2012-11-14T11:07:57-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 1715 1ST AVENUE SE CEDAR RAPIDS IA 52402 990 2011-07-01 134228071 COMMUNITY HEALTH FREE CLINIC COMM 3193772651 947 14TH AVENUE SE CEDAR RAPIDS IA 52401 PATRICIA BARNES 3193630416 2012-11-13 1 DAVID LITTLE P01480921 3193632697 2011 2016-02-24 21:20:13Z PATRICIA BARNES 947 14TH AVENUE SE CEDAR RAPIDS IA 52401 2975018 0 X WWW.COMMUNITYHFC.ORG X 2002 IA TO PROVIDE HEALTH CARE TO THE UNINSURED AND UNDER-SERVED OF EAST CENTRAL IOWA THROUGH MODEL COMMUNITY PARTNERSHIPS. 13 13 44 455 0 0 3167212 2943234 0 0 14536 31784 0 0 3181748 2975018 0 0 0 0 503567 532872 15681 19050 70892 2408049 2277426 2927297 2829348 254451 145670 3180185 3287951 47296 33513 3132889 3254438 TO PROVIDE HEALTH CARE TO THE UNINSURED AND UNDER-SERVED OF EAST CENTRAL IOWA THROUGH MODEL COMMUNITY PARTNERSHIPS. 0 0 2537658 PROVIDED FREE HEALTH CARE SERVICES, INCLUDING MEDICAL, DENTAL, AND VISION FOR ANY UNDER-SERVED OR UNINSURED INDIVIDUAL IN NEED OF HEALTH CARE. APPROXIMATELY 360 NEW PATIENTS WERE SEEN PER MONTH. THE AVERAGE TOTAL OF NEW AND EXISTING INDIVIDUALS SERVICED DURING THE YEAR WAS 29,300. NOW OFFERING A HISPANIC CLINIC ON THE THIRD SATURDAY OF THE MONTH. COMMUNITY HEALTH FREE CLINIC PROUDLY SERVICES INDIVIDUALS ALL OVER THE EAST CENTRAL IOWA AREA. 2537658 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 4 0 44 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 AZ CO FL MN NJ NY NC MO WA WI IL X SUSAN RUSSELL DIRECTOR OF FINANCE 3192211585 715 10TH AVE SE CEDAR RAPIDS IA 52401 AMY JOHNSON BOYLE 1.00 X 0 0 0 JAMES FLYNN JR MD 1.00 X 0 0 0 GREG HAYES 1.00 X 0 0 0 MARK MARZ 1.00 X 0 0 0 THOMAS MCINTOSH 1.00 X 0 0 0 SISTER SUSAN O'CONNOR 1.00 X 0 0 0 MICHAEL SUNDALL 1.00 X 0 0 0 DALE TODD 1.00 X 0 0 0 BRANDT WORLEY 1.00 X 0 0 0 REX ENO 1.00 X X 0 0 0 DAVID MULLER MD 1.00 X X 0 0 0 MICHELLE NIERMANN 1.00 X X 0 0 0 PATRICIA BARNES 1.00 X X 0 0 0 DARLENE SCHMIDT 55.00 X 60699 0 0 60699 0 0 0 0 0 0 0 311167 21183 2610884 1763714 2943234 14305 14305 17479 0 17479 17479 17479 2975018 0 0 31784 61597 24639 21559 15399 433540 356415 58346 18779 37735 29007 6113 2615 13995 13995 19050 19050 3241 3241 1534 1534 157276 63363 87023 6890 14646 11271 2364 1011 63081 48547 10180 4354 15030 15030 DONATED GOODS 1763714 1763714 MEDICATIONS 128830 128830 MEDICAL SERVICES 65818 65818 DONATED INVENTORY ADJ. 32002 32002 18259 14052 2947 1260 2829348 2537658 220798 70892 59364 69933 301885 552492 364812 208877 267051 235049 4086 4187 2005556 525330 1540150 1480226 642837 737187 3180185 3287951 47296 33513 47296 33513 X 2527859 2622863 