2015-04-13T09:49:23-05:00 2014-05-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2013-06-01 680545808 COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI % DON HOLLOMAN COMM 5736320243 3400 WEST TRUMAN BLVD Suite JEFFERSON CITY MO 65109 DON HOLLOMAN CEO 5736320243 2015-04-04 true Brian D Todd P00422601 5736320243 2013 2016-02-25 16:41:14Z DON HOLLOMAN 3400 WEST TRUMAN BLVD JEFFERSON CITY MO 65109 9295200 false X www.chccmo.org X 2003 MO TO PROVIDE MEDICAL, DENTAL AND MENTAL HEALTH SERVICES TO RESIDENTS OF COLE, OSAGE, MONITEAU AND CALLAWAY COUNTIES REGARDLESS OF ABILITY TO PAY. 13 13 117 13 0 0 2248341 2576296 6576324 6718335 -4161 569 0 0 8820504 9295200 0 0 0 0 5857113 6088156 0 0 0 2847418 3694237 8704531 9782393 115973 -487193 5899463 6045029 4173794 4817122 1725669 1227907 X TO PROVIDE IMPROVED ACCESS TO PRIMARY CARE, BEHAVIORAL HEALTHCARE AND ORAL HEALTH CARE SERVICES FOR MEDICALLY UNDERSERVED INDIVIDUALS IN CENTRAL MISSOURI REGARDLESS OF THEIR ABILITY TO PAY. OUR VISION IS EMBRACING PEOPLE AND INSPIRING HEALTH. false false 4307128 3193692 MEDICAL PRACTICE - A WIDE-RANGE OF PRIMARY CARE SERVICES ARE PROVIDED BY A DEDICATED TEAM OF PHYSICIANS, FAMILY NURSE PRACTITIONERS, SOCIAL WORKERS, NURSES, AND SUPPORT STAFF INCLUDING: OBSTETRICAL CARE, PEDIATRIC CARE, ADULT HEALTHCARE, PHYSICAL EXAMS, FAMILY PLANNING, AND PAIN MANAGEMENT. DURING FISCAL YEAR 2014, THE MEDICAL PRACTICE HAD 23,260 VISITS OF WHICH 37% WERE MEDICAID AND 31% WERE UNINSURED, RECEIVING $732,528 IN DISCOUNTS. 2740899 3188136 DENTAL PRACTICE - THE ORGANIZATION OFFERS A FULL RANGE OF PREVENTIVE, FUNCTIONAL, AND RESTORATIVE DENTAL CARE, INCLUDING: CLEANINGS, HYGIENE AND TISSUE MANAGEMENT, SEALANTS, CHECK-UPS AND X-RAYS, FILLINGS, EXTRACTIONS, ORAL CANCER SCREENING, HEALTHY GUM CARE, ROOT CANALS, CROWNS AND BRIDGES, AND FULL AND PARTIAL DENTURES. EMERGENCY DENTAL CARE IS ALSO AVAILABLE. DURING FISCAL YEAR 2014, THE DENTAL PRACTICE HAD 10,512 VISITS OF WHICH 63% WERE MEDICAID AND 21% WERE UNINSURED, RECEIVING $327,585 IN DISCOUNTS. 391557 316603 THE MENTAL HEALTH PRACTICE HAD 2,707 VISITS OF WHICH 41% WERE MEDICAID AND 28% WERE UNINSURED, RECEIVING $109,130 IN DISCOUNTS. SEE SCHEDULE O FOR MORE INFORMATION. 391557 19904 7831141 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 false true false false false false false false false false true false false false false false false false false true 3 0 true 117 true 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 DON HOLLOMAN 5736320243 2730 W MAIN ST JEFFERSON CITY MO 65109 AMANDA GRELLNER PRESIDENT 1.0 X X 0 0 0 LINDA MCANANY VICE PRESIDENT 1.0 X X 0 0 0 TOM NIEKAMP TREASURER 1.0 X X 0 0 0 CHRISTINE ELLINGER SECRETARY 1.0 X X 0 0 0 JIM CLARDY BOARD MEMBER 1.0 X 0 0 0 DARRYL KING BOARD MEMBER 1.0 X 0 0 0 DEBBIE HAMLER BOARD MEMBER 1.0 X 0 0 0 KATHY DOTHAGE BOARD MEMBER 1.0 X 0 0 0 LAWRENCE WANSING BOARD MEMBER 1.0 X 0 0 0 LINDA BICKEL BOARD MEMBER 1.0 X 0 0 0 CHARLES GLASPER BOARD MEMBER 1.0 X 0 0 0 BEVERLY STAFFORD BOARD MEMBER 1.0 X 0 0 0 PAM MURRAY BOARD MEMBER 1.0 X 0 0 0 DON HOLLOMAN EXEC DIRECTOR 40.0 X 141344 0 20262 MARK CONOVER CHIEF OPERATING OFFICER 40.0 X 94049 0 25661 TOBY BARNETT CHIEF FINANCIAL OFFICER 40.0 X 99064 0 19402 CRYSTAL SULLIVAN MD MEDICAL DIRECTOR 40.0 X 198644 0 