2013-02-15T16:16:21-06:00 2012-03-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2011-04-01 830326307 COMMUNITY HEALTH CENTER OF CENTRAL WYOMING % DIAHANN BARRERA COMM 3072336000 2546 EAST 2ND STREET CASPER WY 82609 MARTY THONE 2013-02-08 true 4178658701 2011 2016-03-07 17:11:31Z MARTY THONE 2546 EAST 2ND STREET STE 600 CASPER WY 82609 16295077 false X www.chccw.org X 1999 WY TO MAINTAIN A HIGH QUALITY PATIENT CARE DELIVERY SYSTEM THAT PROVIDES ACCESS TO COMPREHENSIVE HEALTH CARE SERVICES, REGARDLESS OF ABILITY TO PAY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. 12 12 183 13 0 0 1974381 9240080 8923821 7048848 21439 -599383 0 0 10919641 15689545 0 0 0 0 7328856 6662255 0 0 0 3393514 4284519 10722370 10946774 197271 4742771 6021861 11222828 931314 1392743 5090547 9830085 X TO PROVIDE COMPASSIONATE, AFFORDABLE AND HIGH QUALITY PATIENT CARE WITH A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES FOR RESIDENTS OF CENTRAL WYOMING, REGARDLESS OF THEIR INCOME. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false false 6960793 6005384 MEDICAL FACILITY - THE ORGANIZATION PROVIDES LAB, MULTIPHASIC, PHARMACY, AND MEDICAL SERVICES TO PATIENTS. APPROXIMATELY 31,088 PATIENT VISITS WERE SEEN AT THE MEDICAL FACILITY DURING THE FISCAL YEAR. SERVICES INCLUDE: FAMILY MEDICINE, GERIATRIC CARE, PEDIATRICS, INTERNAL MEDICINE AND OBSTETRICS; INPATIENT SERVICES AT WYOMING MEDICAL CENTER AND LONG-TERM CARE FACILITIES; FULL PHARMACY FOR PATIENTS; LABORATORY, X-RAYS, ULTRASOUNDS, AND OTHER SCREENING AND DIAGNOSTIC TESTS, SUCH AS VISION AND HEARING; PATIENT HEALTH EDUCATION, PATIENT ASSISTANCE, PREVENTATIVE CARE, AND SPANISH TRANSLATION SERVICES. 1081348 895613 DENTAL - THE ORGANIZATION'S DENTAL CLINIC OPERATES WITHIN SCOPE AND PROVIDED APPROXIMATELY 6,935 PATIENT VISITS DURING THE FISCAL YEAR. SERVICES INCLUDE: DENTAL HYGIENE, GENERAL RESTORATIVE ORAL CARE (FILLINGS), CROWNS, BRIDGES, ENDODONTIC (ROOT CANALS), EXODONTIA (EXTRACTIONS), PERIODONTAL SURGERY, PROSTHODONTICS (DENTURES, PARTIALS), MINI IMPLANTS FOR DENTURES, EMERGENCY DENTAL APPOINTMENTS, ORAL CANCER SCREENING, AND ELECTRONIC PATIENT RECORDS. 174716 147851 BEHAVIORAL HEALTH - THE ORGANIZATION'S BEHAVIORAL HEALTH DEPARTMENT OPERATES WITHIN SCOPE AND PROVIDED APPROXIMATELY 1,146 PATIENT VISITS DURING THE FISCAL YEAR. SERVICES INCLUDE: PSYCHOLOGICAL EVALUATIONS & TESTING, PERSONAL SKILLS TRAINING, MEDICATION MGMT, PSYCHOTHERAPY, SOCIAL INTERACTION GROUP THERAPY, BEHAVIORAL MODIFICATION TREATMENT FOR ATTENTION DEFICIT DISORDER, SPECIALIZED TREATMENT (POST TRAUMATIC STRESS DISORDER, PSYCHOLOGICAL TRAUMA & ABUSE, AUTISM & ASPERGER'S SYNDROME, HEAD INJURIES), AND PSYCHOLOGICAL EVALUATIONS FOR CHRONIC PAIN MANAGEMENT. 8216857 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 true false false false false false false false false false false false true 44 0 true 183 true false false false false false false false false false false X 12 12 false false true false false false false true true false true true true true true true true true true true false X DIAHANN BARRERA 3072336000 5000 BLACKMORE RD CASPER WY 82609 X DOUG FOLLICK 1.0 X X 0 SEAN ELLIS DDS 1.0 X X 0 DEB JOHNSON 1.0 X 0 SUSAN KARAVITIS 1.0 X 0 RORY FRANKLIN 1.0 X 0 MARTY THONE MS PHD 1.0 X X 300 JEFF MURATORE 1.0 X 0 