2024-01-12T18:58:38-06:00 2023-02-28 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2022-03-01 421527584 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC % ANTONIO FLORES COMM 3197532300 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 ANTONIO FLORES CEO 4178658701 2024-01-15 true ANTONIO FLORES 999009999 Krystal K Creach P01248198 4178658701 2 2022 2023-04-26 12:10:37Z ANTONIO FLORES 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 29159719 false X CHCSEIA.COM X 2001 IA CHCSEIA PROVIDES COMPREHENSIVE HEALTH SERVICES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS, AND OTHER HEALTH CARE SERVICES TO RESIDENTS OF THE SE IOWA REGION. 12 12 224 12 0 0 4481022 5224635 22564702 23541852 100639 202056 2222168 191176 29368531 29159719 0 7200 0 0 15436928 17857633 0 0 0 7900109 9404209 23337037 27269042 6031494 1890677 25641167 27718942 4496275 4683373 21144892 23035569 X TO PROVIDE PRIMARY HEALTH CARE TO RESIDENTS OF THE GREATER SE IOWA REGION, ESPECIALLY THOSE INDIVIDUALS/FAMILIES WITH LIMITED RESOURCES OR WITH OTHER BARRIERS TO HEALTH CARE. SEE SCHEDULE O FOR ADDITIONAL INFORMATION. false false 18061106 7200 23541852 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA PROVIDES SEVERAL HEALTH SERVICES TO THE COMMUNITY, INCLUDING: COMPREHENSIVE HEALTH SERVICES WITH A VARIETY OF PHYSICIAN SPECIALTIES, GENERAL DENTISTRY AND COMMUNITY HEALTH PROGRAMS INVOLVING ORAL HEALTH EDUCATION AND DENTAL SCREENING, FAMILY PLANNING, HEALTH SCREENINGS, IMMUNIZATIONS, CASE MANAGEMENT, AND PHARMACIES. DURING THE FISCAL YEAR, THE HEALTH CENTERS HAD APPROXIMATELY 22,800 DENTAL VISITS AND 62,300 MEDICAL VISITS (INCLUDES BEHAVIORAL HEALTH). 18061106 true true false true false false false false false false true false false true true false true false false false false false false false false false false false true true false false false false false false false false false false false false false false false false false true 43 0 true 224 true false false false false false false false false false false false false X 12 12 false false false false false false false true true false false true true true true true true true true false X ANTONIO FLORES 3197532300 1706 WEST AGENCY ROAD WEST BURLINGTON IA 52655 PATRICK WILLIAMS PEDIATRICIAN 40.0 0.0 X 359940 0 52953 FRANCES JACKSON PEDIATRICIAN 40.0 0.0 X 349530 0 44978 RHEA HARTLEY CHIEF MEDICAL OFFICER 40.0 0.0 X 358070 0 31559 ERIC BOYUM PSYCHIATRIST 40.0 0.0 X 294802 0 46473 SHAILESH DESAI PHYSICIAN 40.0 0.0 X 245897 0 42213 LUCAS LEMBURG CHIEF DENTAL OFFICER 40.0 0.0 X 243642 0 43812 CHRISTINA ANDERSON PHYSICIAN 40.0 0.0 X 268208 0 17636 DIANE ROUSE CFO 40.0 0.0 X 156663 0 41468 ANTONIO FLORES CEO 40.0 0.0 X 165342 0 23042 DAVID WHITAKER DIRECTOR 1.0 0.0 X 0 0 0 DAVID SELMON DIRECTOR 1.0 0.0 X 0 0 0 ANGELICA CARDENAS DIRECTOR END 06/22 1.0 0.0 X 0 0 0 BARRY CORSON DIRECTOR 1.0 0.0 X 0 0 0 BILL STAATS VICE CHAIR 1.0 0.0 X X 0 0 0 CHUCK GRIFFIN DIRECTOR 1.0 0.0 X 0 0 0 CINDY SHARPE DIRECTOR END; TREAS BEG 06/22 1.0 0.0 X X 0 0 0 EBONY GRAY DIRECTOR END 07/22 1.0 0.0 X 0 0 0 JASON STRANDBERG CHAIR END 04/22 1.0 0.0 X X 0 0 0 JEFF STRAUSE