30230 SARAH DUNN PHYSICIAN 40.0 X 284219 0 36502 NANCY HOWE PHYSICIAN 40.0 X 202675 0 30490 RICHARD DAUGHERTY PHYSICIAN 40.0 X 195427 0 29564 JOHNATHAN EHLERS DENTIST 40.0 X 156607 0 4047 BETHANY BAILLARGEON DENTAL DIRECTOR 40.0 X 149211 0 23168 1521240 0 219326 9 false true false TRANSAMERICA FUND SERVICES INVESTMENT MGMT 219145 LABCORP - JC MAIN CLINICAL LABS 198284 BARTON ASSOCIATES INC MEDICAL PROVIDERS 185377 MCKESSON MEDICAL SURGICAL MED SUPPLIES/SRVCS 166040 PATHWAYS MENTAL HLTH PROVIDER 160833 9 58650 1588721 928925 135729 2576296 Net Patient Service Revenue 624100 6438093 6438093 EHR Incentive Revenue 624100 68000 68000 Miscellaneous Income 624100 212242 212242 6718335 569 569 0 0 0 0 0 0 0 0 0 0 9295200 6718335 569 0 0 0 0 628656 228874 399782 0 4470448 4145963 324485 148644 136455 12189 486617 465836 20781 353791 306206 47585 0 95611 95611 68055 68055 0 0 0 779910 574630 205280 102198 102198 658947 351800 307147 155727 123452 32275 0 175227 138911 36316 55983 55983 0 56816 20904 35912 8817 8817 0 456867 357987 98880 14003 11613 2390 MEDICAL SUPPLIES & DRUGS 594612 594612 BAD DEBT 373898 373898 LICENSES, DUES, SUBSCRIPTIONS 56552 56552 RECRUITING & RETENTION 18644 18644 22370 22370 9782393 7831141 1951252 0 35061 110698 1070294 1429150 98747 345242 1626505 1181851 0 0 0 0 0 0 167586 210933 106293 82215 4318410 1727078 2659390 2591332 0 0 39474 43340 0 0 0 0 96113 50268 5899463 6045029 718150 836288 0 0 14875 80834 0 0 0 0 0 0 250769 100000 0 0 3190000 3800000 4173794 4817122 X 1699244 838049 26425 389858 0 0 1725669 1227907 5899463 6045029 X -487193 -10569 X false true X true true true X 1595776 1141830 1445672 2248341 2576296 9007915 0 0 1595776 1141830 1445672 2248341 2576296 9007915 115728 8892187 160 82 180 466 569 1457 0 0 9009372 26356234 0.98699 0.99436 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 I DURING THE FISCAL YEAR, THE ORGANIZATION PAID DUES TO THE MISSOURI PRIMARY CARE ASSOCIATION. A PORTION OF DUES MAY BE ATTRIBUTABLE TO LOBBYING PURPOSES. 667588 667588 1298145 596363 701782 447103 223128 223975 1638018 842838 795180 267556 64749 202807 2591332 0 Due to Third Party Payers 3800000 3800000 8553614 6314 -358042 -351728 8905342 389858 389858 9295200 9414809 6314 6314 9408495 373898 373898 9782393 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 OTHER REVENUE ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $(373,898) BAD DEBT EXPENSE 26,425 NET ASSETS RELEASED FROM RESTRICTION ( 10,569) LOSS ON INVESTMENT IN EQUITY INVESTEE ----------- $(358,042) TOTAL SCHEDULE D, PART XI, LINE 4B OTHER REVENUE ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 389,858 TEMPORARILY RESTRICTED CONTRIBUTIONS SCHEDULE D, PART XII, LINE 4B OTHER EXPENSES ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 373,898 BAD DEBT EXPENSE X X false false false false false false false false false DON HOLLOMAN EXEC DIRECTOR 141344 0 0 0 0 0 3945 0 16317 0 161606 0 0 0 SARAH DUNN PHYSICIAN 284219 0 0 0 0 0 13155 0 23347 0 320721 0 0 0 NANCY HOWE PHYSICIAN 202675 0 0 0 0 0 6108 0 24382 0 233165 0 0 0 RICHARD DAUGHERTY PHYSICIAN 195427 0 0 0 0 0 5890 0 23674 0 224991 0 0 0 CRYSTAL SULLIVAN MD MEDICAL DIRECTOR 198644 0 0 0 0 0 6343 0 23887 0 228874 0 0 0 JOHNATHAN EHLERS DENTIST 156607 0 0 0 0 0 3529 0 518 0 160654 