BLUESTEM HEALTH: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BLUESTEM HEALTH (EIN 41-2056863)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-08-03
IRS object ID
201112159349300541
Schema version
2010v3.2
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)
Timestamp2011-08-03T16:28:11-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SEIM JOHNSON LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT STREET SUITE 200AddressLine1
CityOMAHACity
StateNEState
ZIP Code680224722ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN412056863EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PEOPLE'S HEALTH CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPEOPNameControl
Phone4024761640Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11021 NORTH 27TH STREETAddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68503ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDEBRA SHOEMAKERName
TitleEXECUTIVE DIRECTORTitle
Phone4024761640Phone
Date Signed2011-07-28DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJULIE M GERKENName
Phone4023302660Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDEBRA SHOEMAKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11021 NORTH 27TH STREETAddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68503ZIPCode
FieldValueIRS element (for citing)
Gross Receipts5404370GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PHCLINCOLN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionCOMMUNITY HEALTH SERVICES PROVIDE AFFORDABLE, COMPREHENSIVE, ACCESSIBLE, CULTURALLY APPROPRIATE, COST EFFECTIVE HEALTH AND DENTAL CARE TO INDIVIDUALS AND FAMILIES WITH LIMITED RESOURCES AND/OR OTHER BARRIERS TO SERVICE.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees90TotalNbrEmployees
Total Nbr Volunteers35TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1914467ContributionsGrantsPriorYear
Contributions Grants Current Year2113180ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2665937ProgramServiceRevenuePriorYear
Program Service Revenue CY3286301ProgramServiceRevenueCY
Investment Income Prior Year-16161InvestmentIncomePriorYear
Investment Income Current Year-12InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year4566OtherRevenueCurrentYear
Total Revenue Prior Year4564243TotalRevenuePriorYear
Total Revenue Current Year5404035TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2623222SalariesEtcPriorYear
Salaries Etc Current Year3157618SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1828486OtherExpensePriorYear
Other Expenses Current Year2358185OtherExpensesCurrentYear
Total Expenses Prior Year4451708TotalExpensesPriorYear
Total Expenses Current Year5515803TotalExpensesCurrentYear
Revenues Less Expenses Prior Year112535RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-111768RevenuesLessExpensesCY
Total Assets BOY3778628TotalAssetsBOY
Total Assets EOY2494132TotalAssetsEOY
Total Liabilities BOY389341TotalLiabilitiesBOY
Total Liabilities EOY483240TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3389287NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2010892NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE PEOPLE'S HEALTH CENTER PROVIDES AFFORDABLE, COMPREHENSIVE, ACCESSIBLE, CULTURALLY APPROPRIATE, COST EFFECTIVE PRIMARY HEALTH CARE. THE CENTER WILL SERVE PEOPLE OF THE LINCOLN, NEBRASKA AREA, ESPECIALLY THOSE INDIVIDUALS/FAMILIES WITH LIMITED RESOURCES OR WITH OTHER BARRIERS TO HEALTH CARE TO IMPROVE THEIR OVERALL HEALTH.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense2815368Expense
Revenue2047764Revenue
DescriptionMEDICAL SERVICES - PHC PROVIDES COMPREHENSIVE MEDICAL SERVICES TO ITS PATIENTS. OUR PROVIDER STAFF INCLUDES FAMILY PRACTICE PHYSICIANS, NURSE PRACTITIONERS, A PHYSICIAN ASSISTANT, CERTIFIED NURSE MIDWIVES (PROVIDE OB CARE/DELIVERIES) AND VOLUNTEER SPECIALTY PHYSICIANS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense780107Expense
Revenue567413Revenue
DescriptionDENTAL SERVICES - PHC OFFERS PREVENTATIVE DENTAL SERVICES INCLUDING: X-RAYS, EXAMS, CLEANINGS, FILLINGS AND EXTRACTIONS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense260572Expense
Revenue189528Revenue
DescriptionINTEGRATED BEHAVIORAL HEALTH - INTEGRATED BEHAVIORAL HEALTH IS OFFERED AS A JOINT EFFORT BETWEEN PEOPLE'S HEALTH CENTER, CENTERPOINTE, REGION V SERVICES NETWORK PROVIDERS AND THE COMMUNITY HEALTH ENDOWMENT. THIS PROGRAM IS DESIGNED TO OFFER ASSESSMENT, SHORT-TERM SOLUTION FOCUSED TREATMENT AND REFERRAL IN A COST-EFFECTIVE, EFFICIENT MODEL. DESIRED OUTCOMES INCLUDE LESS FREQUENT NEED FOR MEDICAL CARE, FEWER SOMATIC HEALTH SYMPTOMS, INCREASED MEDICATION COMPLIANCE FOR INDIVIDUALS WITH CHRONIC ILLNESSES, DECREASED ANXIETY, REFERRALS FOR PATIENTS EXPERIENCING ISSUES WITH ALCOHOL AND OTHER DRUG RELATED PROBLEMS, AND MORE PATIENTS RECEIVING SERVICES AT PEOPLE'S HEALTH CENTER DUE TO A REDUCTION IN THE AMOUNT OF TIME PRIMARY HEALTH CARE PROVIDERS ARE NEEDED TO SPEND WITH BEHAVIORAL HEALTH PATIENTS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense662123Expense
Revenue481596Revenue
DescriptionOTHER SERVICES - COMMUNITY SERVICESS, MEDICAL RECORDS, LAB, X-RAY, PHARMACYDescription
FieldValueIRS element (for citing)
Total Of Other Program Service Exp662123TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev481596TotalOfOtherProgramServiceRev
