FURP.ORG / PUBLIC DATA EXPLORER

SIOUXLAND COMMUNITY HEALTH CENTER: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SIOUXLAND COMMUNITY HEALTH CENTER (EIN 42-1374894)
Tax period
2012-02-01 to 2013-01-31
Filed
2013-12-16
IRS object ID
201343509349300719
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

FieldValueIRS element (for citing)
Timestamp2013-12-16T10:02:48-06:00Timestamp
Tax Period End Date2013-01-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1910 E ST LOUIS 200/PO BOX 1190AddressLine1
CitySPRINGFIELDCity
StateMOState
ZIP Code658062523ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-02-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN421374894EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SIOUXLAND COMMUNITY HEALTH CENTERBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JAN ANDERSONInCareOfName
Name ControlSIOUNameControl
Phone7122522477Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11021 NEBRASKA STREETAddressLine1
Address Line2SuiteAddressLine2
CitySIOUX CITYCity
StateIAState
ZIP Code511025410ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARI KAPTAIN-DAHLENName
TitleCHIEF EXECUTIVE OFFICERTitle
Phone7122522477Phone
Date Signed2013-12-09DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBrian D ToddName
Phone4178658701Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMARI KAPTAIN-DAHLENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11021 NEBRASKA STREETAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51102ZIPCode
FieldValueIRS element (for citing)
Gross Receipts18909281GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SLANDCHC.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1991YearFormation
State Legal DomicileIAStateLegalDomicile
Activity Or Mission DescriptionTO BE A PATIENT-CENTERED MEDICAL HOME THAT IMPROVES THE PHYSICAL, DENTAL, AND BEHAVIORAL HEALTH OF THE SIOUXLAND COMMUNITY WHILE ELIMINATING ACCESS BARRIERS.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees230TotalNbrEmployees
Total Nbr Volunteers13TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4775866ContributionsGrantsPriorYear
Contributions Grants Current Year5264888ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12368531ProgramServiceRevenuePriorYear
Program Service Revenue CY13623385ProgramServiceRevenueCY
Investment Income Prior Year5489InvestmentIncomePriorYear
Investment Income Current Year5620InvestmentIncomeCurrentYear
Other Revenue Prior Year-3431OtherRevenuePriorYear
Other Revenue Current Year2799OtherRevenueCurrentYear
Total Revenue Prior Year17146455TotalRevenuePriorYear
Total Revenue Current Year18896692TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year75136GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY74134GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10661288SalariesEtcPriorYear
Salaries Etc Current Year11446412SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year6501484OtherExpensePriorYear
Other Expenses Current Year7045576OtherExpensesCurrentYear
Total Expenses Prior Year17237908TotalExpensesPriorYear
Total Expenses Current Year18566122TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-91453RevenuesLessExpensesPriorYear
Revenues Less Expenses CY330570RevenuesLessExpensesCY
Total Assets BOY17326791TotalAssetsBOY
Total Assets EOY17612730TotalAssetsEOY
Total Liabilities BOY8905516TotalLiabilitiesBOY
Total Liabilities EOY8698853TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8421275NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8913877NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF SIOUXLAND COMMUNITY HEALTH CENTER IS TO PROVIDE PRIMARY HEALTH CARE THAT ELIMINATES ACCESS BARRIERS AND IMPROVES THE HEALTH OF THE SIOUXLAND COMMUNITY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense9643373Expense
Grants74134Grants
Revenue8726005Revenue
DescriptionPRIMARY AND SPECIALTY MEDICAL SERVICES IN FY 2012, SCHC PROVIDED MEDICAL SERVICES TO 17,348 PATIENTS (15.2% INCREASE FROM 2010). MEDICAL SERVICES WERE PROVIDED BY EIGHT PRIMARY CARE PHYSICIANS, EIGHT PHYSICIAN ASSISTANTS, FOUR NURSE PRACTITIONERS, AND A VARIETY OF VOLUNTEER SPECIALTY PROVIDERS FROM THE SIOUXLAND COMMUNITY. SPECIALTY CARE VOLUNTEERS PROVIDE THE FOLLOWING CARE: CARDIOVASCULAR, SURGERY, ORTHOPEDICS, PODIATRY, OPHTHALMOLOGY, PLASTIC SURGERY AND NEPHROLOGY. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense3317197Expense
Revenue3001634Revenue
DescriptionDENTAL CARE SCHC EMPLOYED FOUR FULL-TIME DENTISTS AND TWO-AND-A-HALF DENTAL HYGIENISTS IN 2012 TO PROVIDE ROUTINE DENTAL CARE AND TREATMENT, ESPECIALLY FOR CHILDREN & INFANTS THROUGH AGE 21. ADULT EMERGENCY WALK-IN PATIENTS ARE ACCEPTED DAILY. THE DENTAL DEPARTMENT ALSO PROVIDES PRENATAL ORAL HEALTH EDUCATION, A MONTHLY BABY DAY CLINIC AND DENTAL OUTREACH. THE DENTAL DEPARTMENT SERVED 8,804 PATIENTS IN 2012 (2.7% INCREASE FROM 2010).Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2095046Expense
Revenue1895746Revenue
DescriptionPHARMACY THE SCHC PHARMACY IS AVAILABLE TO ALL PATIENTS RECEIVING HEALTH CARE SERVICES AT THE HEALTH CENTER. THREE PHARMACISTS ARE ON STAFF TO OFFER MEDICATION COUNSELING FOR PRESCRIPTIONS. IN ADDITION, THE HEALTH CENTER EMPLOYS TWO FULL-TIME CLINICAL PHARMACISTS TO ASSIST PATIENTS WITH THEIR CHRONIC MEDICAL CONDITIONS. SCHC IS A PARTICIPANT IN THE 340B DRUG PRICING PROGRAM AND ALSO OFFERS AN INDIGENT PROGRAM TO PROVIDE PRESCRIPTION ASSISTANCE TO QUALIFYING PATIENTS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.Description