MELISSA CONNELY 1.0 X 0 RANDY STUTHEIT 1.0 X 0 MIKE GILMORE 1.0 X X 0 CRAIG ABEL 1.0 X 0 CATHY CARSEN 1.0 X 0 JANICE LYNCH 1.0 X 0 LESLI WRIGHT 1.0 X 0 0 0 CONNIE LONGWELL 40.0 X 107563 0 16666 DANIEL J REINER 40.0 X 152096 0 20552 DR STEEN GODDIK 40.0 X 111467 0 11925 DR LARISSA TOLLEY 40.0 X 126557 0 17482 DR JASON WILLIS 40.0 X 126859 0 2343 DR KARL RADKE 40.0 X 191268 0 16444 DR RUMA SAHA 40.0 X 108122 6750 924232 0 92162 7 false true false FCI CONSTRUCTION INC CONSTRUCTION 5316385 BOULDER ASSOCIATES ARCHITECT FIRM 491998 EMISSARY PHARMACY MANAGEMENT 132324 BKD LLP AUDIT/TAX/CONSULTING 109562 ADBAY ADVERTISING FIRM 105795 5 45030 9194400 650 9240080 PATIENT SERVICE REVENUE 624100 6957325 6957325 OTHER 624100 91523 91523 7048848 6149 6149 0 0 605532 -605532 -605532 -605532 0 0 0 0 15689545 7048848 -599383 0 0 0 0 309875 309875 0 113995 113995 5072171 3962069 1110102 44960 42816 2144 728823 545341 183482 392431 284801 107630 0 98507 98507 103701 103701 0 0 0 548451 426800 121651 136451 136451 322661 8323 314338 204504 183716 20788 0 617595 600311 17284 90601 41362 49239 0 32001 23310 8691 0 0 317950 250962 66988 15872 1141 14731 MEDICAL SUPPLIES & DRUGS 1104479 1104479 BAD DEBT 588580 588580 RECRUITING & RETENTION 74301 74301 LICENSES, DUES, SUBSCRIPTIONS 24549 16395 8154 4316 4316 10946774 8216857 2729917 0 4061 28315 2055347 1102300 171296 577888 805362 627392 0 0 0 0 0 0 120638 94685 104610 128221 10542556 1888907 2760547 8653649 0 0 0 0 0 0 0 0 0 10378 6021861 11222828 884318 1380827 0 0 11916 11916 0 0 0 0 0 0 0 0 0 0 35080 0 931314 1392743 X 5010206 9781195 80341 48890 0 0 5090547 9830085 6021861 11222828 X 4742771 -3233 X false true true X true true X 2477659 2021448 2126591 1974381 9240080 17840159 2477659 2021448 2126591 1974381 9240080 17840159 17840159 85730 25055 10092 21439 6149 148465 17988624 39680938 0.99175 0.98237 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES. 1260084 1260084 5343 201 5142 18302 13222 5080 2477351 1875484 601867 6781476 0 6781476 8653649 15689545 10946774 4742771 -3233 -3233 4739538 16385960 94116 -3233 90883 16295077 -605532 -605532 15689545 11646422 94116 605532 699648 10946774 10946774 UNCERTAIN TAX POSITIONS SCHEDULE D, PART X, LINE 2 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. OTHER RECONCILING CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 ($3,233) RECOVERIES OF PRIOR YEAR GRANT OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B ($605,532) LOSS ON DISPOSAL OF ASSETS OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $605,532 LOSS ON DISPOSAL OF ASSETS X X X X false false false false false false false true false DR KARL RADKE 172107 0 19161 0 0 0 5063 0 11381 0 207712 0 0 0 DANIEL J REINER 134379 0 17717 0 0 0 8770 0 11782 0 172648 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 DAN REINER AND CONNIE LONGWELL RECEIVED KEY EMPLOYEE INCENTIVES, WHICH WERE BONUSES GIVEN TO CERTAIN EMPLOYEES FOR PURPOSES OF RETENTION. THESE BONUSES WERE CALCULATED AS 10% OF EMPLOYEE'S ANNUAL SALARY, WITH 7% PAID IN JUNE 2011 AND 3% PAID IN DECEMBER 2012. OTHER BONUS COMPENSATION SCHEDULE J, PART II, COLUMN (B)(II) DR. RUMA SAHA, DR. LARISSA TOLLEY, AND DR. KARL RADKE RECEIVED PRODUCTIVITY BONUSES, WHICH WERE BONUSES GIVEN TO PROVIDERS BASED ON PRODUCTION GOALS (ENCOUNTERS