PEOPLES COMMUNITY HEALTH CLINIC INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PEOPLES COMMUNITY HEALTH CLINIC INC (EIN 42-1058629)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-02-14
- IRS object ID
- 201440459349301549
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-02-14T11:21:29-06:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOGAN - HANSEN PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 240 | AddressLine1 |
| City | WATERLOO | City |
| State | IA | State |
| ZIP Code | 507040240 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421058629 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PEOPLES COMMUNITY HEALTH CLINIC | BusinessNameLine1 |
| Business Name Line2 | INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | PEOP | NameControl |
| Phone | 3192724300 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 FRANKLIN STREET | AddressLine1 |
| City | WATERLOO | City |
| State | IA | State |
| ZIP Code | 50703 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JENNIFER LIGHTBODY | Name |
| Title | CEO | Title |
| Phone | 3192724300 | Phone |
| Date Signed | 2014-01-31 | DateSigned |
| Authorize Third Party | false | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEVEN K DUGGAN CPA | Name |
| Phone | 3192335225 | Phone |
| Date Prepared | 2014-02-03 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JENNIFER LIGHTBODY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 FRANKLIN STREET | AddressLine1 |
| City | WATERLOO | City |
| State | IA | State |
| ZIP Code | 50703 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11742505 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.PEOPLES-CLINIC.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1976 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | DEDICATED TO PROVIDING ACCESS TO AFFORDABLE, COMPASSIONATE, HIGH QUALITY HEALTH CARE FOR ALL. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 179 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 3903928 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 3715687 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7798314 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 8026816 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -955 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11701287 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11742505 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8249715 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7853103 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3877705 | OtherExpensePriorYear |
| Other Expenses Current Year | 3817344 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12127420 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11670447 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -426133 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 72058 | RevenuesLessExpensesCY |
| Total Assets BOY | 6840711 | TotalAssetsBOY |
| Total Assets EOY | 6364639 | TotalAssetsEOY |
| Total Liabilities BOY | 1194664 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 646534 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5646047 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5718105 | NetAssetsOrFundBalancesEOY |
| Mission Description | DEDICATED TO PROVIDING ACCESS TO AFFORDABLE, COMPASSIONATE, HIGH QUALITY HEALTH CARE FOR ALL. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 9398446 | Expense |
| Revenue | 8026816 | Revenue |
| Description | PRIMARY MEDICAL HEALTH CARE AND DENTAL SERVICES PROVIDED TO THE PUBLIC. | Description |
| Total Program Service Expense | 9398446 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 15 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 179 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANNE MERSHON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3192724300 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 905 FRANKLIN STREET | AddressLine1 |
| City | WATERLOO | City |
| State | IA | State |
| ZIP Code | 50703 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| RYAN SHERIDAN | ||||||||
| CHAIRPERSON | 0.50 | X | X | 0 | 0 | 0 | ||
| DEBRA HARMON | ||||||||
| VICECHAIR | 0.50 | X | X | 0 | 0 | 0 | ||
| SEAN GRANT | ||||||||
| TREASURER | 0.50 | X | X | 0 | 0 | 0 | ||
| BRUCE JEFFERSON | ||||||||
| SECRETARY | 0.50 | X | X | 0 | 0 | 0 | ||
| TIM HORRIGAN | ||||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |||
| TIM HUBER | ||||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |||
| LYNN NEILL | ||||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |||
| DERVISA SISIC | ||||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |||
| KRISTEN VAN VELDHUIZEN | ||||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |||
| JENNIFER LIGHTBODY | ||||||||
| CEO | 40.00 | X | 90989 | 0 | 20613 | |||
| CHRISTINE KEMP | ||||||||
| COO | 40.00 | X | 69827 | 0 | 16355 | |||
| ANNE MERSHON | ||||||||
| CFO | 40.00 | X | 61617 | 0 | 16006 | |||
| DR SHARON DUCLOS | ||||||||
| CO-MEDICAL D | 40.00 | 169590 | 0 | 18632 | X | |||
| DR DANIEL WRIGHT | ||||||||
| PEDIATRIC PH | 40.00 | 162370 | 0 | 24864 | X | |||
| DR VICKI HENDERSON | ||||||||
| FAMILY PRACT | 40.00 | 149202 | 0 | 18083 | X | |||
| DR KIMBERLY NEUMANN | ||||||||
| CO-MEDICAL D | 40.00 | 135108 | 0 | 22154 | X | |||
| DR ALINA STANICA | ||||||||
| PEDIATRIC PH | 40.00 | 134544 | 0 | 23303 | X | |||