0 0 0 BETHANY BAILLARGEON DENTAL DIRECTOR 149211 0 0 0 0 0 6343 0 16825 0 172379 0 0 0 X 1 135729 FMV false false false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTORS: THE ORGANIZATION RECEIVED VACCINES FROM A SINGLE DONOR. FORM 990, PART I, LINE 6 NUMBER OF VOLUNTEERS: THE TOTAL NUMBER OF VOLUNTEERS INCLUDES NON-COMPENSATED MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART III, LINE 4C PROGRAM SERVICES: FOR PATIENTS NEEDING BEHAVIORAL AND MENTAL HEALTH SERVICES, THE ORGANIZATION HAS PARTNERED WITH PATHWAYS COMMUNITY BEHAVIORAL HEALTH CARE, A NON-FOR-PROFIT COMMUNITY MENTAL HEALTH COMPANY. COMMITTED TO PROVIDING EXCEPTIONAL CARE FOR THE MIND, BODY, AND SPIRIT, COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI OFFERS HIGHLY TRAINED PROFESSIONALS TO PROVIDE BEHAVIORAL HEALTH AND ADDICTION SERVICES FOR INDIVIDUALS AND THEIR FAMILIES IN A CARING AND CONFIDENTIAL MANNER. THE ORGANIZATION KNOWS THAT MENTAL, EMOTIONAL AND BEHAVIORAL WELLNESS CONTRIBUTE TO PHYSICAL WELL BEING. THEREFORE, IT INTEGRATES BEHAVIORAL HEALTH SERVICES INTO ITS DISEASE MANAGEMENT AND PRIMARY/PREVENTATIVE CARE. THE ORGANIZATION'S PROFESSIONALS WORK TOGETHER TO PROVIDE TOOLS AND TREATMENTS INCLUDING: ASSESSMENT AND PRIVATE CONSULTATIONS, GROUP THERAPY SESSIONS, PHARMACOLOGICAL SUPPORT, FAMILY COUNSELING, AND OUTSIDE REFERRALS FOR MORE SPECIALIZED CARE. FORM 990, PART III, LINE 4D OTHER PROGRAM SERVICES: ADDITIONAL PROGRAM SERVICES PROVIDED BY THE HEALTH CENTER INCLUDE THE VISION AND OUTREACH PROGRAMS. FORM 990, PART VI, SECTION B, LINE 11B 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 FILING, THE FORM 990 IS FIRST REVIEWED BY TOP MANAGEMENT. ONCE MANAGEMENT IS CONFIDENT WITH THE RETURN, A FINAL DRAFT IS E-MAILED TO EACH BOARD MEMBER FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE CONFLICT OF INTEREST POLICY IS REVIEWED AND SIGNED ANNUALLY BY BOARD MEMBERS AND ADMINISTRATIVE TEAM MEMBERS. POLICY: CONFLICT OF INTEREST AVOIDANCE PROCEDURES HELP BOARD MEMBERS, CONSULTANTS, EMPLOYEES AND THOSE WHO PROVIDE SERVICES OR FURNISH GOODS TO THE COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI IDENTIFY SITUATIONS THAT ARE OR MAY BE A CONFLICT OF INTEREST OR THE APPEARANCE OF CONFLICT OF INTEREST. A. CONFLICT OF INTEREST DEFINED. THE FOLLOWING CIRCUMSTANCES SHALL BE DEEMED TO CREATE CONFLICTS OF INTEREST: 1. OUTSIDE INTERESTS. (I) A CONTRACT OR TRANSACTION BETWEEN COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI AND A RESPONSIBLE PERSON OR FAMILY MEMBER. (II) A CONTRACT OR TRANSACTION BETWEEN COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI AND AN ENTITY IN WHICH A RESPONSIBLE PERSON OR FAMILY MEMBER HAS A MATERIAL FINANCIAL INTEREST OR OF WHICH SUCH PERSON IS A DIRECTOR, OFFICER, AGENT, PARTNER, EMPLOYEE, ASSOCIATE, TRUSTEE, PERSONAL REPRESENTATIVE, RECEIVER, GUARDIAN, CUSTODIAN, CONSERVATOR, OR OTHER LEGAL REPRESENTATIVE. 2. OUTSIDE ACTIVITIES. (I) A RESPONSIBLE PERSON COMPETING WITH COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI IN THE RENDERING OF SERVICES OR ANY OTHER CONTRACT OR TRANSACTION WITH A THIRD PARTY. (II) A RESPONSIBLE PERSON'S HAVING A MATERIAL FINANCIAL INTEREST IN; OR SERVING AS A DIRECTOR, OFFICER, EMPLOYEE, AGENT, PARTNER, ASSOCIATE, TRUSTEE, PERSONAL REPRESENTATIVE, RECEIVER, GUARDIAN, CUSTODIAN, CONSERVATOR, OR OTHER LEGAL REPRESENTATIVE OF, OR CONSULTANT TO; AN ENTITY OR INDIVIDUAL THAT COMPETES WITH COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI IN THE PROVISION OF SERVICES OR IN ANY OTHER CONTRACT OR TRANSACTION WITH A THIRD PARTY. 