FieldValueIRS element (for citing)
Total Program Service Expense15055616TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109638NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees230NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJAN ANDERSONNamePerson
Telephone Number7122522477TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11021 NEBRASKA STREETAddressLine1
CitySIOUX CITYCity
StateIAState
ZIP Code51102ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
COREY WRENN
PRESIDENT1.0XX00
ALICE KELLY FERDIG
DIRECTOR ENDING 9/121.0X00
JENNIFER GOMEZ
DIRECTOR1.0X00
MARI KAPTAIN-DAHLEN
DIRECTOR1.0X00
BIBI JAURON
DIRECTOR1.0X00
JOAN KELLY
SECRETARY1.0XX00
GEORGE BOYKIN
DIRECTOR1.0X00
NANCY METCALF
DIRECTOR1.0X00
OMAR SUAREZ
DIRECTOR1.0X00
KELLEY MCCARTHY
DIRECTOR1.0X00
DAVID OLSON
TREASURER BEGINNING 6/121.0XX00
CHAD MARKHAM
DIRECTOR BEGINNING 8/121.0X00
PERLA ALACORN-FLORY
DIRECTOR BEGINNING 5/121.0X00
ANDREA BUCKLEY
DIRECTOR BEGINNING 1/131.0X00
MICHELLE STEPHAN RN BSN
CEO40.0X139702026375
JAN ANDERSON CPA MBA
CFO40.0X115003019929
KRISTI WALZ MD
CO-MEDICAL DIRECTOR40.0224804030298X
RYAN MCKENNA MD
DENTAL DIRECTOR40.0193038023848X
THOR SWANSON MD
CO-MEDICAL DIRECTOR40.0218851032038X
GARY HATTAN MD
PHYSICIAN40.0227494028277X
JULIA HEATON MD
PHYSICIAN40.0185376024197X
MARIA TUDOR MO
PHYSICIAN40.0229060022357X
STEPHEN PALLONE MD
PHYSICIAN40.0183907031865X
DAVID FALDMO PA
PHYSICIAN ASSISTANT40.0179109029132X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1896344TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation268316TotalOtherCompensation
Number Individuals GT100 K22NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
INCONCERT CARE INC
COMPUTER SERVICES194266
BKD LLP
AUDIT/TAX/CONSULTING151417
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Fundraising Events13420FundraisingEvents
Government Grants3566058GovernmentGrants
All Other Contributions1685410AllOtherContributions
Noncash Contributions1721618NoncashContributions
Total Contributions5264888TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE6241001325066013250660
OTHER REVENUE624100372725372725
FieldValueIRS element (for citing)
Total Program Service Revenue13623385TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5620TotalRevenueColumn
Exclusion$5,620ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Income Fundraising Events15388GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events13420CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses12589FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column2799TotalRevenueColumn
Exclusion$2,799ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column18896692TotalRevenueColumn
Related Or Exempt Function Income13623385RelatedOrExemptFunctionIncome
Exclusion$8,419ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total74134Total
Program Services74134ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1038155Total
Program Services731803ProgramServices
Management And General306352ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8539609Total
Program Services7040609ProgramServices
Management And General1499000ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total314564Total
Program Services261875ProgramServices
Management And General52689ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total878584Total
Program Services723943ProgramServices
Management And General154641ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total675500Total
Program Services549274ProgramServices
Management And General126226ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total94487Total
Management And General94487ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total129842Total
Management And General129842ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total812189Total
Program Services686562ProgramServices
Management And General125627ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total56491Total
Program Services14444ProgramServices
Management And General42047ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total327210Total
Program Services177036ProgramServices
Management And General150174ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total86464Total
Program Services58824ProgramServices
Management And General27640ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total179844Total
Program Services105237ProgramServices
Management And General74607ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total83995Total
Program Services23057ProgramServices
Management And General60938ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total153893Total
Program Services64377ProgramServices
Management And General89516ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total311731Total
Management And General311731ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total645791Total
Program Services516543ProgramServices
Management And General129248ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total38822Total
Management And General38822ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT10567731056773
MEDICAL SUPPLIES & DRUGS29626322962632