TREASURER END; CHAIR BEG 04/22 1.0 0.0 X X 0 0 0 JOANNA SCHNEDEN DIRECTOR 1.0 0.0 X 0 0 0 JULIE SCHILLING SECRETARY 1.0 0.0 X X 0 0 0 SUE SORENSEN DIRECTOR 1.0 0.0 X 0 0 0 DAVE HADEN DIRECTOR BEG 12/22 1.0 0.0 X 0 0 0 DELANEY RICHARDS DIRECTOR BEG 01/23 1.0 0.0 X 0 0 0 2442094 0 344134 33 false true false ICON MEDICAL NETWORK 525 3RD ST SUITE 304 LAKE OSWEGO OR 97034 PEDIATRIC SERVICES 383671 PAIN CENTERS OF IOWA 5515 UTICA RIDGE ROAD 600 DAVENPORT IA 52807 HEALTH SERVICES 321945 NEXTGEN 1811 VON KARMAN AVE STE 800 IRVINE TX 92612 SOFTWARE SUPPORT 299335 AMERICAN HEALTHCARE STAFFING ASSOCI 3051 WILLOWOOD ROAD EDMOND OK 73034 PEIDATRIC SERVICES 188162 FORVIS LLP 910 E ST LOUIS ST SPRINGFIELD MO 65801 AUDIT & CONSULT SVCS 128358 6 5030357 194278 7200 5224635 NET PATIENT SERVICE REVENUE 624100 23304533 23304533 OTHER REVENUE 624100 237319 237319 23541852 202056 202056 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GAIN ON INV IN EQUITY INVESTEE 900099 191176 191176 191176 29159719 23541852 393232 0 7200 7200 0 0 1063598 677083 386515 0 13367764 8689629 4678135 540579 345002 195577 1910013 1046929 863084 975679 621040 354639 0 86307 86307 148953 148953 0 0 0 3352377 2871831 480546 49475 3798 45677 890878 287100 603778 0 0 725830 26291 699539 48421 13190 35231 0 40775 33019 7756 94182 11301 82881 0 580962 232669 348293 129120 52959 76161 0 MEDICAL SUPPLIES & DRUGS 3016658 3016658 LICENSES, DUES, SUBSCRIPTIONS 136656 43672 92984 RECRUITING & RETENTION 103615 81735 21880 27269042 18061106 9207936 0 749903 1161821 8343659 11196229 36190 547767 3421422 2848826 0 0 0 0 0 0 361862 343668 93779 638817 13249352 5408635 6942697 7840717 0 0 0 0 495339 686515 578900 513364 4617416 1941218 25641167 27718942 1746641 2099441 0 0 279092 26236 0 0 0 0 0 0 1928725 1818044 281461 143732 260356 595920 4496275 4683373 X 21121326 22403067 23566 632502 21144892 23035569 25641167 27718942 1890677 X false true X true true true X 3213276 3299706 5415566 4481022 5224635 21634205 0 0 3213276 3299706 5415566 4481022 5224635 21634205 0 21634205 5069 28523 61533 101380 202056 398561 0 0 22032766 95768687 0.98191 0.99023 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true false SCHEDULE C, PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC), THE IOWA PRIMARY CARE ASSOCIATION (IAPCA), AND THE ILLINOIS PRIMARY HEALTHCARE ASSOCIATION (ILPHCA). A PORTION OF THESE DUES MAY BE USED FOR LOBBYING PURPOSES. 223943 223943 9168145 2885895 6282250 224028 222909 1119 2942028 2295181 646847 691208 4650 686558 7840717 DUE FROM THIRD PARTY PAYERS 1080000 OTHER RECEIVABLES 265298 ROU ASSETS 273341 457(B) ASSETS 322579 1941218 0 457(B) PLAN PAYABLE 322579 ROU LEASE LIABILITY 273341 595920 28565783 15000 15000 28550783 608936 608936 29159719 27284042 15000 15000 27269042 27269042 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: 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. SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 608,936 CONTRIBUTIONS WITH DONOR RESTRICTIONS true BOOKS 3000 7200 FMV BOOKS SCHEDULE I, PART I, LINE 2 GRANTS MONITORING: CHCSEIA MAINTAINS AN INDIVIDUAL SPREADSHEET FOR EACH