314040 335035 290990 296540 3132889 3254438 3180185 3287951 X 145670 -24121 X X 0 1 1 X 0 X 874393 1882342 3050743 3167212 2943234 11917924 874393 1882342 3050743 3167212 2943234 11917924 59935 11857989 24520 17140 15285 14056 14305 85306 12003230 0.98790 0.98770 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 387335 247581 2179 3241 633854 301409 28948 54125 2853 387335 239667 34491 30009 2758 301409 313438 1198 -72630 2339 239667 0.53220 0.46780 0.00000 1 0 1761717 303533 1458184 243839 221797 22042 1480226 BENEFICIAL INTEREST IN COMMUNITY FOUNDATION 633854 ASSETS HELD FOR SALE 3000 LONG TERM CD 100333 737187 2975018 2829348 145670 -24121 -24121 121549 6743563 -24121 3795907 3771786 2971777 3241 3241 2975018 6622014 3795907 3795907 2826107 3241 3241 2829348 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: CHFC INTENDS TO USE THE EARNINGS FROM CHFC'S ENDOWMENT FUNDS FOR LONG TERM FINANCIAL SUPPORT OF THE CLINIC. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION HAS DETERMINED THAT IT WAS NOT REQUIRED TO RECORD A LIABILITY RELATED TO UNCERTAIN TAX POSITIONS. X X X X 1 JEAN BJORSETH 715 10TH AVE SE CEDAR RAPIDS IA 52401 GRANTWRITING 0 205979 19206 186929 205979 19206 186929 AZ CO FL MN NJ NY WA IL NC WI MO GRANTWRITING EXPENSES SCHEDULE G, PART I, LINE 2B GRANTWRITING FEES PAID TO CONTRACTOR - $19,050. REIMBURSEMENTS OF EXPENSES TOTALED $156. REIMBURSEMENTS ARE BASED ON RECEIPTS SUBMITTED FOR EXPENSES PAID. X 1075021 1763714 FMV 0 0 1 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): LINE 20 IS ESTIMATED QUANTITY OF MEDICINES DONATED. FORM 990, PART VI, SECTION B, LINE 11 AFTER THE PUBLIC AUDIT FIRM PREPARES A DRAFT OF THE FEDERAL FORM 990, THE DIRECTOR OF FINANCE AND TREASURER REVIEW THE DRAFT AND MAKE ANY CHANGES IF NECESSARY. FEDERAL FORM 990 IS MARKED DRAFT UNTIL APPROVED BY THE CHFC BOARD OF DIRECTORS. THE DRAFT DOCUMENT IS SENT TO ALL BOARD MEMBERS BY ELECTRONIC MAIL FOR THEIR REVIEW AND COMMENT. COMMENTS BY THE BOARD MEMBERS, IF ANY, WILL BE ADDRESSED BY THE DIRECTOR OF FINANCE AND TREASURER BEFORE THE FEDERAL FORM 990 IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C UPON FIRST BEING ELECTED TO THE BOARD OF DIRECTORS, APPOINTED TO A BOARD COMMITTEE OR ELECTED AS AN OFFICER OF COMMUNITY HEALTH FREE CLINIC (CHFC), THE BOARD MEMBER, BOARD COMMITTEE MEMBER OR OFFICER IS REQUIRED TO COMPLETE THE CONFLICT OF INTEREST DISCLOSURE STATEMENT AND SUBMIT THE STATEMENT TO THE BOARD PRESIDENT. IF THE BOARD PRESIDENT HAS CONCERNS ABOUT ANY STATEMENT, HE/SHE SHALL SUBMIT THE STATEMENT TO THE EXECUTIVE COMMITTEE OF THE CHFC BOARD OF DIRECTORS. EACH