATIONS, CASE MANAGEMENT, AND PHARMACIES. DURING THE FISCAL YEAR, THE HEALTH CENTERS HAD APPROXIMATELY 12,100 DENTAL VISITS AND 43,900 MEDICAL VISITS. 7687109 true true false true false false false false false false true false false false false false true false false false false false false false false false false false false true false false false false false false false false false false false false false false false false false true 32 0 true 120 true false false false false false false false false false false X 11 11 false false true false false false false true true false false true true true true true true true true false X RONALD KEMP 3197532300 1706 WEST AGENCY ROAD WEST BURLINGTON IA 52655 BARB BAKER CHAIR 1.0 0.0 X X 0 0 0 BILL STAATS VICE CHAIR 1.0 0.0 X X 0 0 0 BARRY CORSON TREASURER 1.0 0.0 X X 0 0 0 MICHAEL MAUZY JR SECRETARY 1.0 0.0 X X 0 0 0 PATRICIA PETTY DIRECTOR END 10/2015 1.0 0.0 X 0 0 0 JULIE SCHILLING DIRECTOR 1.0 0.0 X 0 0 0 DAVID WHITAKER DIRECTOR 1.0 0.0 X 0 0 0 KATHY VANCE DIRECTOR 1.0 0.0 X 0 0 0 MICHAEL WAGNER DIRECTOR ENDING 03/2015 1.0 0.0 X 0 0 0 MALLORY SMITH DIRECTOR ENDING 12/2015 1.0 0.0 X 0 0 0 CHUCK GRIFFIN DIRECTOR 1.0 0.0 X 0 0 0 CRAIG SYMONS DIRECTOR ENDING 01/2016 1.0 0.0 X 0 0 0 JOYCE MARTIN DIRECTOR BEG 11/2015 1.0 0.0 X 0 0 0 JASON STRANDBERG DIRECTOR BEG 01/2016 1.0 0.0 X 0 0 0 JONI WALLER DIRECTOR BEG 01/2016 1.0 0.0 X 0 0 0 RONALD KEMP CEO 40.0 0.0 X 119430 0 14938 DIANE ROUSE CFO 40.0 0.0 X 72136 0 19855 MONICA MEEKER CHIEF MEDICAL OFFICER 40.0 0.0 X 289655 0 17833 MARK STROPE PHYSICIAN BEG 04/2015 40.0 0.0 X 137990 0 13204 ALISHA BASSLER DENTIST 40.0 0.0 X 133118 0 23334 JAMES DEMMEL PHYSICIAN 40.0 0.0 X 128282 0 9637 LUCAS LEMBURG DENTIST BEG 06/2015 40.0 0.0 X 146267 0 27947 VANDHANA KISWANI-BARLEY PHYSICIAN BEG 07/2015 40.0 0.0 X 144118 0 7293 1170996 0 134041 10 false true false TRI-STATE MEDICAL GROUP 1600 MORGAN STREET KEOKUK IA 52632 HEALTH SERVICES 808556 QUEST DIAGNOSTICS 12989 COLLECTIONS CENTER DRIVE CHICAGO IL 606930129 HEALTH SERVICES 127039 PAIN CENTERS OF IOWA PC 5515 UTICA RIDGE ROAD 600 DAVENPORT IA 52807 HEALTH SERVICES 135260 DELTA LOCUM TENENS PO BOX 202940 DALLAS TX 753202940 HEALTH SERVICES 191637 4 2026151 161578 2187729 NET PATIENT SERVICE REVENUE 624100 9755778 9755778 MEANINGFUL USE REVENUE 624100 140250 140250 OTHER REVENUE 624100 75908 75908 9971936 2501 2501 0 0 0 0 0 0 0 0 0 GAIN ON INV IN EQUITY INVESTEE 900099 7832 7832 7832 12169998 9971936 10333 X 0 0 0 0 533847 307488 226359 0 4739231 3602890 1136341 161289 127611 33678 682191 486874 195317 374096 278939 95157 0 16728 16728 52182 52182 0 0 0 1757664 666366 1091298 21885 21885 347079 113440 233639 0 0 255867 161967 93900 27641 9500 18141 0 41578 41578 49109 49109 0 390917 255216 135701 62646 62646 MEDICAL SUPPLIES & DRUGS 964997 964997 BAD DEBT 711821 711821 RECRUITING & RETENTION 120605 120605 LICENSES, DUES, SUBSCRIPTIONS 84582 84582 11395955 7687109 3708846 0 74003 420321 270941 957621 645610 5709 937004 1137721 0 0 0 0 0 0 