CHARLES DREW HEALTH CENTER INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CHARLES DREW HEALTH CENTER INC (EIN 47-0666715)
Tax period
2009-09-01 to 2010-08-31
Filed
2011-04-18
IRS object ID
201111089349300901
Schema version
2009v1.3
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)
Timestamp2011-04-18T13:29:23-07:00Timestamp
Tax Period End Date2010-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1HAMILTON ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line120 PEARL STAddressLine1
CityCOUNCIL BLUFFSCity
StateIAState
ZIP Code515030817ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN470666715EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHARLES DREW HEALTH CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHARNameControl
Phone4024571200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12915 GRANT STREETAddressLine1
CityOMAHACity
StateNEState
ZIP Code68111ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRICHARD BROWNName
TitleCEOTitle
Phone4024571200Phone
Date Signed2011-04-13DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NamePAUL E HAMILTONName
Phone7123220277Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRICHARD BROWNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12915 GRANT STAddressLine1
CityOMAHACity
StateNEState
ZIP Code68111ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9933430GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1984YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionPROVIDING QUALITY COMPREHENSIVE HEALTH CARE FOR THE TOTAL PERSON, THROUGH THE MEDIUM OF MANAGING AND OPERATING A COORDINATED HEALTH FACILITY AND ITS PROGRAMS.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees134TotalNbrEmployees
Total Nbr Volunteers25TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year6073282ContributionsGrantsPriorYear
Contributions Grants Current Year6500819ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2940478ProgramServiceRevenuePriorYear
Program Service Revenue CY3431663ProgramServiceRevenueCY
Investment Income Prior Year4599InvestmentIncomePriorYear
Investment Income Current Year948InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year9018359TotalRevenuePriorYear
Total Revenue Current Year9933430TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5086104SalariesEtcPriorYear
Salaries Etc Current Year5164879SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year324957TotalFundrsngExpCurrentYear
Other Expense Prior Year4377116OtherExpensePriorYear
Other Expenses Current Year3789672OtherExpensesCurrentYear
Total Expenses Prior Year9463220TotalExpensesPriorYear
Total Expenses Current Year8954551TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-444861RevenuesLessExpensesPriorYear
Revenues Less Expenses CY978879RevenuesLessExpensesCY
Total Assets BOY6222413TotalAssetsBOY
Total Assets EOY7151262TotalAssetsEOY
Total Liabilities BOY1164065TotalLiabilitiesBOY
Total Liabilities EOY1114035TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5058348NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6037227NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDING QUALITY COMPREHENSIVEMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense5959329Expense
Revenue2499308Revenue
DescriptionCHARLES DREW HEALTH CENTER PROVIDES CARE FOR THE ENTIRE FAMILY. SERVICES INCLUDE FAMILY PRACTICE, INTERNAL MEDICINE, PEDIATRICS, OB/GYN, PHARMACY, RADIOLOGY, EYE SERVICES, MINOR SURGERY, CARDIOLOGY AND PODIATRY. THE HEALTH CENTER SERVED 12,898 PATIENTS AND FASCILITATED 44,206 PATIENT ENCOUNTERS (VISITS) IN 2009. SEE STATEMENT 2 FOR MORE INFORMATION.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense617850Expense
Revenue595120Revenue
DescriptionTHE CDHC DENTAL PROGRAM PROVIDES THE FOLLOWING SERVICES: DENTAL SCREENINGS, ORAL EXAMS, SEALANTS, FLOURIDE TREATMENTS, RESTORATIVE SERVICES, ORAL SURGERY (EXTRACTIONS) EMERGENCY SERVICES, AND REHABILITATION SERVICES. THE HEALTH CENTER FASCILITATED 6,256 DENTAL PATIENT ENCOUNTERS (VISITS) IN 2009.Description
FieldValueIRS element (for citing)
Total Program Service Expense6577179TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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 RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109639NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees134NumberOfEmployees
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
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
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 BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCALVIN MCGRUDERNamePerson
Telephone Number4024571215TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12915 GRANT STAddressLine1
