2013-12-16T10:02:48-06:00 2013-01-31 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2012-02-01 421374894 SIOUXLAND COMMUNITY HEALTH CENTER % JAN ANDERSON SIOU 7122522477 1021 NEBRASKA STREET Suite SIOUX CITY IA 511025410 MARI KAPTAIN-DAHLEN 7122522477 2013-12-09 true Brian D Todd 4178658701 2012 2016-03-07 17:11:31Z MARI KAPTAIN-DAHLEN 1021 NEBRASKA STREET SIOUX CITY IA 51102 18909281 false X WWW.SLANDCHC.COM X 1991 IA TO BE A PATIENT-CENTERED MEDICAL HOME THAT IMPROVES THE PHYSICAL, DENTAL, AND BEHAVIORAL HEALTH OF THE SIOUXLAND COMMUNITY WHILE ELIMINATING ACCESS BARRIERS. 13 13 230 13 0 0 4775866 5264888 12368531 13623385 5489 5620 -3431 2799 17146455 18896692 75136 74134 0 0 10661288 11446412 0 0 0 6501484 7045576 17237908 18566122 -91453 330570 17326791 17612730 8905516 8698853 8421275 8913877 X THE 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. false false 9643373 74134 8726005 PRIMARY 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. 3317197 3001634 DENTAL 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). 2095046 1895746 PHARMACY 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. 15055616 true true false true false false false false false false true false false false true false true false false false false false false false true false false true false true true false false false false false false false false false false true false false false false false false false false true 38 0 true 230 true false false false false false false false false false false X 13 13 false false false false false false false true true false false false true true true true true true false false X JAN ANDERSON 7122522477 1021 NEBRASKA STREET SIOUX CITY IA 51102 COREY WRENN 1.0 X X 0 0 ALICE KELLY FERDIG 1.0 X 0 0 JENNIFER GOMEZ 1.0 X 0 0 MARI KAPTAIN-DAHLEN 1.0 X 0 0 BIBI JAURON 1.0 X 0 0 JOAN KELLY 1.0 X X 0 0 GEORGE BOYKIN 1.0 X 0 0 NANCY METCALF 1.0 X 0 0 OMAR SUAREZ 1.0 X 0 0 KELLEY MCCARTHY 1.0 X 0 0 DAVID OLSON 1.0 X X 0 0 CHAD MARKHAM 1.0 X 0 0 PERLA ALACORN-FLORY 1.0 X 0 0 ANDREA BUCKLEY 1.0 X 0 0 MICHELLE STEPHAN RN BSN 40.0 X 139702 0 26375 JAN ANDERSON CPA MBA 40.0 X 115003 0 19929 KRISTI WALZ MD 40.0 X 224804 0 30298 RYAN MCKENNA MD 40.0 X 193038 0 23848 THOR SWANSON MD 40.0 X 218851 0 32038 GARY HATTAN MD 40.0 X 227494 0 28277 JULIA HEATON MD 40.0 X 185376 0 24197 MARIA TUDOR MO 40.0 X 229060 0 22357 STEPHEN PALLONE MD 40.0 X 183907 0 31865 DAVID FALDMO PA 40.0 X 179109 0 29132 1896344 0 268316 22 false true false INCONCERT CARE INC COMPUTER SERVICES 194266 BKD LLP AUDIT/TAX/CONSULTING 151417 2 13420 3566058 1685410 1721618 5264888 NET PATIENT SERVICE REVENUE 624100 13250660 13250660 OTHER REVENUE 624100 372725 372725 13623385 5620 5620 0 0 0 0 0 0 15388 13420 12589 2799 2799 0 0 0 18896692 13623385 8419 74134 74134 0 0 0 1038155 731803 306352 0 8539609 7040609 1499000 314564 261875 52689 878584 723943 154641 675500 549274 126226 0 94487 94487 129842 129842 0 0 0 812189 686562 125627 56491 14444 42047 327210 177036 150174 86464 58824 27640 0 179844 105237 74607 83995 23057 60938 0 153893 64377 89516 311731 311731 0 645791 516543 129248 38822 38822 BAD DEBT 1056773 1056773 MEDICAL SUPPLIES & DRUGS 2962632 2962632 LICENSES, DUES, SUBSCRIPTIONS 84057 8493 75564 RECRUITING & RETENTION 6696 6696 14659 14659 18566122 15055616 3510506 0 287788 3796 3249368 3649428 169167 239598 1269612 1492732 0 0 0 0 0 0 340289 424205 288077 315224 14437993 2950246 11722490 11487747 0 0 0 0 0 0 0 0 0 0 17326791 17612730 1107395 1156776 0 0 0 0 6270112 6001516 0 0 0 0 0 0 0 284584 1528009 1255977 8905516 8698853 X 8105188 8530432 316087 383445 0 0 8421275 8913877 17326791 17612730 330570 162032 X false true X true true true X 4465931 4932289 5189538 4775866 5264888 24628512 0 0 4465931 4932289 5189538 4775866 5264888 24628512 3137956 21490556 102968 10863 6307 5939 5620 131697 0 0 24760209 55443160 0.86795 0.86941 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 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. 