STATEMENT SHALL BE RESUBMITTED WITH ANY NECESSARY CHANGES EACH YEAR OR AS ANY ADDITIONAL CONFLICTS OF INTEREST ARISE. STATEMENTS ARE RETAINED BY THE EXECUTIVE DIRECTOR OF CHFC IN THE CLINIC'S OFFICE. FORM 990, PART VI, SECTION B, LINE 15A IN JULY OF EACH YEAR, THE CEO/CLINIC EXECUTIVE DIRECTOR DRAFTS A LIST OF ANNUAL GOALS & OBJECTIVES AND PROVIDES IT TO THE PRESIDENT OF THE BOARD. THE BOARD OF DIRECTORS REVIEWS THE GOALS AND OBJECTIVES AT THE ANNUAL BEGINNING OF FISCAL YEAR MEETING IN JULY. ANY MODIFICATIONS SUGGESTED ARE INCORPORATED AS APPROPRIATE AND THE BENCHMARK FOR THE FISCAL YEAR IS FINALIZED. IN JUNE (END OF FISCAL YEAR) CEO/CLINIC EXECUTIVE DIRECTOR PROVIDES THE PRESIDENT OF THE BOARD WITH A DOCUMENT THAT DETAILS HIS/HER PERFORMANCE AGAINST THE ANNUAL GOALS AND OBJECTIVES APPROVED IN THE PRIOR JULY. AFTER A FACE-TO-FACE REVIEW WITH THE CEO/CLINIC EXECUTIVE DIRECTOR, THE PRESIDENT OF THE BOARD ASSIGNS THE PERFORMANCE REVIEW AN OVERALL GRADE OF (A) FAILS TO MEET EXPECTATIONS, (B) MEETS EXPECTATIONS OR (C) EXCEEDS EXPECTATIONS. DURING JUNE AND JULY THE PRESIDENT OF THE BOARD CALLS UPON ONE OR MORE BUSINESSES IN THE AREA TO LEARN WHAT COMPARABLE SALARY AND WAGE CHANGES ARE BEING CONSIDERED IN THE AREA FOR THE NEXT FISCAL YEAR AND DETERMINES THE SPECIFIC SALARY CHANGES APPROPRIATE FOR CHFC BASED UPON THE CEO/CLINIC EXECUTIVE DIRECTOR'S PERFORMANCE, PROGRESS OF THE ORGANIZATION AND BUDGETARY CONSTRAINTS (NORMALLY STATED AS X% TO Y% INCREASE). THE BOARD PRESIDENT SEEKS CONCURRENCE OF THE EXECUTIVE COMMITTEE (WITHOUT THE INVOLVEMENT OF THE CEO/CLINIC EXECUTIVE DIRECTOR) FOR THE OVERALL GRADE AND SUGGESTED SALARY INCREASE. THE CEO/CLINIC EXECUTIVE DIRECTOR'S OVERALL GRADE AND SALARY INCREASE ARE VOTED ON BY THE BOARD OF DIRECTORS. THE SPECIFICS OF THE SALARY INCREASE ARE NOT DOCUMENTED IN BOARD MEETING MINUTES TO PROVIDE THE CEO/CLINIC EXECUTIVE DIRECTOR WITH CONFIDENTIALITY. THE PRESIDENT'S COMMUNICATION WITH THE EXECUTIVE COMMITTEE AND THE FOLLOW-UP COMMUNICATION WITH THE TREASURER ARE SUFFICIENT DOCUMENTATION. SALARY CHANGES BECOME EFFECTIVE THE FIRST FISCAL DAY OF THE YEAR. FORM 990, PART VI, SECTION B, LINE 15B: THERE IS NOT A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS OR KEY EMPLOYEES BECAUSE THEY DO NOT HAVE ANY EMPLOYEES THAT MEET THE DEFINITION OF THE POSITION. FORM 990, PART VI, SECTION C, LINE 19 CHFC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST EITHER BY HARD COPY OR ELECTRONIC FORMAT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -24,121. AUDIT OVERSIGHT COMMITTEE FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.