LICENSES, DUES, SUBSCRIPTIONS84057849375564
RECRUITING & RETENTION66966696

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total14659Total
Management And General14659ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total18566122Total
Program Services15055616ProgramServices
Management And General3510506ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY287788BOY
EOY3796EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3249368BOY
EOY3649428EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY169167BOY
EOY239598EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1269612BOY
EOY1492732EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY340289BOY
EOY424205EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY288077BOY
EOY315224EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis14437993LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2950246LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11722490BOY
EOY11487747EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY17326791BOY
EOY17612730EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1107395BOY
EOY1156776EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY6270112BOY
EOY6001516EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY284584EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1528009BOY
EOY1255977EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8905516BOY
EOY8698853EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8105188BOY
EOY8530432EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY316087BOY
EOY383445EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8421275BOY
EOY8913877EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17326791BOY
EOY17612730EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses330570ReconcilationRevenueExpenses
Reconciliation Unrealized Invest162032ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4465931CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4932289CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5189538CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4775866CurrentTaxYearMinus1Year
Current Tax Year5264888CurrentTaxYear
Total24628512Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4465931CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4932289CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5189538CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4775866CurrentTaxYearMinus1Year
Current Tax Year5264888CurrentTaxYear
Total24628512Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total3137956AmountsSubstContributorsTotal
Public Support Total17021490556PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years102968CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10863CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6307CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5939CurrentTaxYearMinus1Year
Current Tax Year5620CurrentTaxYear
Total131697Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support24760209TotalSupport
Gross Receipts From Admissions Etc55443160GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.86795PublicSupportPertcentage170
Public Support Pertcent Prior Year0.86941PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER LOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1(I)ReturnReference
ExplanationTHE ORGANIZATION PAID DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE IOWA PRIMARY CARE ASSOCIATION. A PORTION OF THE DUES MAY BE ATTRIBUTABLE TO LOBBYING PURPOSES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1197727OtherCostOrOtherBasis
Book Value1197727BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10550128OtherCostOrOtherBasis
Depreciation1769002Depreciation
Book Value8781126BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2367241OtherCostOrOtherBasis
Depreciation1181244Depreciation
Book Value1185997BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis322897OtherCostOrOtherBasis
Book Value322897BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11487747TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
INTEREST RATE SWAP$1,165,977
EST AMT DUE TO 3RD PARTY$90,000
FieldValueIRS element (for citing)
Total Of Amounts1255977TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt18032440TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments162032NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities17900DonatedSrvcAndUseOfFacilities
Other Revenues-1056773OtherRevenues
Revenue Not Rptd F990-876841RevenueNotRptdF990
Revenue Subtotal18909281RevenueSubtotal
Other Revenues Not Included-12589OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-12589RevenueNotRptdOnFinStmt
Total Revenue Per Form99018896692TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt17539838TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities17900DonatedServicesUseOfFacilities
Other Expenses Included12589OtherExpensesIncluded
Expenses Not Rptd F99030489ExpensesNotRptdF990
Expenses Subtotal17509349ExpensesSubtotal
Other Expenses Not Included1056773OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1056773ExpensesNotRptdOnFinStmt
Total Expenses Per Form99018566122TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
UNCERTAIN TAX POSITIONSSCHEDULE D, PART X, LINE 2MANAGEMENT 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.
AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12SCHEDULE D, PART XI, LINE 2DBAD DEBT EXPENSE $( 1,056,773)
AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1SCHEDULE D, PART XI, LINE 4BSPECIAL EVENT EXPENSES $( 12,589)
AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25SCHEDULE D, PART XII, LINE 2DSPECIAL EVENT EXPENSES $ 12,589
AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1SCHEDULE D, PART XII, LINE 4BBAD DEBT EXPENSE $ 1,056,773

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1FALL DINNERNameOfEvent1
Gross Receipts Event121711GrossReceiptsEvent1
Charitable Contributions Event19820CharitableContributionsEvent1
Gross Revenue Event111891GrossRevenueEvent1
Non Cash Prizes Event12380NonCashPrizesEvent1
Rent Facility Costs Event1550RentFacilityCostsEvent1
Food And Beverage Event15481FoodAndBeverageEvent1
Other Direct Expenses Event11663OtherDirectExpensesEvent1
Name Of Event25KNameOfEvent2
Gross Receipts Event27097GrossReceiptsEvent2
Charitable Contributions Event23600CharitableContributionsEvent2
Gross Revenue Event23497GrossRevenueEvent2
Non Cash Prizes Event21045NonCashPrizesEvent2
Food And Beverage Event2200FoodAndBeverageEvent2
Other Direct Expenses Event21270OtherDirectExpensesEvent2
Total Number Of Other Events0TotalNumberOfOtherEvents
Gross Receipts Total28808GrossReceiptsTotal
Charitable Contributions Total13420CharitableContributionsTotal
Gross Revenue Total Events15388GrossRevenueTotalEvents
Non Cash Prizes Total Events3425NonCashPrizesTotalEvents
Rent Facility Costs Total Events550RentFacilityCostsTotalEvents
Food And Beverage Total Events5681FoodAndBeverageTotalEvents
Other Direct Expenses Total Events2933OtherDirectExpensesTotalEvents
Direct Expense Summary Events12589DirectExpenseSummaryEvents
Net Income Summary2799NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1NEBRASKA AIDS PROJECTBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1250 S 77TH ST STE AAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient470786622EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant74134AmountOfCashGrant
Purpose Of GrantHIV PART B & HUD HOUSINGPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierMONITORING OF GRANT FUNDSIdentifier
Return ReferenceSCHEDULE I, PART I, LINE 2ReturnReference
ExplanationNEBRASKA AIDS PROJECT CONTINUED TO BE A SUBCONTRACTED AGENCY IN ORDER TO PROVIDE CONTRACTUAL HIV/AIDS SERVICES IN SOUTHWEST IA. THEY WERE CHOSEN ON THE BASIS OF PRIOR EXPERIENCE WITH WORKING WITH TARGETED POPULATION, AND STAFF CREDENTIALS/EXPERIENCE. THE AGENCY SUBMITS MONTHLY FINANCIAL REPORTS WITH EXPENSE DOCUMENTATION AND TIME TRACKING IN ORDER TO BE REIMBURSED. THEY ALSO SUBMIT THEIR ANNUAL AUDIT FOR REVIEW AND AN ON-SITE MONITORING REVIEW IS PERFORMED ANNUALLY.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHELLE STEPHAN RN BSN
CEO13381905833050073850189900166077000
KRISTI WALZ MD
CO-MEDICAL DIRECTOR21544801214081420113180189800255102000
GARY HATTAN MD
PHYSICIAN22616201282050088570194200255771000
JULIA HEATON MD
PHYSICIAN184286010400500114720127250209573000
MARIA TUDOR MO
PHYSICIAN227723012870500114530109040251417000
STEPHEN PALLONE MD
PHYSICIAN18279001067050094450224200215772000
DAVID FALDMO PA
PHYSICIAN ASSISTANT172826084105442091120200200208241000
RYAN MCKENNA MD
DENTAL DIRECTOR1886290103603373055560182920216886000
THOR SWANSON MD
CO-MEDICAL DIRECTOR217541012600500111180209200250889000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierNON-FIXED PAYMENTSIdentifier
Return ReferenceSCHEDULE J, PART 1, LINE 7ReturnReference