1197727 1197727 10550128 1769002 8781126 2367241 1181244 1185997 322897 322897 11487747 0 INTEREST RATE SWAP 1165977 EST AMT DUE TO 3RD PARTY 90000 1255977 18032440 162032 17900 -1056773 -876841 18909281 -12589 -12589 18896692 17539838 17900 12589 30489 17509349 1056773 1056773 18566122 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. AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XI, LINE 2D BAD DEBT EXPENSE $( 1,056,773) AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1 SCHEDULE D, PART XI, LINE 4B SPECIAL EVENT EXPENSES $( 12,589) AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XII, LINE 2D SPECIAL EVENT EXPENSES $ 12,589 AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $ 1,056,773 FALL DINNER 21711 9820 11891 2380 550 5481 1663 5K 7097 3600 3497 1045 200 1270 0 28808 13420 15388 3425 550 5681 2933 12589 2799 true NEBRASKA AIDS PROJECT 250 S 77TH ST STE A OMAHA NE 68114 470786622 501(C)(3) 74134 HIV PART B & HUD HOUSING 1 MONITORING OF GRANT FUNDS SCHEDULE I, PART I, LINE 2 NEBRASKA 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. X X X false false false false false false false true false MICHELLE STEPHAN RN BSN 133819 0 5833 0 50 0 7385 0 18990 0 166077 0 0 0 KRISTI WALZ MD 215448 0 1214 0 8142 0 11318 0 18980 0 255102 0 0 0 GARY HATTAN MD 226162 0 1282 0 50 0 8857 0 19420 0 255771 0 0 0 JULIA HEATON MD 184286 0 1040 0 50 0 11472 0 12725 0 209573 0 0 0 MARIA TUDOR MO 227723 0 1287 0 50 0 11453 0 10904 0 251417 0 0 0 STEPHEN PALLONE MD 182790 0 1067 0 50 0 9445 0 22420 0 215772 0 0 0 DAVID FALDMO PA 172826 0 841 0 5442 0 9112 0 20020 0 208241 0 0 0 RYAN MCKENNA MD 188629 0 1036 0 3373 0 5556 0 18292 0 216886 0 0 0 THOR SWANSON MD 217541 0 1260 0 50 0 11118 0 20920 0 250889 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART 1, LINE 7 THE 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. A WOODBURY COUNTY IOWA 426005221 2007-09-25 7000000 CONSTRUCTION OF NEW FACILITY false false false A 0 0 7000000 0 0 0 100000 0 0 6900000 0 0 2009 false false true true A false false false false 0 true false false true A false false true true WELLS FARGO 20. false false false 0 false false A true NO REBATE DUE SCHEDULE K, PART IV, LINE 2C THE COMPUTATION WAS PERFORMED AS OF 9/25/2012. X 10 1721618 FMV false false false NUMBER OF CONTRIBUTIONS SCHEDULE M, PART I, LINE 20, COLUMN (B) THE ORGANIZATION RECEIVED DRUGS AND MEDICAL SUPPLIES FROM 10 DIFFERENT DONORS THROUGHOUT THE YEAR. ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 SIOUXLAND 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 SERVICES FORM 990, PART III, LINE 4 SIOUXLAND 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 #1 FORM 990, PART III, LINE 4A LABORATORY 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 #3 FORM 990, PART III, LINE 4C THE 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 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 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 POLICY FORM 990, PART VI, SECTION B, LINE 12C A 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 REVIEW FORM 990, PART VI, SECTION B, LINES 15A & 15B THE 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 DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS WILL BE PROVIDED TO INQUIRING PARTIES UPON REQUEST.