| DR BRENT BUHR | ||||||||
| INTERNAL MED | 40.00 | 134084 | 0 | 15433 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1107331 | TotalReportableCompFromOrg |
| Total Other Compensation | 175443 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LAPCORP | |||||
| 358 SOUTH MAIN STREET | BURLINGTON | NC | 27215 | LAB | 346824 |
| MCKESSON | |||||
| ONE POST STREET | SAN FRANCISCO | CA | 94104 | PHARMACY | 346160 |
| INCONCERT CARE | |||||
| 9943 HICKMAN RD SUITE 103 | URBANDALE | IA | 50322 | PRIMARY CARE | 311931 |
| HENRY SCHEIN | |||||
| 135 DURYEA ROAD | MELVILLE | NY | 11747 | SUPPLIES | 178406 |
| ALLEN MEMORIAL HOSPITAL | |||||
| 1825 LOGAN AVENUE | WATERLOO | IA | 50703 | HOSPITAL | 147940 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Federated Campaigns | 88599 | FederatedCampaigns |
| Government Grants | 2670605 | GovernmentGrants |
| All Other Contributions | 956483 | AllOtherContributions |
| Noncash Contributions | 947646 | NoncashContributions |
| Total Contributions | 3715687 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| MEDICAID | 5077429 | 5077429 |
| PRIVATE INSURANCE | 1548855 | 1548855 |
| PATIENT FEE | 687178 | 687178 |
| MEDICARE | 472394 | 472394 |
| OPERATING INCOME | 240960 | 240960 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 8026816 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2 | TotalRevenueColumn |
| Exclusion | $2 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11742505 | TotalRevenueColumn |
| Related Or Exempt Function Income | 8026816 | RelatedOrExemptFunctionIncome |
| Exclusion | $2 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 590875 | Total |
| Program Services | 339979 | ProgramServices |
| Management And General | 250896 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5807811 | Total |
| Program Services | 4887126 | ProgramServices |
| Management And General | 920685 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197531 | Total |
| Program Services | 166217 | ProgramServices |
| Management And General | 31314 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 806447 | Total |
| Program Services | 608775 | ProgramServices |
| Management And General | 197672 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 450439 | Total |
| Program Services | 365931 | ProgramServices |
| Management And General | 84508 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20485 | Total |
| Management And General | 20485 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18350 | Total |
| Management And General | 18350 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 174347 | Total |
| Program Services | 57277 | ProgramServices |
| Management And General | 117070 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115890 | Total |
| Program Services | 97842 | ProgramServices |
| Management And General | 18048 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13562 | Total |
| Program Services | 7656 | ProgramServices |
| Management And General | 5906 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11166 | Total |
| Program Services | 6385 | ProgramServices |
| Management And General | 4781 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4845 | Total |
| Management And General | 4845 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310205 | Total |
| Program Services | 261922 | ProgramServices |
| Management And General | 48283 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30548 | Total |
| Program Services | 14386 | ProgramServices |
| Management And General | 16162 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 1584685 | 1581378 | 3307 |
| REFERRALS/OTHER | 694631 | 694631 | |
| COMPUTER EXPENSE | 421624 | 16321 | 405303 |
| PURCHASED SERVICE | 233754 | 144995 | 88759 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 183252 | Total |
| Program Services | 147625 | ProgramServices |
| Management And General | 35627 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11670447 | Total |
| Program Services | 9398446 | ProgramServices |
| Management And General | 2272001 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2945 | BOY |
| EOY | 2572 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 439274 | BOY |
| EOY | 477103 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108093 | BOY |
| EOY | 183619 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 842608 | BOY |
| EOY | 543857 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108886 | BOY |
| EOY | 104764 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47594 | BOY |
| EOY | 51501 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7962867 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2983112 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5264188 | BOY |
| EOY | 4979755 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27123 | BOY |
| EOY | 21468 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6840711 | BOY |
| EOY | 6364639 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 869149 | BOY |
| EOY | 646534 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 325515 | BOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1194664 | BOY |
| EOY | 646534 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5646047 | BOY |
| EOY | 5718105 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5646047 | BOY |