GRANT AWARDED TO THE ENTITY THAT TRACKS ALL EXPENSES RELATED TO THE PARTICULAR GRANT. THIS GRANT EXPENSE SPREADSHEET IS UPDATED ON A MONTHLY BASIS. X true true X X X false false false false false false false true false DIANE ROUSE CFO 145407 0 6772 0 4484 0 8256 0 33212 0 198131 0 0 0 ANTONIO FLORES CEO 155070 0 10272 0 0 0 8406 0 14636 0 188384 0 0 0 LUCAS LEMBURG CHIEF DENTAL OFFICER 207406 0 22429 0 13807 0 12488 0 31324 0 287454 0 0 0 RHEA HARTLEY CHIEF MEDICAL OFFICER 308653 0 49417 0 0 0 18017 0 13542 0 389629 0 0 0 CHRISTINA ANDERSON PHYSICIAN 252936 0 15272 0 0 0 3034 0 14602 0 285844 0 0 0 ERIC BOYUM PSYCHIATRIST 279530 0 15272 0 0 0 15083 0 31390 0 341275 0 0 0 FRANCES JACKSON PEDIATRICIAN 294758 0 54772 0 0 0 17450 0 27528 0 394508 0 0 0 PATRICK WILLIAMS PEDIATRICIAN 295344 0 64596 0 0 0 18179 0 34774 0 412893 0 0 0 SHAILESH DESAI PHYSICIAN 212376 0 16970 0 16551 0 12684 0 29529 0 288110 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH CLUB DUES: THE ORGANIZATION OFFERS A WELLNESS PROGRAM TO ITS EMPLOYEES WHICH PROVIDES DIRECT REIMBURSEMENT OF UP TO $25 PER MONTH TOWARDS DOCUMENTED PARTICIPATION IN AN APPROVED HEALTH ACTIVITY. EMPLOYEES MUST SUBMIT PROOF OF PAYMENT FOR THE EMPLOYEE'S MEMBERSHIP FOR THE MONTH ALONG WITH PROOF OF ATTENDANCE OF AT LEAST THREE TIMES PER MONTH. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: BONUS AMOUNTS PAID ARE BASED ON PRODUCTION LEVELS AND QUALITY MEASURES. FORM 990, PART I, LINE 6 VOLUNTEERS: THE ORGANIZATION'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION: CHCSEIA IS A FEDERALLY QUALIFIED HEALTH CENTER WHOSE MISSION IS TO PROVIDE AFFORDABLE, COMPREHENSIVE, CULTURALLY APPROPRIATE, COST EFFECTIVE HEALTH CARE TO RESIDENTS OF THE GREATER SOUTHEASTERN IOWA REGION IN ORDER TO IMPROVE THEIR OVERALL HEALTH STATUS. THE MAIN PURPOSES OF THE ORGANIZATION ARE THE FOLLOWING: -PROVIDE PRIMARY MEDICAL CARE, GENERAL DENTAL SERVICES, AND INTEGRATED BEHAVIORAL HEALTH SERVICES -CREATE NEW HEALTH CARE RESOURCES AND HEALTH CARE ARRANGEMENTS TO OFFER TO THE COMMUNITIES SERVED BY THE CORPORATION -EXPAND ACCESS TO HEALTH CARE TO THOSE INDIVIDUALS UNABLE TO OBTAIN ADEQUATE HEALTH CARE -REDUCE UNNECESSARY DUPLICATION OF SERVICES, TECHNOLOGY AND FACILITIES BY COORDINATING THE DELIVERY OF HEALTH CARE SERVICES ON A COST-EFFECTIVE BASIS -CARRY ON ANY EDUCATIONAL ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED OR THE PROMOTION OR HEALTH WHICH MAY BE JUSTIFIED BY THE FACILITIES, PERSONNEL, FUNDS OR OTHER REQUIREMENTS THAT ARE OR CAN BE MADE AVAILABLE -PROMOTE AND CARRY ON SPECIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED INSOFAR AS SAID RESEARCH CAN BE CARRIED ON, OR IN CONNECTION WITH, THE FACILITIES AND PROGRAMS OPERATED BY THIS CORPORATION -TAKE AND HOLD BY BEQUEST, DEVISE, GIFT, GRANT, PURCHASE, LEASE OR OTHERWISE ANY PROPERTY, REAL, PERSONAL, TANGIBLE OR INTANGIBLE, OR ANY UNDIVIDED INTEREST THEREIN, WITHOUT LIMITATION AS TO AMOUNT OR VALUE -SELL, CONVEY OR TO OTHER DISPOSE OF ANY SAID PROPERTY AND INVEST, REINVEST, OR DEAL WITH THE PRINCIPAL OR THE INCOME THEREOF IN SAID MANNER AS, IN THE JUDGEMENT OF THE DIRECTORS OF