CityOMAHACity
StateNEState
ZIP Code68111ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JULIETA CLARKE
CHAIRPERSON1.00X000
PATRICIA BROWN
VICE-CHAIRPERSON1.00X000
BILLY HOUSE
SECRETARY1.00X000
STEPHEN CUMMINGS
TREASURER1.00X000
LIZ CAMPBELL
PAST CHAIRPERSON1.00X000
OTHA COUNCIL
BOARDMEMBER1.00X000
ERIC PAYNE
BOARD MEMBER1.00X000
BEVERLY FRAZIER
BOARD MEMBER1.00X000
PATRICIA CUNNINGHAM
BOARD MEMBER1.00X000
RICK BELL
BOARD MEMBER1.00X000
TEENA FOSTER
BOARD MEMBER1.00X000
REV LEROY ADAMS
BOARD MEMBER1.00X000
FREDERICK EDEGBELE
BOARD MEMBER1.00X000
RICHARD GREGORY
BOARD MEMBER1.00X000
DR RUBENS PAMIES
BOARD MEMBER1.00X000
DR RICHARD BROWN
CEO40.00138835034841X
CALVIN MCGRUDER
CFO40.0074792018597X
DR GREGORY OCHUBA
MEDICAL DIRECTOR4018240929599X
DR MONIQUE TOLSTON
FAMILY PRACTICE PHYSICIAN4016017620685X
DR JUSTIN JONES
DENTAL DIRECTOR401456271012X
DR TAKASHI KAWAMITSI
FAMILY PRACTICE PHYSICIAN4014902620516X
DR LUCILLE WOODARD
FAMILY PRACTICE PHYSICIAN401346526372X
DR ARLANA PHILLUPS
PEDIATRICIAN4013134815096X
DR ERIN WETZEL
DENTIST401133719658X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1230236TotalReportableCompFromOrg
Total Other Compensation156376TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BARRY LARSON
6060 WENNINGHOFF RDOMAHANE68134CONSTRUCTION CONTRACTOR244799
CUSTOM COMPUTING
11135 MILL VALLEY RDOMAHANE68154MEDICAL BILLING145383
NEXTGEN
PO BOX 511449LOS ANGELESCA90051SOFTWARE PROVIDER278679
REGIONAL CARE
905 W 27TH STSCOTTSBLUFFNE69361MEDICAL SERVICES493821
VISITING NURSE SERVICES
12565 W CENTER RD STE 100OMAHANE68144NURSING SERVICES111646
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Federated Campaigns41100FederatedCampaigns
Government Grants6282390GovernmentGrants
All Other Contributions177329AllOtherContributions
Total Contributions6500819TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE62410030944283094428
MISCELLANEOUS6241007712777127
DEVELOPMENT624100260108260108
FieldValueIRS element (for citing)
Total Program Service Revenue3431663TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column948TotalRevenueColumn
Exclusion$948ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9933430TotalRevenueColumn
Related Or Exempt Function Income3431663RelatedOrExemptFunctionIncome
Exclusion$948ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total267065Total
Program Services0ProgramServices
Management And General267065ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4055344Total
Program Services3368010ProgramServices
Management And General583431ManagementAndGeneral
Fundraising103903Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total89064Total
Program Services69997ProgramServices
Management And General16419ManagementAndGeneral
Fundraising2648Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total410791Total
Program Services328895ProgramServices
Management And General77148ManagementAndGeneral
Fundraising4748Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total342615Total
Program Services270506ProgramServices
Management And General63452ManagementAndGeneral
Fundraising8657Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total45167Total
Program Services0ProgramServices
Management And General45167ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1430096Total
Program Services908853ProgramServices
Management And General483323ManagementAndGeneral
Fundraising37920Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total145100Total
Program Services39793ProgramServices
Management And General0ManagementAndGeneral
Fundraising105307Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total521160Total
Program Services440302ProgramServices
Management And General62790ManagementAndGeneral
Fundraising18068Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total356351Total
Program Services288644ProgramServices
Management And General67707ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total7253Total
Program Services4521ProgramServices
Management And General2732ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total180643Total
Program Services95870ProgramServices
Management And General80712ManagementAndGeneral
Fundraising4061Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total407459Total
Program Services330042ProgramServices
Management And General77417ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total76527Total
Program Services61987ProgramServices
Management And General14540ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBT29300329300300
COMMUNICATIONS9060148591357166294
LICENSES129425240171054080
DUES AND SUBSCRIPTIONS362681512347560
MISCELLANEOUS372682636346320

