2013-07-31T10:07:09-05:00 2012-09-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2011-10-01 430899356 Samuel U Rodgers Health Center Inc % BOB THEIS SAMU 8164744920 825 Euclid Avenue Kansas City MO 64124 HILDA FUENTES 2013-08-15 true Jim Still 8162216300 2011 2016-02-24 21:20:13Z Hilda Fuentes 825 Euclid Avenue Kansas City MO 64124 21259059 false X www.rodgershealth.org X 1968 MO THE CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE FOR ALL. 17 17 269 166 0 0 21684654 12151541 6867922 7413466 38585 76539 61974 510449 28653135 20151995 11547110 0 0 0 10142543 10897182 0 0 83015 5621098 6710049 27310751 17607231 1342384 2544764 29899731 32575409 1677241 1537379 28222490 31038030 X THE CENTER'S MISSION IS TO PROVIDE HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE FOR ALL. false true 13537194 7413466 SEE SCHEDULE O 13537194 true true false false false false false true false false true false false true false true true false false false false false false false true false false false false true false false false false false false false false true false false false false true true true false false true 53 0 true 269 true false false false false false false false false false false X 17 17 false false false false false false false true true false false true true true true true true true true false MO X BOB THEIS 8168894802 825 EUCLID AVENUE Kansas City MO 64124 X Ralph C Johnson MS CPA 1.0 X X Steven Israellite 1.0 X X 0 0 0 Harry S Jonas MD 1.0 X 0 0 0 Joseph L Hiersteiner 1.0 X X 0 0 0 Ursula Copeland MSW 1.0 X X 0 0 0 Farah Abdi 1.0 X Charles Houseworth 1.0 X Mona Lee Perry 1.0 X Manuel Solano MD 1.0 X Nhoung Tran 1.0 X ROBERT BROOKS 1.0 X JERRY STOLOV 1.0 X Maime Hughes 1.0 X JOE VALENCIANO 1.0 X X 0 0 0 BRADLEY SANCHEZ HOUSETON 1.0 X RANDALL FERGUSON 1.0 X KATRENA ARMSTRONG 1.0 X CATHY WALLACE 1.0 X Ruth Terrell 40.0 X 114592 12034 Hilda Fuentes 40.0 X 188706 13269 Ralph Caro 40.0 X 118435 11505 Daniel T Purdom MD 40.0 X 166680 16065 Helen K Darby RN 40.0 X 113449 7680 Bob Theis CPA 40.0 X 106966 10843 Sudha Chaudhuri MD 24.0 X 154485 12902 Cindy Ruttan MD 40.0 X 144601 13167 GREGORY BUHLER DO 40.0 X 147873 17157 MICHAEL WELLS DO 40.0 X 139765 12471 KHURSHEED ZIA MD 40.0 X 133873 18842 Charlene Mason-Dozier DDS 40.0 X 123606 10919 1653031 0 156854 19 true true false WORKSMART MD MEDICAL BILLING 335116 PHARMACY SYSTEMS PHARMACY MANAGEMENT 323438 ALEXANDER OPEN SYSTEMS MIS CONTRACT MGMT 273003 CASEY ASSOCIATES INC DOCUMENT MANAGEMENT 124500 4 175640 65207 10624757 1285937 152167 12151541 Net Patient Service Revenue 621400 7413466 7413466 7413466 24142 24142 0 0 1060394 5230 1013227 47167 5230 52397 52397 23873 65207 93837 -69964 -69964 0 0 Other Income 900099 39812 39812 EHR INCENTIVES 900099 510000 510000 RECOVERY OF LOSS ON IMPAIRMENT 900099 30601 30601 580413 20151995 7413466 586988 0 0 0 0 782816 614041 168775 0 7578365 6433423 1079942 65000 255240 199275 55965 1549291 1428375 109484 11432 731470 628654 96233 6583 0 55615 55615 87375 87375 0 0 0 1830262 1140210 690052 212742 207838 4904 536921 448491 88430 259039 106088 152951 0 465703 328462 137241 69198 58492 10706 0 22611 10864 11747 227 227 0 1565663 594766 970897 78975 78975 Bad Debt Expense 494526 494526 Repairs & Maintenance 152750 111478 41272 MEDICAL SUPPLIES 639639 639639 Dues & Subscriptions 120356 36517 83839 118447 55828 62619 17607231 13537194 3987022 83015 118401 267813 1260024 1357631 728728 688620 500347 615231 0 0 0 0 0 0 54286 47306 125969 140053 29906483 4507336 4102624 25399147 1057904 1259543 0 0 0 78946 0 0 21951448 2721119 29899731 32575409 1386508 1307581 0 0 270457 229798 0 0 0 0 0 0 20276 0 0 0 0 1677241 1537379 X 8551409 30768895 19671081 269135 0 0 28222490 31038030 29899731 32575409 X 2544764 270776 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X false false false 1485793 1485793 22031549 1588571 20442978 262984 79200 183784 6116706 2839565 3277141 9451 9451 25399147 EST AMTS DUE FROM 3RD PARTIES 2400000 OTHER A/R 8546 SUR LEGACY FUND 43438 INT IN NET ASSETS OF SURHCF 269135 2721119 0 0 20151995 17607231 2544764 119051 151725 270776 2815540 20364883 119051 93837 212888 20151995 20151995 17701068 93837 93837 17607231 17607231 COLLECTIONS OF ART SCHEDULE D, PART III, LINE 4 Paintings by Rita Blitt were installed at the Health Center in April 2012. These paintings are part of the Rita Blitt Museum Without Walls exhibition. The Rita Blitt Museum Without