ExplanationTHE BONUSES PAID TO EMPLOYEES ARE COMPUTED BASED ON PERFORMANCE, SUBJECT TO THE DISCRETION OF THE CEO. BONUSES ARE ALSO COMPUTED IF THE EMPLOYEE IS "CAPPED" ON THEIR SALARY RANGE. THE CEO OF THE ORGANIZATION ALSO RECEIVED A BONUS THIS YEAR. THE BOARD OF DIRECTORS DETERMINES WHETHER A BONUS WILL BE PAID TO THE CEO DURING THE ANNUAL PERFORMANCE EVALUATION.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1WOODBURY COUNTY IOWABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN426005221IssuerEIN
Date Issued2007-09-25DateIssued
Issue Price7000000IssuePrice
Description Of PurposeCONSTRUCTION OF NEW FACILITYDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired0AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds7000000TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds100000IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures6900000CapitalExpenditures
Other Spent Proceeds0OtherSpentProceeds
Amount Unspent0AmountUnspent
Year Of Subst Completion2009YearOfSubstCompletion
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Prcntge Prvt Business Use By Others0PrcntgePrvtBusinessUseByOthers
Bond Iss Meet Prvt Security Pay TesttrueBondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed PropfalseChangeInUseBondFinancedProp
Remedial Action TakenfalseRemedialActionTaken
Non Qualified Bond Remed ProcdrstrueNonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiled
No Rebate DuefalseNoRebateDue
Variable Rate IssuetrueVariableRateIssue
Hedge Identified In Books And RecdstrueHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1WELLS FARGOBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge20.TermOfHedge
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvested
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective ActiontrueProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierNO REBATE DUEIdentifier
Return ReferenceSCHEDULE K, PART IV, LINE 2CReturnReference
ExplanationTHE COMPUTATION WAS PERFORMED AS OF 9/25/2012.Explanation

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications
Clothing And Household GoodsClothingAndHouseholdGoods
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions10NumberOfContributions
Noncash Contribs Rptd F9901721618NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII

FieldValueIRS element (for citing)
IdentifierNUMBER OF CONTRIBUTIONSIdentifier
Return ReferenceSCHEDULE M, PART I, LINE 20, COLUMN (B)ReturnReference
ExplanationTHE ORGANIZATION RECEIVED DRUGS AND MEDICAL SUPPLIES FROM 10 DIFFERENT DONORS THROUGHOUT THE YEAR.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990, PART III, LINE 1SIOUXLAND COMMUNITY HEALTH CENTER IS A NONPROFIT ORGANIZATION DEDICATED TO MEETING THE HEALTH CARE NEEDS OF THE COMMUNITY AND SUPPORTS THE PHILOSOPHY OF THE PATIENT-CENTERED MEDICAL HOME. OUR MISSION IS TO BE A PATIENT-CENTERED MEDICAL HOME THAT IMPROVES THE PHYSICAL, DENTAL, AND BEHAVIORAL HEALTH OF THE SIOUXLAND COMMUNITY WHILE ELIMINATING ACCESS BARRIERS. OUR VALUES INCLUDE COMMITMENT, ADVANCEMENT, RESPECT, EXCELLENCE, AND SUPPORT.
PROGRAM SERVICESFORM 990, PART III, LINE 4SIOUXLAND COMMUNITY HEALTH CENTER (SCHC) IS DEDICATED TO MEETING THE HEALTHCARE NEEDS OF THE SIOUXLAND AND IS A LEVEL THREE PATIENT CENTERED MEDICAL HOME. SCHC OFFERS THE FOLLOWING SERVICES: PRIMARY AND SPECIALTY MEDICAL SERVICES, LABORATORY, RADIOLOGY, HIV/AIDS AND HEPATITIS CARE, BEHAVIORAL HEALTH, PHARMACY, AND DENTAL SERVICES. SCHC PROVIDES FINANCIAL ASSISTANCE TO THE UNINSURED AND UNDERINSURED TO ELIMINATE ACCESS BARRIERS. IN 2012, SCHC SERVED 23,383 PATIENTS (14.1% INCREASE FROM 2010).