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total33351Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising33351Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8954551Total
Program Services6577179ProgramServices
Management And General2052415ManagementAndGeneral
Fundraising324957Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY13012BOY
EOY8785EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY252554BOY
EOY465514EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY192695BOY
EOY248844EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY246817BOY
EOY482856EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY19075BOY
EOY16258EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY10466BOY
EOY39176EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8184214LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2533131LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5221781BOY
EOY5651083EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY266013BOY
EOY238746EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6222413BOY
EOY7151262EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1138380BOY
EOY1084776EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY13593BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12092BOY
EOY29259EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1164065BOY
EOY1114035EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4993829BOY
EOY6003287EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY64519BOY
EOY33940EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5058348BOY
EOY6037227EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6222413BOY
EOY7151262EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

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)
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$30,232OtherActivitiesAmount
Total Lobbying Expenditures IIB30232TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPt II-B Line 1iIdentifier
ExplanationTHE ORGANIZATION PAYS DUES TO NACHC AND IANEPCA. AExplanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis95653OtherCostOrOtherBasis
Book Value95653BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6611503OtherCostOrOtherBasis
Depreciation1623463Depreciation
Book Value4988040BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1112243OtherCostOrOtherBasis
Depreciation829431Depreciation
Book Value282812BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis364815OtherCostOrOtherBasis
Depreciation80237Depreciation
Book Value284578BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5651083TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionESTIMATED AMOUNTS DUE FROM THIRD PARTY PAYERSDescription
Book Value238746BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets238746TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDEFERRED OFFICER COMPENSATIONDescription
Amount$29,259Amount
FieldValueIRS element (for citing)
Total Of Amounts29259TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrg
DR RICHARD BROWN
1388351752917312173676148196
DR GREGORY OCHUBA
182409695222646212007186772
DR MONIQUE TOLSTON
160176590814776180860163820
DR TAKASHI KAWAMITSI
149026573214783169541154157

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
HEARTLAND COMMUNITY HEALTH NETWORK
SEE STATEMENT 1160348ADMINISTRATIVE FEESfalse
HEARTLAND COMMUNITY HEALTH NETWORK
SEE STATEMENT 178236EQUIPMENT PURCHASESfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (70 entries)

IdentifierIdentifierExplanationExplanation
Pt VI-B, Line 11ATHE ORGANIZATION'S CEO AND CFO REVIEW THE FORM 990
IN DETAIL PRIOR TO FILING. THEN, COPIES ARE HANDED
OUT AT THE BOARD MEETING PRIOR TO FILING THE
RETURN.
Pt VI-B, Line 12cTHE BOARD OF DIRECTORS (PERSONNEL COMMITTEE) MEETS
MONTHLY TO DISCUSS ANY CONFLICTS OF INTEREST WITH
THE HUMAN RESOURCE'S DIRECTOR AND CEO.
BOARD DIRECTORS AND MEMBERS OF THEIR IMMEDIATE
FAMILY ARE PROHIBITED FROM BEING EMPLOYEES OR
CONTRACTORS OF THE HEALTH CENTER, AS IT RELATES TO
BOARD BUSINESS.
ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF THE
INTEREST ON PART OF ANY DIRECTOR SHALL BE DISCLOSED
TO THE GOVERNING BODY IMMEDIATELY. EACH YEAR PRIOR
TO NOMINATIONS, ALL DIRECTORS MUST PREPARE AND FILE
WITH THE RECORDING SECRETARY, A WRITTEN DECLARATION
OF INTERESTS AND ACTIVITIES, WHICH CREATE OR MIGHT
CREATE A DUAL INTEREST OR CONFLICT OF INTEREST ON
THE PART OF THE DIRECTOR. SUCH WRITTEN DECLARATION
SHALL BE IN THE FORM AS APPROVED BY THE BOARD OF
DIRECTORS. THE CHAIRMAN REVIEWS THE WRITTEN
DECLARATION. A DIRECTOR HAVING A DUALITY OF
INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY
MATTER SHALL NOT VOTE OR USE HIS OR HER PERSONAL
INFLUENCE IN THE MATTER. THE MINUTES REFLECT THE
DISCLOSURE, VOTING, AND QUORUM STATUS.