Total Program Service Expense4518170TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees90NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1GRETCHEN THORNBURG FINANCE DIRECTORBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4024761640TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11021 N 27TH STREETAddressLine1
CityLINCOLNCity
StateNEState
ZIP Code68503ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JILL JENSEN
CHAIR5.00XX000
SUSANNE BLUE
CO-CHAIR2.00XX000
JOAN ANDERSON
SECRETARY2.00XX000
CARLEEN SANCHEZ PHD
TREASURER2.00XX000
KATHLEEN CAMPBELL
DIRECTOR1.00X000
JANET COLEMAN
DIRECTOR1.00X000
WAYNE CRAMM
DIRECTOR1.00X000
RYAN GRATOPP
DIRECTOR1.00X000
PAULA GUERRERO
DIRECTOR1.00X000
JOSIE RODRIGUEZ
DIRECTOR1.00X000
EMMETT SNOW
DIRECTOR1.00X000
DEBRA SHOEMAKER
EXECUTIVE DIRECTOR40.00X8528007296
PAMELA HANSON 0110 - 0810
FINANCE DIRECTOR40.00X6057207781
GRETCHEN THORNBURG 0910 - PRESENT
FINANCE DIRECTOR40.00X192210940
DR ALBERT HALLS
PHYSICIAN40.00139452020048X
DR MARYAM MAHMOODIAN
MEDICAL DIRECTOR40.00147597014125X
DR DAVID PAULUS
CHIEF MEDICAL OFFICER40.00165056023852X
DR ARATHI REDDY
DENTAL DIRECTOR32.0012694305078X
FieldValueIRS element (for citing)
Total Reportable Comp From Org744121TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation79120TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants1705404GovernmentGrants
All Other Contributions407776AllOtherContributions
Total Contributions2113180TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT FEES62140016802661680266
MEDICAID62140011279151127915
MEDICARE621400339929339929
CASE MANAGEMENT FEES6214007893578935
PHARMACY6214005925659256
FieldValueIRS element (for citing)
Total Program Service Revenue3286301TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column323TotalRevenueColumn
Exclusion$323ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other335Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-335Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-335TotalRevenueColumn
Exclusion-$335ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events3500GrossIncomeFundraisingEvents

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column3500TotalRevenueColumn
Exclusion$3,500ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column1066TotalRevenueColumn
Exclusion$1,066ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1066TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column5404035TotalRevenueColumn
Related Or Exempt Function Income3286301RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,554ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total181090Total
Management And General181090ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2316713Total
Program Services1844586ProgramServices
Management And General472127ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total52115Total
Program Services43384ProgramServices
Management And General8731ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total401447Total
Program Services300704ProgramServices
Management And General100743ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total206253Total
Program Services150075ProgramServices
Management And General56178ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total8064Total
Management And General8064ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total23340Total
Management And General23340ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total811729Total
Program Services755590ProgramServices
Management And General56139ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total372282Total
Program Services314362ProgramServices
Management And General57920ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total203438Total
Program Services203438ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total14378Total
Program Services9992ProgramServices
Management And General4386ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total10829Total
Program Services8482ProgramServices
Management And General2347ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2700Total
Management And General2700ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total134384Total
Program Services122478ProgramServices
Management And General11906ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE716506716506
LICENSES, FEES & MEMBER37709319105799
MISCELLANEOUS EXPENSES22666165036163
SUBSCRIPTIONS160160

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5515803Total
Program Services4518170ProgramServices
Management And General997633ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY47626BOY
EOY700EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY494185BOY
EOY106232EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1421289BOY
EOY124094EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY504975BOY
EOY838933EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY10013BOY
EOY11701EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1984596LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec572124LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1300540BOY
EOY1412472EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3778628BOY
EOY2494132EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY178341BOY
EOY244240EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY211000BOY
EOY199000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY40000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY389341BOY
EOY483240EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2122658BOY
EOY2010892EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1266629BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3389287BOY