Walls was developed in 2012 to list and illustrate exhibitions that are available for loan to galleries and museums, to map the numerous public places throughout the world that one can visit to view Blitts artwork, to share educational curriculum and films relating to her practice, and to showcase works in her portfolio. The exhibition featured in the On View section will change on a monthly basis. Blitt has indefinitely loaned collections of her art to non-profit organizations through the Rita Blitt Foundation, whose mission is to share, educate, and inspire through the artworks of Blitt. UNCERTAIN TAX POSITIONS DISCLOSURE 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. RECONCILIATION OF CHANGE IN NET ASSETS SCHEDULE D, PART XI, LINE 8 CHANGE IN INTEREST OF SURHCF $ 151,275 RECONCILIATION OF REVENUES PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII, LINE 2D FUNDRAISING EVENT EXPENSES $ 93,837 RECONCILIATION OF EXPENSES PER AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XIII, LINE 2D FUNDRAISING EVENT EXPENSES $ 93,837 NEW BEGINNING 89080 65207 23873 10156 25740 7940 50001 0 89080 65207 23873 10156 25740 7940 50001 93837 -69964 X X X X false false false false false false false false false Hilda Fuentes 172199 16237 270 7904 5365 201975 Daniel T Purdom MD 166410 0 270 8640 7425 182745 Charlene Mason-Dozier DDS 123404 0 202 6281 4638 134525 Sudha Chaudhuri MD 154364 0 121 7987 4915 167387 Cindy Ruttan MD 144331 0 270 6983 6184 157768 GREGORY BUHLER DO 147603 0 270 4800 12357 165030 MICHAEL WELLS DO 139495 0 270 7106 5365 152236 KHURSHEED ZIA MD 133603 0 270 7000 11842 152715 X 1 107793 COST X DENTAL EQUIPMENT 1 44374 FMV false true false NUMBER OF CONTRIBUTIONS SCHEDULE M, PART I, COLUMN B THE AMOUNTS IN COLUMN B REPRESENT THE NUMBER OF CONTRIBUTIONS MADE. CHANGES TO PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 3 The Health Center completed construction of a new facility and moved from its previous Downtown Campus at 825 Euclid to the new facility with the same address. A legacy park was constructed at the previous location. PROGRAM SERVICE ACCOMPLISHMENT FORM 990, PART III, LINE 4A The Health Center is located in a community that is a vital part of the metropolitan area's multicultural fabric. Located northeast of the Vine District, the Health Center is accessible to neighborhood residents including individuals and families residing in nearby public housing family developments. The Health Centers goal is the same as its mission which is to provide high quality, compassionate health care to all. Comprehensive care is delivered to people throughout the Kansas City metropolitan area and rural Lafayette county and surrounding area in Missouri. Our outpatient primary care services include: - Adult & Senior Services - Behavioral Health - Children's & Adolescents Health - Women's Health - Dental Health - Podiatry On-site ancillary and supportive services include: - Laboratory - Imaging - Radiology - Pharmacy - Interpreters - Patient Transportation A full range of outreach services complete the array of primary care services. They include: - Education and screening for breast and cervical cancer - Counseling and treatment for alcohol, tobacco and other drug abuse - WIC and nutrition education services (serving 3,200 individuals monthly) - Missouri HealthNet enrollment - Community outreach and health education Today's constantly changing health care system has added a special challenge to the Health Center's ability to care for the medically underserved people in our service area: - The Kansas City area is home to an increasing number of financially indigent and uninsured patients who are ineligible for public support programs; - Many of the Health Center's patients are medically uninsured while third party reimbursement remains flat. The Health Center's patient base is extraordinarily diverse. Because we are located near one of the largest refugee resettlement facilities in the Midwest, our Health Center is a point of entry to primary care services for immigrants from war-torn nations. More than twenty percent of the 1.8 million residents of the Kansas City metropolitan area are uninsured or are on Medicaid. About 27% of our patients are best served in a language other than English. To ensure these patients receive high quality care, the Health Center employs a cadre of interpreters who speak 12 languages. Among patients served, 