58076 107018 75710 118793 7747111 2486072 5354927 5261039 0 0 0 0 0 7832 0 0 643026 190346 8059297 8206400 1894028 867421 0 0 0 0 0 0 0 0 0 0 740450 1140117 0 0 0 0 2634478 2007538 X 5424819 6198862 0 0 0 0 5424819 6198862 8059297 8206400 774043 X false true X true true true X 2541990 2358080 2483034 2793614 2187729 12364447 0 0 2541990 2358080 2483034 2793614 2187729 12364447 0 12364447 3172 2892 2888 3414 10333 22699 0 0 12387146 39152893 0.99817 0.99830 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true false SCHEDULE C, PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC), THE IOWA PRIMARY CARE ASSOCIATION (IAPCA), AND THE ILLINOIS PRIMARY HEALTHCARE ASSOCIATION (ILPHCA). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES. 37199 37199 5906434 1125565 4780869 88171 62131 26040 1152056 836293 315763 563251 462083 101168 5261039 11458177 -711821 -711821 12169998 12169998 10684134 10684134 711821 711821 11395955 SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: ($ 711,821) BAD DEBT EXPENSE SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 711,821 BAD DEBT EXPENSE X true true X X false false false false false false false true false MARK STROPE PHYSICIAN BEG 04/2015 129470 0 8520 0 0 0 6964 0 6240 0 151194 0 0 0 ALISHA BASSLER DENTIST 103246 0 23300 0 6572 0 6476 0 16858 0 156452 0 0 0 LUCAS LEMBURG DENTIST BEG 06/2015 120842 0 25425 0 0 0 7726 0 20221 0 174214 0 0 0 VANDHANA KISWANI-BARLEY PHYSICIAN BEG 07/2015 92538 0 51580 0 0 0 4340 0 2953 0 151411 0 0 0 MONICA MEEKER CHIEF MEDICAL OFFICER 220645 0 51010 0 18000 0 0 0 17833 0 307488 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: THE ORGANIZATION OFFERS A WELLNESS PROGRAM TO ITS EMPLOYEES WHICH PROVIDES DIRECT REIMBURSEMENT OF UP TO $25 PER MONTH AFTER THE EMPLOYEES HAVE USED THE GYM OR WEIGHT WATCHERS PROGRAM THREE TIMES DURING THE MONTH. EMPLOYEE MUST SHOW DOCUMENTATION OF PAYMENT OF FEES AND ATTENDANCE. IF ATTENDANCE IS LESS THAN THREE TIMES A MONTH, NO PAYMENT IS MADE. DURING THE FISCAL YEAR, THREE INDIVIDUALS FROM FORM 990, PART VII RECEIVED PAYMENT FOR THEIR PARTICIPATION IN THE PROGRAM: ALISHA BASSLER $175 RONALD KEMP $100 JAMES DEMMEL $ 50 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: THE BONUSES PAID TO LUCAS LEMBURG, ALISHA BASSLER, MARK STROPE AND JAMES DEMMEL ARE BASED ON PRODUCTION LEVELS. MONICA MEEKER'S BONUS CONSISTS OF $50,000 SIGN ON BONUS AND $1,010 OF BONUS BASED ON PRODUCTION LEVELS, VANDHANA KISWANI-BARLEY'S BONUS CONSISTS OF $50,000 SIGN ON BONUS AND $1,580 BONUS BASED ON PRODUCTION LEVELS. FORM 990, PART I, LINE 6 VOLUNTEERS: THE ORGANIZATION'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD. FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION: CHCSEIA IS A FEDERALLY QUALIFIED HEALTH CENTER WHOSE MISSION IS TO PROVIDE AFFORDABLE, COMPREHENSIVE, CULTURALLY APPROPRIATE, COST EFFECTIVE HEALTH CARE TO RESIDENTS OF THE GREATER SOUTHEASTERN IOWA REGION IN ORDER TO IMPROVE THEIR OVERALL HEALTH STATUS. THE MAIN PURPOSES OF THE ORGANIZATION