2016-11-11T15:34:23-06:00 2015-12-31 460403496 CASEY PETERSON & ASSOCIATES LTD 909 ST JOSEPH ST SUITE 101 RAPID CITY SD 57701 990 2015-01-01 460418932 COMMUNITY HEALTH CENTER OF THE BLACK HIL COMM 6057218939 350 PINE STREET RAPID CITY SD 57701 Tim Trithart CHief Executive officer 6057218939 2016-11-11 1 deidre budahl cpa P01273830 6053481930 2016-11-11 2015 2017-02-10 21:41:12Z X Tim Trithart 350 PINE STREET RAPID CITY SD 57701 9276550 0 X www.chcbh.com X 1992 SD TO PROVIDE QUALITY MEDICAL, DENTAL, AND MENTAL HEALTH CARE FOR THE COMMUNITY. 11 11 109 0 0 0 2748108 4484980 4202177 4684397 457 74844 6456 4314 6957198 9248535 0 0 0 0 4419034 4953678 0 0 0 2382186 2585597 6801220 7539275 155978 1709260 5489135 7803273 1539798 2144676 3949337 5658597 X To provide quality medical, dental, and mental health care for the community. 0 0 4654371 3658957 Community Health Center of the Black Hills, Inc. had 30,789 patient visits during 2015 in the Rapid City facilities. We provided primary preventative health care to pediatrics and adults. Services include family planning, women's health, mental health, acute walk-in clinic, and pediatrics. 891352 644350 Community Health Center of the Black Hills, Inc. had 5,820 patient visits during 2015 in the Oral Health facility. We provide general dentistry by appointment and acute walk-in visits. 173782 376560 Community Health Center of the Black Hills, Inc. had 3,421 patient visits IN THE GENERAL BEADLE SCHOOL BASED CENTER during 2015.Community Health Center of the Black Hills, Inc. provides health care education including disease prevention and family planning. 262264 8844 COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. HAD 812 PATIENT VISITS IN THE OUTREACH CLINIC. THROUGH THE OUTREACH PROGRAM, we offer assistance to adults and children that are homeless. COMMUNITY HEALTH CENTER OF THE BLACK HILLS, INC. ALSO PERFORMS COMMUNITY AWARENESS CAMPAIGNS THROUGHOUT THE YEAR. 262264 8844 5981769 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 1 0 0 0 0 1 0 0 0 1 4 0 1 109 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 1.00 X X 0 0 0 MARY CORBINE VICE PRESIDENT 1.00 X X 0 0 0 S ROY DISHMAN CPA TREASURER 1.00 1.00 X X 0 0 0 JERI ERVIN DIRECTOR 1.00 X 0 0 0 MARNIE HERMANN DIRECTOR 1.00 X 0 0 0 STAN ADELSTEIN DIRECTOR 1.00 X 0 0 0 LOIS AIMES 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 106998 0 30071 LAURA JONES CFO 39.00 1.00 X 62133 0 14743 JOAN BARKER MEDICAL DIRECTOR 40.00 X 203994 0 39952 JACQUELINE VAN EGERAAT PROVIDER 35.00 X 141498 0 35040 TIMOTHY KELLY PROVIDER 40.00 X 155000 0 34478 TERESA EASTMAN PHARMACIST 40.00 X 140000 0 35000 DOUGLAS LEHMANN PROVIDER 40.00 X 188921 0 39952 DONALD BLOWER PROVIDER 28.00 X 121036 0 0 1119580 0 229236 9 0 1 0 KT CONNECTIONS 829 QUINCY ST STE A RAPID CITY SD 57701 IT CONSULTING 116082 GREENWAY PO Box 203658 DALLAS TX 75320 MAINTENANCE OF ELECTRONIC MEDIAL RECORDS 100416 2 46001 2853919 1585060 39949 4484980 PATIENT SERVICES 621110 4388927 4388927 WIC Contract Revenue 621110 174386 174386 Family Planning Revenu 621110 121084 121084 4684397 102859 102859 28015 -28015 -28015 -28015 Medical Records 621110 4314 4314 4314 9248535 4688711 0 74844 X 4042022 3520153 521869 625059 506987 118072 286597 238983 47614 850 850 23350 23350 783687 597924 185763 13708 13708 395460 245230 150230 229743 178839 50904 10837 5001 5836 32287 32287 242745 215130 27615 31770 22003 9767 Medical SUpplies & Equi 246791 208814 37977 TRANSFER OF CAPITAL TO 199871 199871 Pharmacy 110479 110479 0 BAD DEBTS 98813 0 98813 165206 118518 46688 7539275 5981769 1557506 0 1282385 212613 894721 904446 38434 447328 344030 332069 0 4247632 119602 75021 17429 28916 1928732 644210 2587934 1284522 204600 270726 5489135 7803273 539798 508202 1000000 0 0 1626176 0 10298 1539798 2144676 X 2918393 5164034 1030944 494563 3949337 5658597 5489135 7803273 1709260 0 X X 0 1 X 1 1 1 X 2192234 2746835 3699489 2748108 4802350 16189016 2192234 2746835 3699489 2748108 4802350 16189016 674148 15514868 275 457 102859 103591 16292607 19729824 0.95230 0.99920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15428 1025 14403 1913304 643185 1270119 1284522 ACCRUED INTEREST EXPENSE 10298 10298 X Part X, Line 2: CHCBH follows the provisions of Financial Accounting Standards Board (FASB) ASC 740, Income Taxes. Using that guidance, tax positions initially need to be recognized in the financial statements when it is more-likely-than-not the position will be sustained upon examination by the taxing authorities. CHCBH is exempt from federal income taxes under section 501(c)(3) of the Internal Revenue Code and is not considered a private foundation. CHCBH is not liable for income taxes if it operates within the confines of its exempt status. However, CHCBH may be responsible for taxes on unrelated business activities. In the event of an examination of the income tax returns, the tax liability of CHCBH could be changed if taxing authorities make adjustments to the tax-exempt purpose of CHCBH or if taxing authorities determine activities are subject to unrelated business income. As of December 31, 2015, 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 2012. 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 203994 0 0 0 0 0 0 0 39952 0 243946 0 0 0 JACQUELINE VAN EGERAAT PROVIDER 141498 0 0 0 0 0 0 0 35040 0 176538 0 0 0 TIMOTHY KELLY PROVIDER 155000 0 0 0 0 0 0 0 34478 0 189478 0 0 0 TERESA EASTMAN PHARMACIST 140000 0 0 0 0 0 0 0 35000 0 175000 0 0 0 DOUGLAS LEHMANN PROVIDER 188921 0 0 0 0 0 0 0 39952 0 228873 0 0 0 X 2 39949 wholesale cost 0 0 0 Form 990, Part VI, Section B, line 11 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. Form 990, Part IX, line 11g Contracted Services: Program service expenses 597,924. Management and general expenses 185,763. Fundraising expenses 0. Total expenses 783,687. 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 0 0 0 0 0 0 0 1 0 CHCBH QALICB INC R 199871 BOOK VALUE OF ASSETS TRANSFERRED