EOY2010892EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3778628BOY
EOY2494132EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-111768ReconcilationRevenueExpenses
Reconcilation Other Changes-1266627ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1131850CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1408724CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1556666CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1914467CurrentTaxYearMinus1Year
Current Tax Year2113180CurrentTaxYear
Total8124887Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1131850CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1408724CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1556666CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1914467CurrentTaxYearMinus1Year
Current Tax Year2113180CurrentTaxYear
Total8124887Total
FieldValueIRS element (for citing)
Public Support Total1708124887PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years5849CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1340CurrentTaxYearMinus1Year
Current Tax Year323CurrentTaxYear
Total7512Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1749209CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2331904CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2205099CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2665938CurrentTaxYearMinus1Year
Current Tax Year3290867CurrentTaxYear
Total12243017Total
FieldValueIRS element (for citing)
Total Support20375416TotalSupport
Public Support Pertcentage1700.39880PublicSupportPertcentage170
Public Support Pertcent Prior Year0.43640PublicSupportPertcentPriorYear
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 D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1073180OtherCostOrOtherBasis
Depreciation238654Depreciation
Book Value834526BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis911416OtherCostOrOtherBasis
Depreciation333470Depreciation
Book Value577946BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1412472TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLINE OF CREDITDescription
Amount$40,000Amount
FieldValueIRS element (for citing)
Total Of Amounts40000TotalOfAmounts
Total Revenue5404035TotalRevenue
Total Expenses5515803TotalExpenses
Excess Or Deficit For Year-111768ExcessOrDeficitForYear
Prior Period Adjustments-1266629PriorPeriodAdjustments
Other$2OtherAmount
Total Adjustments-1266627TotalAdjustments
Excess Or Deficit Per FS-1378395ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt5468803TotRevenueEtcAuditedFinclStmt
Donated Srvc And Use Of Facilities64768DonatedSrvcAndUseOfFacilities
Revenue Not Rptd F99064768RevenueNotRptdF990
Revenue Subtotal5404035RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9905404035TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6847200TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities64768DonatedServicesUseOfFacilities
Prior Year Adjustments1266629PriorYearAdjustments
Expenses Not Rptd F9901331397ExpensesNotRptdF990
Expenses Subtotal5515803ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9905515803TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE HEALTH CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2010 AND 2009, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS.
PART XI, LINE 8 - OTHER ADJUSTMENTS:PRIOR PERIOD ROUNDING ADJUSTMENT 2.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base 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
DR ALBERT HALLS
1394520000057930142550159500000
DR MARYAM MAHMOODIAN
1475970000000141250161722000
DR DAVID PAULUS
1650560000068170170350188908000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NEW PROGRAM SERVICESFORM 990, PART III, LINE 2BEHAVIORAL HEALTH INTEGRATION - FUNDED BY REGION V WILL ALLOW FOR A BEHAVIORAL HEALTH THERAPIST TO BE HIRED AND IMPLEMENT BEHAVIORAL HEALTH SERVICES TO OUR PATIENTS.
FORM 990, PART VI, SECTION B, LINE 11THE FINANCE COMMITTEE REVIEWS THE FORM 990 AND PRESENTS IT TO THE BOARD OF DIRECTORS WITH A RECOMMENDATION FOR APPROVAL BEFORE IT IS SUBMITTED.
FORM 990, PART VI, SECTION B, LINE 12CTHE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY RESPONSIBLE PERSONS AND EACH RESPONSIBLE PERSON MUST ANNUALLY COMPLETE A DISCLOSURE FORM IDENTIFYING ANY POSSIBLE CONFLICTS OF INTEREST. THE CONFLICT OF INTEREST STATEMENTS ARE REVIEWD AND UPDATED AT THE ANNUAL MEETING EACH YEAR.
FORM 990, PART VI, SECTION B, LINE 15THE BOARD OF DIRECTORS OF PEOPLE'S HEALTH CENTER SETS THE COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. THEY REVIEW AN ANNUAL SALARY SURVEY CONDUCTED BY THE IOWA/NEBRASKA PRIMARY CARE ASSOCIATION, WHICH IS A SALARY RANGE SURVEY COMPLETED BY EIGHTEEN COMMUNITY HEALTH CENTERS. THE BOARD ALSO REVIEWS THE SALARY SURVEY FOR NONPROFIT ORGANIZATIONS IN THE SURROUNDING AREAS PRODUCED BY THE NONPROFIT ASSOCIATION OF THE MIDLANDS. DECISIONS FOR COMPENSATION ARE BASED ON A PERSON'S EXPERIENCE, SKILLS AND EDUCATIONAL LEVEL. THE SALARIES ARE APPROVED WITH A MAJORITY VOTE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19THE PEOPLE'S HEALTH CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:PRIOR PERIOD ADJUSTMENTS: -1,266,629. PRIOR PERIOD ROUNDING ADJUSTMENT 2. TOTAL TO FORM 990, PART XI, LINE 5: -1,266,627.
FORM 990, PART XII, LINE 2C:THE BOARD OF DIRECTORS OF PEOPLE'S HEALTH CENTER ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

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