PROGRAM SERVICE ACTIVITY #1FORM 990, PART III, LINE 4ALABORATORY SIOUXLAND COMMUNITY HEALTH CENTER CURRENTLY CONDUCTS OVER 90% OF ITS LABORATORY TESTS ONSITE AND IS A MODERATE COMPLEX LABORATORY. FOR THOSE TESTS NOT PERFORMED ONSITE, THEY ARE SENT TO A REFERENCE LABORATORY WHERE THE MAJORITY OF TEST RESULTS ARE RETURNED WITHIN 24 HOURS. CONDUCTING THE MAJORITY OF TESTS ONSITE ENSURES RAPID TURNAROUND FOR DIAGNOSIS AND MONITORING OF CHRONIC MEDICAL CONDITIONS. THE LABORATORY IS ACCREDITED BY THE JOINT COMMISSION. IN 2012, THE LABORATORY PERFORMED 287,364 TESTS. RADIOLOGY SCHC ALSO CONDUCTS RADIOLOGY SERVICES. IT PERFORMED 3,743 TESTS IN 2012. HIV/AIDS AND HEPATITIS THE HIV TEAM SERVES THE TRI-STATE SIOUXLAND AREA, AS WELL AS 18 NORTHWEST IOWA COUNTIES. APPROXIMATELY 40% OF PATIENTS RECEIVING HIV/AIDS CARE LIVE IN RURAL AREAS. IN ADDITION TO MEDICAL CARE, THE HIV TEAM COORDINATES DENTAL CARE, CASE MANAGEMENT, TRANSPORTATION, AND HOUSING ASSISTANCE. IN 2012, THE HIV TEAM SERVED 129 PATIENTS IN 2012. FINANCIAL SERVICES TO ENSURE PATIENTS HAVE ACCESS TO CARE AT AN AFFORDABLE RATE, SCHC OFFERS A SLIDING FEE DISCOUNT TO PATIENTS BASED ON INCOME ELIGIBILITY AND ACCEPTS MEDICAID (TITLE 19), MEDICARE (TITLE 18), HAWK-I (STATE CHIP) AND MOST PRIVATE INSURANCES. IN 2012, 30.8% OF PATIENTS RECEIVING CARE WERE UNINSURED, 41.4% HAD COVERAGE BY MEDICAID/HAWK-I, 7.9% HAD MEDICARE COVERAGE, AND 19.9% FROM OTHER PAYERS.
PROGRAM SERVICE ACTIVITY #3FORM 990, PART III, LINE 4CTHE HEALTH CENTER EMPLOYS AN INDIGENT PROGRAM COORDINATOR TO ASSIST WITH ELIGIBILITY DETERMINATION. THE SCHC PHARMACY ALSO PARTICIPANTS IN OTHER PHARMACEUTICAL ASSISTANCE PROGRAMS TO ENSURE PATIENTS HAVE ACCESS TO NEEDED PRESCRIPTION DRUGS.
REVIEW OF THE FORM 990FORM 990, PART VI, SECTION B, LINE 11BTHE 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 PRIOR TO ITS SUBMISSION. A COPY OF THE 990 WILL BE DISTRIBUTED TO THE EXECUTIVE COMMITTEE MEMBERS PRIOR TO IT BEING FILED, WHILE ALL BOARD MEMBERS WILL RECEIVE A COPY OF THE 990 AFTER IT HAS BEEN FILED.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CA CONFLICT OF INTEREST POLICY IS STATED IN THE EMPLOYEE HANDBOOK. PER THE BYLAWS, IF A QUESTION CONCERNING A CONFLICT OF INTEREST FOR ANY DIRECTOR IS RAISED, A WRITTEN SECRET BALLOT MAY BE USED BY THE REMAINING DIRECTORS TO DETERMINE IF SUCH CONFLICT OF INTEREST EXISTS. SHOULD A CONFLICT OF INTEREST, PECUNIARY OR OTHERWISE, BE DETERMINED FOR ANY DIRECTOR, SUCH DIRECTOR SHALL BE EXCLUDED FROM VOTING ON THAT SUBJECT MATTER. A SIMPLE, AFFIRMATIVE MAJORITY OF THOSE PRESENT SHALL RULE. IN ALL EVENTS, A DIRECTOR SHALL DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINES 15A & 15BTHE CEO'S COMPENSATION WAS EVALUATED IN 2012, BY THE BOARD OF DIRECTORS, USING A PEER REVIEW. EACH YEAR A SALARY ANALYSIS IS DONE USING DATA OBTAINED LOCALLY AND REGIONALLY. THIS ANALYSIS IS COMPILED AND A RECOMMENDATION IS TAKEN TO THE BOARD. THE ANALYSIS/RECOMMENDATIONS ARE GROUPED BY TITLE OF THE POSITION. THE CEO'S YEARLY EVALUATION IS PREPARED BY THE BOARD AND THE SCORE IS CALCULATED TO DETERMINE THE CURRENT YEAR SALARY. THE SAME PROCESS IS FOLLOWED FOR THE KEY EMPLOYEES, THE ONLY DIFFERENCE BEING THAT THE CEO DOES THE REVIEW.
DOCUMENT DISCLOSUREFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS WILL BE PROVIDED TO INQUIRING PARTIES UPON REQUEST.