THE FOREGOING REQUIREMENTS, HOWEVER, SHALL NOT BE
CONSTRUED AS PREVENTING THE DIRECTOR FROM STATING
HIS OR HER POSITION A MATTER OR FROM ANSWERING
PERTINENT QUESTIONS OF OTHER DIRECTORS, SINCE HIS
OR HER KNOWLEDGE MAY BE OF GREAT ASSISTANCE TO THE
BOARD. ACCORDING TO CONFLICT OF INTEREST UNDER
ARTICLE VI, IF A CONFLICT OF INTEREST ARISES DURING
BOARD PROCEEDINGS, THE MEMBER WITH THE CONFLICT OF
INTEREST MAY EXCUSE HIM OR HERSELF PRIOR TO VOTING.
THE MEMBER SHOULD STATE CLEARLY THE CONFLICT OF
INTEREST, AND THE RECORDING SECRETARY SHALL REFLECT
SUCH ACTION IN THE MINUTES OF THE BOARD.
DIRECTORS SHALL NOT ACCEPT GIFTS, EXCESSIVE
ENTERTAINMENT OR OTHER GRATUITIES FROM ANY OUTSIDE
PERSON OR ORGANIZATION THAT DOES OR IS SEEKING TO
DO BUSINESS WITH OR IS A COMPETITOR OF CHARLES
DREW HEALTH CENTER CORPORATION UNDER CIRCUMSTANCES
FROM WHICH IT MIGHT BE INFERRED THAT SUCH ACTION
WAS INTENDED TO INFLUENCE OR POSSIBLY WOULD
INFLUENCE THE DIRECTOR IN THE PERFORMANCE OF DUTIES.
SUCH RESTRICTIONS DO NOT INCLUDE THE ACCEPTANCE OF
ITEMS OF NOMINAL OR MINOR VALUE THAT ARE CLEARLY
TOKENS OF RESPECT OR FRIENDSHIP OR ACTIVITY OF THE
CORPORATION.
NO DIRECTOR SHALL DISCLOSE OR USE CONFIDENTIAL
INFORMATION RELATING TO THE BUSINESS OF THE
CORPORATION FOR THE PERSONAL PROFIT OR ADVANTAGE OF
THE DIRECTOR OR THE DIRECTOR'S IMMEDIATE FAMILY.
Pt VI-B, Line 15THE ENTIRE BOARD OF DIRECTORS APPROVES THE CEO'S
SALARY. SALARY SURVEYS WITH OTHER COMMUNITY HEALTH
CENTERS ARE USED TO COMPARE THE CEO'S SALARY.
Pt XI, Line 2cTHE ORGANIZATION IS A MEMBER OF A CONSOLIDATED GROUP
WHICH RECEIVES AUDITED FINANCIAL STATEMENTS ON A
CONSOLIDATED BASIS. THE CONSOLIDATED AUDITED
FINANCIAL STATEMENTS INCLUDE FINANCIAL INFORMATION
FOR CHARLES DREW HEALTH CENTER FOUNDATION, WHO FILES
A SEPARATE TAX RETURN NOT INCLUDED ON THIS FORM 990.
THE ORGANIZATION'S AUDIT COMMITTEE ASSUMES
RESPONSIBILITY FOR THE OVERSIGHT OF THE CONSOLIDATED
AUDIT, AS WELL AS THE CHOICE OF AN INDEPENDANT
ACCOUNTANT.
Pt VI-C, Line 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND
FINANCIAL STATEMENTS WILL BE MADE AVAILABLE BY MAIL UPON
REQUEST AND/OR ON-SITE.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CHARLES DREW HEALTH CENTER FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12915 GRANT STAddressLine1
CityOMAHACity
StateNEState
ZIP Code68111ZIPCode
FieldValueIRS element (for citing)
EIN300216692EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateNELegalDomicileState
Exempt Code Section501(c)3ExemptCodeSection
Public Charity Status11PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1CHARLES DREW HEALTH CENTER FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypecTransactionType
Amount Involved231244AmountInvolved

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