ARE THE FOLLOWING: -PROVIDE PRIMARY MEDICAL CARE, GENERAL DENTAL SERVICES, AND INTEGRATED BEHAVIORAL HEALTH SERVICES -CREATE NEW HEALTH CARE RESOURCES AND HEALTH CARE ARRANGEMENTS TO OFFER TO THE COMMUNITIES SERVED BY THE CORPORATION -EXPAND ACCESS TO HEALTH CARE TO THOSE INDIVIDUALS UNABLE TO OBTAIN ADEQUATE HEALTH CARE -REDUCE UNNECESSARY DUPLICATION OF SERVICES, TECHNOLOGY AND FACILITIES BY COORDINATING THE DELIVERY OF HEALTH CARE SERVICES ON A COST-EFFECTIVE BASIS -CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED OR THE PROMOTION OF HEALTH WHICH MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS OR OTHER REQUIREMENTS THAT ARE OR CAN BE MADE AVAILABLE -PROMOTE AND CARRY ON SPECIAL RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED INSOFAR AS SAID RESEARCH CAN BE CARRIED ON, OR IN CONNECTION WITH, THE FACILITIES AND PROGRAMS OPERATED BY THIS CORPORATION -TAKE AND HOLD BY BEQUEST, DEVISE, GIFT, GRANT, PURCHASE, LEASE OR OTHERWISE ANY PROPERTY, REAL, PERSONAL, TANGIBLE OR INTANGIBLE, OR ANY UNDIVIDED INTEREST THEREIN, WITHOUT LIMITATION AS TO AMOUNT OR VALUE -SELL, CONVEY OR OTHERWISE DISPOSE OF ANY SAID PROPERTY AND INVEST, REINVEST, OR DEAL WITH THE PRINCIPAL OR THE INCOME THEREOF IN SAID MANNER AS, IN THE JUDGMENT OF THE DIRECTORS OF THIS CORPORATION, WILL BEST PROMOTE THE PURPOSES OF THE CORPORATION WITHOUT LIMITATION, EXCEPT SUCH LIMITATIONS, IF ANY, AS MAY BE CONTAINED IN THE INCORPORATION, THE BYLAWS OF THE CORPORATION, OR ANY OTHER LAWS THERETO APPLICABLE0 -RAISE GIFTS, BEQUESTS, DONATIONS AND OTHER FUNDS FROM THE PUBLIC AND FROM ALL OTHER SOURCES AVAILABLE, RECEIVE AND MAINTAIN SUCH FUNDS AND EXPEND PRINCIPAL AND INCOME THERE FROM IN SUPPORT OF OR IN FURTHERANCE OF THE CHARITABLE PURPOSES OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: THE FOLLOWING PARAGRAPHS REGARDING CONFLICTS OF INTEREST WERE ADDED TO THE BYLAWS DURING THE FISCAL YEAR. ARTICLE IV GOVERNING BOARD, SECTION 2 THE GOVERNING BOARD SHALL CONSIST OF AT LEAST TEN (10) BUT NO MORE THAN EIGHTEEN (18) DIRECTORS. THE EXECUTIVE COMMITTEE WOULD SERVE AS THE NOMINATING COMMITTEE OF THE BOARD. THIS COMMITTEE WOULD REVIEW APPLICATIONS FROM POTENTIAL BOARD MEMBERS AND MAKE RECOMMENDATIONS TO THE FULL BOARD BASED UPON THE COMPOSITION NEEDS OF THE BOARD. MEMBERSHIP MUST BE APPROVED BY THE FULL BOARD. ARTICLE VIII PROHIBITION ON CONFLICTS OF INTEREST A. GENERAL PRINCIPLES PROHIBITING CONFLICTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR MEMBER OF THE BOARD OF DIRECTORS OF CHC/SEIA WILL PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT (SUPPORTED BY FEDERAL FUNDS) IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER, OR ANY MEMBER OF HIS OR HER IMMEDIATE FAMILY, HIS OR HER PARTNER, OR AN ORGANIZATION WHICH EMPLOYS OR IS ABOUT TO EMPLOY ANY OF THE PARTIES INDICATED HEREIN, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD. B. CONFLICTS OF INTEREST AND DISCLOSURE REQUIREMENTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER WILL HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST IN, OR RECEIVE ANY COMPENSATION OR OTHER BENEFITS AS A RESULT OF, TRANSACTIONS BETWEEN CHC/SEIA AND ANY INDIVIDUAL OR BUSINESS FIRM WITHOUT DISCLOSING THE CONFLICT OF INTEREST. NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS MAY PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT IN WHICH FEDERAL FUNDS ARE USED, IF THEY HAVE A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD WITHOUT DISCLOSING THE CONFLICT OF INTEREST. IF AN EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS BELIEVES THAT ONE OF THE AFOREMENTIONED CONFLICTS ACTUALLY OR POTENTIALLY EXISTS, HE OR SHE MUST IMMEDIATELY DISCLOSE THIS INFORMATION IN WRITING TO THE CEO. DISCLOSURES BY MEMBERS OF THE BOARD OF DIRECTORS MUST ALSO BE MADE TO THE CHAIR OF THE BOARD OF DIRECTORS (AND IF IT IS THE CEO OR THE CHAIR WHO HAS SUCH A FINANCIAL INTEREST, HE OR SHE MUST MAKE DISCLOSURE TO THE CHAIR OR VICE CHAIR, RESPECTIVELY). THE CHC/SEIA REQUIRES THAT ALL EMPLOYEES, CONTRACTORS, AGENTS, OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS AND CANDIDATES FOR BOARD MEMBERSHIP DISCLOSE IN WRITING (AND UPDATE AT LEAST ANNUALLY) AT OR AROUND THEIR JANUARY MEETING: - ALL BUSINESS AND FAMILY RELATIONSHIPS WHICH CREATE AN ACTUAL OR POTENTIAL A CONFLICT OF INTEREST, AND - WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. TO FACILITATE DISCLOSURE, CHC/SEIA REQUIRES EMPLOYEES, CONTRACTORS, AGENTS) OFFICERS AND BOARD MEMBERS TO COMPLETE A CHC/SEIA CONFLICT OF INTEREST FORM. COMPLETION THE FORM DOES NOT RELIEVE INDIVIDUALS OF THE OBLIGATION TO NOTIFY THE CEO OR BOARD CHAIR IF CHANGES OCCUR SINCE FILING OF THE FORM REGARDING A NEW CONFLICT OF INTEREST. NO MEMBER OF THE BOARD OF DIRECTORS MAY VOTE ON ANY MATTER WHICH MAY DIRECTLY OR INDIRECTLY RESULT IN FINANCIAL OR OTHER GAIN TO THAT MEMBER, OR WHICH MAY CONFLICT WITH THAT MEMBER'S OBLIGATIONS TO ANOTHER ORGANIZATION'S BOARD OF DIRECTORS OR TO HIS OR HER EMPLOYER. PROVIDED THAT THE MEMBER OF THE BOARD OF DIRECTORS HAS FIRST DISCLOSED A CONFLICT OR POTENTIAL CONFLICT) AND ABSTAINS FROM VOTING IN THAT REGARD, HE OR SHE MAY PARTICIPATE IN DISCUSSIONS RELATING TO THAT MATTER. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: 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. PRIOR TO BEING FILED, THE RETURN IS REVIEWED BY THE ORGANIZATION'S CEO AND CFO. IT IS THEN PROVIDED TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: A. GENERAL PRINCIPLES PROHIBITING CONFLICTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR MEMBER OF THE BOARD OF DIRECTORS OF CHC/SEIA WILL PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT (SUPPORTED BY FEDERAL FUNDS) IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER, OR ANY MEMBER OF HIS OR HER IMMEDIATE FAMILY, HIS OR HER PARTNER, OR AN ORGANIZATION WHICH EMPLOYS OR IS ABOUT TO EMPLOY ANY OF THE PARTIES INDICATED HEREIN, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD. B. CONFLICTS OF INTEREST AND DISCLOSURE REQUIREMENTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER WILL HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST IN, OR RECEIVE ANY COMPENSATION OR OTHER BENEFITS AS A RESULT OF, TRANSACTIONS BETWEEN CHC/SEIA AND ANY INDIVIDUAL OR BUSINESS FIRM WITHOUT DISCLOSING THE CONFLICT OF INTEREST. NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS MAY PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT IN WHICH FEDERAL FUNDS ARE USED, IF THEY HAVE A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD WITHOUT DISCLOSING THE CONFLICT OF INTEREST. IF AN EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS BELIEVES THAT ONE OF THE AFOREMENTIONED CONFLICTS ACTUALLY OR POTENTIALLY EXISTS, HE OR SHE MUST IMMEDIATELY DISCLOSE THIS INFORMATION IN WRITING TO THE CEO. DISCLOSURES BY MEMBERS OF THE BOARD OF DIRECTORS MUST ALSO BE MADE TO THE CHAIR OF THE BOARD OF DIRECTORS (AND IF IT IS THE CEO OR THE CHAIR WHO HAS SUCH A FINANCIAL INTEREST, HE OR SHE MUST MAKE DISCLOSURE TO THE CHAIR OR VICE CHAIR, RESPECTIVELY). THE CHC/SEIA REQUIRES THAT ALL EMPLOYEES, CONTRACTORS, AGENTS, OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS AND CANDIDATES FOR BOARD MEMBERSHIP DISCLOSE IN WRITING (AND UPDATE AT LEAST ANNUALLY) AT OR AROUND THEIR JANUARY MEETING: - ALL BUSINESS AND FAMILY RELATIONSHIPS WHICH CREATE AN ACTUAL OR POTENTIAL A CONFLICT OF INTEREST, AND - WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. TO FACILITATE DISCLOSURE, CHC/SEIA REQUIRES EMPLOYEES, CONTRACTORS, AGENTS) OFFICERS AND BOARD MEMBERS TO COMPLETE A CHC/SEIA CONFLICT OF INTEREST FORM. COMPLETION THE FORM DOES NOT RELIEVE INDIVIDUALS OF THE OBLIGATION TO NOTIFY THE CEO OR BOARD CHAIR IF CHANGES OCCUR SINCE FILING OF THE FORM REGARDING A NEW CONFLICT OF INTEREST. NO MEMBER OF THE BOARD OF DIRECTORS MAY VOTE ON ANY MATTER WHICH MAY DIRECTLY OR INDIRECTLY RESULT IN FINANCIAL OR OTHER GAIN TO THAT MEMBER, OR WHICH MAY CONFLICT WITH THAT MEMBER'S OBLIGATIONS TO ANOTHER ORGANIZATION'S BOARD OF DIRECTORS OR TO HIS OR HER EMPLOYER. PROVIDED THAT THE MEMBER OF THE BOARD OF DIRECTORS HAS FIRST DISCLOSED A CONFLICT OR POTENTIAL CONFLICT) AND ABSTAINS FROM VOTING IN THAT REGARD, HE OR SHE MAY PARTICIPATE IN DISCUSSIONS RELATING TO THAT MATTER. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: DURING FISCAL YEAR 2015, THE CEO, CFO, AND BOARD APPROVED RATES USING SALARY SURVEYS FOR COMPARABLE POSITIONS FORM THE IAPCA, ILPHCA, NACHC, IOWA WORKFORCE AND OTHER SOURCES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC EXCEPT IN CASES WHERE IT IS REQUIRED BY LAW. FINANCIAL STATEMENTS ARE ONLY RELEASED FOR ACTIVITIES THAT ARE DEEMED NECESSARY FOR BONA FIDE BUSINESS PURPOSES, SUCH AS LOANS, OR IN CASES WHERE IT IS REQUIRED BY LAW. FORM 990, PART XI, LINE 11G BREAK OUT OF OTHER FEES FOR SERVICES: $ 594,198 CONTRACT SERVICES 427,278 KHS MANAGEMENT FEES 297,022 OTHER PROFESSIONAL FEES 282,671 HIT EXPENSE 94,946 PHARMACEUTICAL FEES 29,814 INTERPRETER SERVICES 26,830 CONSULTING FEES 4,905 CONTRACTED MAINTENANCE ------------ $1,757,664 TOTAL