AND CHARGES) STIPULATED IN THEIR EMPLOYMENT CONTRACTS. GOLDIE OLSON SISTER OF C. LONGWELL 68081 EMPLOYEE COMPENSATION false TONYA WILLIAMS COUSIN OF C. LONGWELL 45914 EMPLOYEE COMPENSATION false ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 IT IS THE MISSION OF THE COMMUNITY HEALTH CENTER OF CENTRAL WYOMING (CHCCW) TO MAINTAIN A HIGH QUALITY PATIENT CARE DELIVERY SYSTEM THAT PROVIDES 100% ACCESS TO COMPREHENSIVE HEALTH CARE SERVICES FOR ALL RESIDENTS OF CASPER AND NATRONA COUNTIES AND THROUGHOUT WYOMING, REGARDLESS OF ABILITY TO PAY. IT IS ALSO THE DESIRE OF CHCCW TO SUPPORT THE EDUCATION AND TRAINING OF MULTIPLE DISCIPLINES OF HEALTH CARE PROFESSIONALS. FROM PRENATAL CARE TO GERIATRIC CARE, COMPREHENSIVE SERVICES COVER ALL LIFE SPANS, MAKING THE CHCCW A TRUE HEALTHCARE HOME. AS STEWARDS OF THE COMMUNITY, THE ORGANIZATION SEEKS TO UNDERSTAND, RESPOND TO, AND SERVE COMMUNITY NEEDS, OFFERING ASSISTANCE TO THOSE WITH LIMITED OPTIONS AND REMOVING BARRIERS THAT PREVENT PEOPLE FROM ACCESSING CARE. THE VISION OF CHCCW IS FOR CENTRAL WYOMING TO BECOME THE HEALTHIEST REGION IN THE STATE. VOLUNTEERS FORM 990, PART I, LINE 6 THE ORGANIZATION'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD. BOARD-APPROVED MISSION STATEMENT FORM 990, PART III, LINE 1 THE BOARD-APPROVED MISSION STATEMENT IS AS FOLLOWS: IT IS THE MISSION OF CHCCW TO PROVIDE COMPASSIONATE, AFFORDABLE AND HIGH QUALITY PATIENT CARE WITH A COMPREHENSIVE RANGE OF HEALTH CARE SERVICES FOR RESIDENTS OF CENTRAL WYOMING, REGARDLESS OF THEIR INCOME. IT IS THE DESIRE OF CHCCW TO TREAT ALL PATIENTS WITH THE DIGNITY AND RESPECT THEY DESERVE. SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS FORM 990, PART VI, SECTION A, LINE 4 THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE BYLAWS OF THE ORGANIZATION: IF A BOARD MEMBER VACANCY OCCURS DURING THE YEAR, THE NEWLY APPOINTED INDIVIDUAL WILL COMPLETE THE REMAINING TERM OF THE DEPARTING MEMBER OR, IN THE CASE OF A NEWLY OPENED SEAT, THE REMAINING MONTHS PRIOR TO THE ANNUAL MEETING. TERMS OF OFFICE WERE MODIFIED TO STATE THAT A TERM IS FOUR (4) YEARS AND THAT MEMBERS ARE ELIGIBLE TO SERVE FOR A MAXIMUM OF FOUR (4) FULL FOUR-YEAR TERMS. SPECIFIC RESPONSIBILITIES OF THE BOARD OFFICERS THAT WERE NOT PREVIOUSLY LISTED IN THE BYLAWS WERE ADDED. THE CHAIRPERSON IS RESPONSIBLE FOR ORGANIZATION, INTERNAL DISCIPLINE, TEAM BUILDING, SERVING AS A LIAISON BETWEEN THE BOARD AND CEO, ENSURING AGENDA ITEMS ARE DISCUSSED AND TASK DELEGATION. THE VICE CHAIRPERSON IS RESPONSIBLE TO STAY ABREAST OF CURRENT BOARD ISSUES AND OPERATIONS. THE SECRETARY IS RESPONSIBLE FOR THE ACCURACY AND COMPLETENESS OF THE NOTES/MINUTES AND FOR THE CENTER'S HISTORICAL AND LEGAL DOCUMENTS. THE TREASURER IS RESPONSIBLE FOR ADEQUATE RETENTION OF FINANCIAL RECORDS, TIMELY FINANCIAL REPORTS AND ENSURING THAT THE CENTER'S FINANCES ARE AUDITED ANNUALLY. THE BOARD OF DIRECTORS SELF EVALUATION FORM WILL BE COMPLETED AT LEAST ONCE A YEAR BY EACH BOARD MEMBER. REVIEW OF FORM 990 FORM 990, PART VI, SECTION B, LINE 11B 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. THE CEO AND CFO REVIEW THE RETURN IN DETAIL WITH THE INDEPENDENT ACCOUNTING FIRM PREPARING THE FORM. UPON COMPLETION OF TOP MANAGEMENT'S REVIEW, A TENTATIVE FINAL DRAFT IS EMAILED/MAILED TO ALL BOARD MEMBERS FOR THEIR REVIEW. ANY QUESTIONS OR RECOMMENDED CHANGES ARE DIRECTED TO THE CFO AND CHANGED IF NECESSARY PRIOR TO FILING. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS, THROUGH THE SENIOR MANAGEMENT, IS ACCOUNTABLE FOR IMPLEMENTATION, ENFORCEMENT, MONITORING, OVERSIGHT, AND COMMUNICATION OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. DEPARTMENTAL DIRECTORS AND SUPERVISORS ARE ACCOUNTABLE FOR IMPLEMENTATION, ENFORCEMENT, MONITORING, OVERSIGHT, AND COMMUNICATION OF THE CONFLICT OF INTEREST POLICY IN THEIR DEPARTMENTS. MEMBERS OF THE BOARD MUST NOT ENGAGE IN ANY ACTIVITIES OR RELATIONSHIPS WHICH MIGHT DIRECTLY OR INDIRECTLY RESULT IN A CONFLICT OF INTEREST, OR IMPAIR THEIR INDEPENDENCE OF JUDGMENT. THEY MUST NOT ACCEPT GIFTS, FAVORS, OR BENEFITS THAT MIGHT TEND IN ANY WAY TO INFLUENCE THEM IN PERFORMANCE OF THEIR DUTIES AS TRUSTEES. CONFLICT OF INTEREST IS IDENTIFIED BY A MEMBER OF THE BOARD OF DIRECTORS OR SENIOR MANAGEMENT WHO CAN OBJECTIVELY ASSESS THE SITUATION AND IMPOSE THE NECESSARY RESTRICTIONS TO PROTECT THE INTERESTS OF THE ORGANIZATION. IF A CONFLICT WAS TO ARISE, THE INTERESTED PERSON WOULD NOT PARTICIPATE IN DECISION MAKING RELATED TO THE CONFLICT. CORPORATE OFFICERS AND KEY EMPLOYEES ARE ALSO REQUIRED TO ANNUALLY REVIEW POTENTIAL CONFLICTS OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, DISCLOSURE WOULD BE MADE TO A MEMBER OF THE SENIOR MANAGEMENT WHO CAN OBJECTIVELY ASSES THE SITUATION. IF THE CONFLICT INVOLVES A SENIOR MANAGER, DISCLOSURE SHOULD BE MADE TO THE MEDICAL DIRECTOR OF COMPLIANCE AND EXCELLENCE OR A MEMBER OF THE BOARD. IF THE CONFLICT WARRANTS ACTION, SUCH ACTION WILL BE TAKEN TO PROTECT THE INTEREST OF THE ORGANIZATION SUCH AS THE TERMINATION IN THEIR PARTICIPATION OF THE DECISION MAKING RELATED TO THE CONFLICT. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B EACH YEAR AS PART OF THE BUDGET PROCESS, IN EXECUTIVE SESSION THE BOARD OF DIRECTORS CONDUCTS A COMPENSATION REVIEW. TO OBTAIN THE APPROPRIATE COMPENSATION PACKAGE FOR THE CEO, THE BOARD OF DIRECTORS REVIEWS COMPARABLE DATA FOR THE ORGANIZATION'S LOCATION, INCLUDING ANY COMPENSATION DATA PROVIDED BY THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS(NACHC) AND THE CHAMPS SALARY GUIDE. THIS DATA IS SPECIFIC TO REGION, SIZE OF ORGANIZATION, AND NUMBER OF ENCOUNTERS GENERATED. THE REVIEW PROCESS IS MENTIONED IN THE BOARD MINUTES. EACH YEAR, THE CEO REVIEWS THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE CEO REVIEWS ALL ANNUAL SALARY INCREASES USING COMPARABILITY DATA FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC). HOWEVER, IF A SALARY CHANGES BY $10,000 OR 10%, THE BOARD IS REQUIRED TO REVIEW AND APPROVE THE SALARY CHANGE. THIS REVIEW PROCESS IS MENTIONED IN THE BOARD MINUTES. DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST AND WILL BE MAILED OR EMAILED TO THE REQUESTING PERSON. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS CURRENTLY AVAILABLE ON THE ORGANIZATION'S WEBSITE OR UPON REQUEST. A COPY CAN ALSO BE OBTAINED VIA MAIL OR EMAIL. FINANCIAL STATEMENTS ARE ONLY MADE AVAILABLE FOR BONA FIDE BUSINESS PURPOSES, SUCH AS REQUESTS FROM FINANCIAL INSTITUTIONS, VENDORS, AND THIRD PARTY AGENCIES. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 ($3,233) RECOVERIES OF PRIOR YEAR GRANTS