31 percent are Hispanic/Latino, 32 percent Caucasian, 20 percent African American, 10 percent representing other ethnicities and 7 percent are Asian/Pacific Islander. Children represent 38 percent of our patient base. Thus, protecting children from childhood diseases is a vital part of our mission. Unchecked, the ravages of childhood illnesses such as Measles, Mumps, and Rubella can cause permanent disability or even death. In 2011 SURHC - Provided health care for 19,047 individuals through over 69,500 visits - Launched a dental practice at J.A. Rogers Elementary School to provide oral health care services for low-income children - Provided $2.9 million in indigent care. 2012 -Provided health care for 21,114 individuals through over 77,000 visits - Launched a dental practice at the Clay County location to expand the Health Centers presence at that location - Provided $4.4 million in indigent care. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11A AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 IS THEN PROVIDED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR THEIR REVIEW PRIOR TO FILING THE 990. ANY QUESTIONS AND CONCERNS THE FINANCE COMMITTEE HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C Duty to Disclose: If an Interested Person has a Position or Financial Interest in any business or other entity with which the Health Center is considering entering into an arrangement or transaction, the Interested Person must disclose the existence of the conflict to the Health Center's Board of Directors ("Board"). Determining Whether a Conflict of Interest Exists: The Board of Directors will make the determination. Procedures for Addressing the Conflict of Interest: - Prior to any discussion and vote on whether a conflict of interest exists, an Interested Person may make a presentation to the Board or the Executive Committee regarding the Interested Person's Position or Financial Interest. After such presentation, the Interested Person will leave the meeting during the discussion of, and the vote on, the Proposed Transaction. - The Board or the Executive Committee will undertake appropriate due diligence and inform itself of all material information reasonably available to it and explore all reasonable alternatives to the Proposed Transaction that would not involve the conflict of interest. - If a more advantageous transaction or arrangement is not reasonably possible under circumstances not producing a conflict of interest, the Board or the Executive Committee will determine by a majority vote of the Disinterested Directors whether the Proposed Transaction is (i) in the Health Center's best interest, (ii) for the Health Center's own benefit, and (iii) fair and reasonable to the Health Center. In conformity with this determination, the Board or the Executive Committee will make its decision as to whether the Health Center may enter into the Proposed Transaction. Violations of the Conflicts of Interest Policy: If the Board or the Executive Committee determines that the Covered Person has in fact failed to disclose a Position or a Financial Interest, the Board or the Executive Committee will take appropriate disciplinary and corrective action. Documentation in Minutes: With respect to the determination of whether a conflict of interest exists, the name of the Interested Person who disclosed or was otherwise found to have a Position or Financial Interest in connection with an actual or potential conflict of interest; the nature of the Position or Financial Interest; any action taken to determine whether a conflict of interest was present; and the Board or the Executive Committee's decision as to whether a conflict of interest in fact existed. Annual Statements: Each Covered Person will annually sign a statement that affirms such person: - Has received a copy of this Policy; - Has read and understands the Policy; - Has agreed to comply with the Policy; and - Understand the Health Center is exempt from federal income tax and to maintain its federal tax exemption the Health Center must engage primarily in activities that accomplish one or more of its tax-exempt purposes. In addition, each Covered Person will annually complete, sign and promptly return to the Board or the Executive Committee a Questionnaire and Disclosure Statement substantially in the form attached hereto. A Covered Person need not disclose Compensation paid to the Covered