| EOY | 5718105 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6840711 | BOY |
| EOY | 6364639 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 72058 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3562275 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3814827 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4192957 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3903928 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3715687 | CurrentTaxYear |
| Total | 19189674 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3562275 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3814827 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4192957 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3903928 | CurrentTaxYearMinus1Year |
| Current Tax Year | 3715687 | CurrentTaxYear |
| Total | 19189674 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 19189674 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3875 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6117 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3272 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2 | CurrentTaxYear |
| Total | 13268 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 19202942 | TotalSupport |
| Gross Receipts From Admissions Etc | 8026816 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.99930 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.99910 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | SCHEDULE C, PART I-A, LINE 1 | ReturnReference |
| Explanation | DUES ARE PAID TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND A PORTION OF THESE DUES MAY BE ATTRIBUTABLE TO LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 730530 | OtherCostOrOtherBasis |
| Book Value | 730530 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6000928 | OtherCostOrOtherBasis |
| Depreciation | 2007947 | Depreciation |
| Book Value | 3992981 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1231409 | OtherCostOrOtherBasis |
| Depreciation | 975165 | Depreciation |
| Book Value | 256244 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4979755 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 11742505 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 11742505 | RevenueSubtotal |
| Total Revenue Per Form990 | 11742505 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11670447 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 11670447 | ExpensesSubtotal |
| Total Expenses Per Form990 | 11670447 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | MANAGEMENT ANNUALLY MAKES AN APPROPRIATE EVALUATION OF ANY UNCERTAIN INCOME TAX POSITIONS BASED UPON CURRENT STATUTES IN COMPLETING THESE FINANCIAL STATEMENTS AND THE NOTES TO THE FINANCIAL STATEMENTS. AS OF JUNE 30, 2013, MANAGEMENT BELIEVES THAT THERE WERE NO UNCERTAIN INCOME TAX POSITIONS FOR WHICH A MATERIAL CHANGE IN THE UNRECOGNIZED EFFECT WOULD BE REASONABLY POSSIBLE WITHIN THE NEXT 12 MONTHS. THE OPEN YEARS FOR AUDIT OF THE ORGANIZATION'S INCOME TAX RETURNS ARE 2010-2013. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|
| DR SHARON DUCLOS | ||||
| CO-MEDICAL DIRECTOR | 169590 | 8633 | 9999 | 188222 |
| DR DANIEL WRIGHT | ||||
| PEDIATRIC PHYSICIAN | 162370 | 8513 | 16351 | 187234 |
| DR VICKI HENDERSON | ||||
| FAMILY PRACTICE PHYS | 149202 | 8513 | 9570 | 167285 |
| DR KIMBERLY NEUMANN | ||||
| CO-MEDICAL DIRECTOR | 135108 | 8042 | 14112 | 157262 |
| DR ALINA STANICA | ||||
| PEDIATRIC PHYSICIAN | 134544 | 6861 | 16442 | 157847 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION | Identifier |
| Return Reference | SCHEDULE J, PAGE 1, PART I, LINE 3 | ReturnReference |
| Explanation | THE CEO REVIEWS COMPARATIVE SALARY INFOMRATION COLLECTED THROUGH THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE IOWA/NEBRASKA PRIMARY HEALTH CARE ASSOCIATION THEN RECOMMENDS COMPENSATION FOR PHYSICIANS AND KEY EMPLOYEES THROUGH THE ANNUAL BUDGETING PROCESS. THE BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE BUDGET. | Explanation |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSupplies
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 16613 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 947646 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | 340B PRICING | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | true | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | PRIOR TO BEING FILED THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND PRESENTED TO THE FULL BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY WITH DIRECTORS, OFFICERS AND KEY EMPLOYEES. WRITTEN CERTIFICATION IS REQUESTED AT THE TIME OF REVIEW. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS COMPARATIVE SALARY INFORMATION COLLECTED THROUGH THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE IOWA/NEBRASKA PRIMARY CARE ASSOCIATION THEN DETERMINES COMPENSATION FOR THE EXECUTIVE DIRECTOR. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE DIRECTOR REVIEWS COMPARATIVE SALARY INFORMATION COLLECTED THROUGH THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE IOWA/NEBRASKA PRIMARY HEALTH CARE ASSOCIATION THEN RECOMMENDS COMPENSATION FOR KEY EMPLOYEES THROUGH THE ANNUAL BUDGETING PROCESS. THE BOARD OF DIRECTORS ANNUALLY APPROVES THE BUDGET. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THE ORGANIZATION'S MAIN OFFICE UPON REQUEST. |
Comments