3. GIFTS, GRATUITIES AND ENTERTAINMENT. A RESPONSIBLE PERSON ACCEPTING GIFTS, ENTERTAINMENT, OR OTHER FAVORS FROM ANY INDIVIDUAL OR ENTITY THAT: (I) DOES OR IS SEEKING TO DO BUSINESS WITH, OR IS A COMPETITOR OF COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI; OR (II) HAS RECEIVED, IS RECEIVING, OR IS SEEKING TO RECEIVE A LOAN OR GRANT, OR TO SECURE OTHER FINANCIAL COMMITMENTS FROM COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI; (III) IS A CHARITABLE ORGANIZATION; UNDER CIRCUMSTANCES WHERE IT MIGHT BE INFERRED THAT SUCH ACTION WAS INTENDED TO INFLUENCE OR POSSIBLY WOULD INFLUENCE THE RESPONSIBLE PERSON IN THE PERFORMANCE OF HIS OR HER DUTIES. THIS DOES NOT PRECLUDE THE ACCEPTANCE OF ITEMS OF NOMINAL OR INSIGNIFICANT VALUE OR ENTERTAINMENT OF NOMINAL OR INSIGNIFICANT VALUE THAT ARE NOT RELATED TO ANY PARTICULAR TRANSACTION OR ACTIVITY OF COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI. B. PROCEDURES 1. BOARD MEMBERSHIP. NO BOARD MEMBER MAY BE AN EMPLOYEE OF THE COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI OR IMMEDIATE FAMILY MEMBER OF AN EMPLOYEE. 2. BOARD PARTICIPATION. BEFORE BOARD OR COMMITTEE ACTION ON A CONTRACT OR TRANSACTION INVOLVING A CONFLICT OF INTEREST OR APPEARANCE OF A CONFLICT OF INTEREST, A DIRECTOR OR COMMITTEE MEMBER HAVING A CONFLICT OF INTEREST AND WHO IS IN ATTENDANCE AT THE MEETING SHALL DISCLOSE ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. 3. RESPONSIBLE PERSONS WHO ARE NOT MEMBERS OF THE BOARD OF DIRECTORS OF COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI, OR WHO HAVE A CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT OR TRANSACTION THAT IS NOT THE SUBJECT OF BOARD OR COMMITTEE ACTION, SHALL DISCLOSE TO THE CHAIR OR THE CHAIR'S DESIGNEE ANY CONFLICT OF INTEREST THAT SUCH RESPONSIBLE PERSON HAS WITH RESPECT TO A CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL BE MADE AS SOON AS THE CONFLICT OF INTEREST IS KNOWN TO THE RESPONSIBLE PERSON. THE RESPONSIBLE PERSON SHALL REFRAIN FROM ANY ACTION THAT MAY AFFECT COMMUNITY HEALTH CENTER OF CENTRAL MISSOURI'S PARTICIPATION IN SUCH CONTRACT OR TRANSACTION. IN THE EVENT IT IS NOT ENTIRELY CLEAR THAT A CONFLICT OF INTEREST EXISTS, THE INDIVIDUAL WITH THE CONFLICT SHALL DISCLOSE THE CIRCUMSTANCES TO THE BOARD PRESIDENT WHO SHALL DETERMINE WHETHER THERE EXISTS A CONFLICT OF INTEREST THAT IS SUBJECT TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION REVIEW POLICY: IN FY 2014, THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS CONDUCTED AN ANNUAL PERFORMANCE AND COMPENSATION REVIEW FOR THE CEO. MPCA SALARY DATA WAS USED AS COMPARABILITY DATA. THE BOARD'S DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE EXECUTIVE COMMITTEE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN REQUEST FOR A LEGITIMATE BUSINESS PURPOSE (AS DETERMINED BY TOP MANAGEMENT). APPROVED DOCUMENTS WILL BE DISTRIBUTED VIA MAIL. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $(10,569) LOSS ON INVESTMENT IN EQUITY INVESTEE