Person by Health Center pursuant to a resolution of the Board. Periodic Reviews: The periodic reviews as required by the policy will, at a minimum, include the following subjects: - Whether the Health Center Compensation arrangements are reasonable, based on competent survey information, and are the result of arm's-length bargaining; and - Whether transactions and arrangements with other entities and individuals conform to the Health Center's policies, are properly recorded, reflect reasonable payments for goods and services, further the Health Center's tax-exempt purposes and do not result in private inurnment, impermissible private benefit, or in an excess benefit transaction. COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINE 15A The last evaluation for the CEO was in April 2012. This evaluation was done by the Health Center's Board of Directors. The Chairperson of the Board will lead the assessment process. The chair shall select a Performance and Compensation Committee and its chair. The CEO will complete a self-assessment. This allows the Board and CEO to compare one another's perception of the CEO's performance. The Chairperson of the Performance and Compensation Committee will have each board member complete the Assessment form individually and compile results. Distribution of the assessment form: The Committee Chairperson will distribute the CEO Self-Assessment and the Board's Assessment of the CEO well enough in advance to allow ample time for completion. The Committee Chairperson will set a deadline for completing the Board's Assessment of the CEO. Analysis of the results: The responses for each question will be added together and the average response computed. Next, the average responses for each question will be added together and the average response for the assessment as a whole should be calculated. The results will be shared with the Board for discussion and analysis in closed session. Review of the results with the CEO: The CEO and the Board will meet in a closed executive session or a special meeting to review and discuss the results. Based on the results, the Board and CEO will develop a written performance plan and performance goals for the CEO describing areas of focus and improvement for the next year. The performance assessment will be used as a basis for determining compensation. An independent committee, using comparability data will conduct compensation analysis. Such deliberations and decisions regarding compensation shall be documented and substantiated. This compensation review methodology shall be used for all Chief Officer Positions. Solicit the CEO's feedback: The Board will obtain the CEO's feedback regarding the assessment process. Feedback will include understanding the CEO's agreement or disagreement with the Board's assessment; whether the format was appropriate, whether the Board and the CEO believed that the form used captured all of the necessary elements, and which areas could be improved in the next assessment. Other officers and key employees: On a regular basis, human resources will conduct salary surveys to ensure current job pay ranges and median pay for certain benchmarked positions remain competitive in the marketplace and consistent with the company's compensation philosophy. An independent committee using comparability data will conduct compensation analysis. Such deliberations and decisions regarding compensation should be documented and substantiated. AVAILABILITY OF DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 NET UNREALIZED GAINS/(LOSSES) $ 119,051 CHANGE IN INTEREST OF SURHCF $ 151,725 --------- $ 270,776 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ralph C. Johnson, MS, CPA TITLE:Director/Chairperson HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Manuel Solano, M.D. TITLE:Director HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Maime Hughes TITLE:Emeritus (Non-Voting Director) HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Hilda Fuentes TITLE:Chief Executive Officer HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Ralph Caro TITLE:Chief Operating Officer HOURS:1 Samuel U Rodgers Health Ctr Foundation 825 Euclid Avenue Kansas City MO 64124 200751739 SUPPORT ORG MO 501(C)(3) 11A SURHC true false false true false false false false false false false true false true true false false true true Samuel U Rodgers Health Center Foundation R 19550543 COST