THIS CORPORATION, WILL BEST PROMOTE THE PURPOSES OF THE CORPORATION WITHOUT LIMITATION, EXCEPT SUCH LIMITATIONS, IF ANY AS MAY BE CONTAINED IN THE INCORPORATION, THE BYLAWS OF THE CORPORATION, OR ANY OTHER LAWS THERETO APPLICABLE -RAISE GIFTS, BEQUESTS, DONATIONS, AND OTHER FUNDS FROM THE PUBLIC AND FROM ALL OTHER SOURCES AVAILABLE, RECEIVE AND MAINTAIN SUCH FUNDS AND EXPEND PRINCIPAL AND INCOME THERE FROM IN SUPPORT OF OR IN FURTHERANCE OF THE CHARITABLE PURPOSES OF THE CORPORATION FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: 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. PRIOR TO BEING FILED, THE RETURN IS REVIEWED BY THE ORGANIZATION'S CEO AND CFO. IT IS THEN PROVIDED TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: A. GENERAL PRINCIPLES PROHIBITING CONFLICTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR MEMBER OF THE BOARD OF DIRECTORS OF CHC/SEIA WILL PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT (SUPPORTED BY FEDERAL FUNDS) IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER, OR ANY MEMBER OF HIS OR HER IMMEDIATE FAMILY, HIS OR HER PARTNER OR AN ORGANIZATION WHICH EMPLOYS OR IS ABOUT TO EMPLOY ANY OF THE PARTIES INDICATED HEREIN, HAS A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD. B. CONFLICTS OF INTEREST AND DISCLOSURE REQUIREMENTS: NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER OR BOARD MEMBER WILL HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST IN OR RECEIVE ANY COMPENSATION OR OTHER BENEFITS AS A RESULT OF TRANSACTIONS BETWEEN CHC/SEIA AND ANY INDIVIDUAL OR BUSINESS FIRM WITHOUT DISCLOSING THE CONFLICT OF INTEREST. NO EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS MAY PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF A CONTRACT OR GRANT IN WHICH FEDERAL FUNDS ARE USED, IF THEY HAVE A FINANCIAL OR OTHER INTEREST IN THE FIRM SELECTED FOR THE CONTRACT OR AWARD WITHOUT DISCLOSING THE CONFLICT OF INTEREST. IF AN EMPLOYEE, CONTRACTOR, AGENT, OFFICER, OR MEMBER OF THE BOARD OF DIRECTORS BELIEVES THAT ONE OF THE AFOREMENTIONED CONFLICTS ACTUALLY OR POTENTIALLY EXISTS, HE OR SHE MUST IMMEDIATELY DISCLOSE THIS INFORMATION IN WRITING TO THE CEO. DISCLOSURES BY MEMBERS OF THE BOARD OF DIRECTORS MUST ALSO BE MADE TO THE CHAIR OF THE BOARD OF DIRECTORS (AND IF IT IS THE CEO OR THE CHAIR WHO HAS SUCH A FINANCIAL INTEREST, HE OR SHE MUST MAKE DISCLOSURE TO THE CHAIR OR VICE CHAIR, RESPECTIVELY). CHC/SEIA REQUIRES THAT ALL EMPLOYEES, CONTRACTORS, AGENTS, OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS AND CANDIDATES FOR BOARD MEMBERSHIP DISCLOSE IN WRITING (AND UPDATE AT LEAST ANNUALLY) AT OR AROUND THEIR JANUARY MEETING: - ALL BUSINESS AND FAMILY RELATIONSHIPS WHICH CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, AND -WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. TO FACILITATE DISCLOSURE, CHC/SEIA REQUIRES EMPLOYEES, CONTRACTORS, AGENTS, OFFICERS AND BOARD MEMBERS TO COMPLETE A CHC/SEIA CONFLICT OF INTEREST FORM. COMPLETION THE FORM DOES NOT RELIEVE INDIVIDUALS OF THE OBLIGATION TO NOTIFY THE CEO OR BOARD CHAIR IF CHANGES OCCUR SINCE FILING OF THE FORM REGARDING A NEW CONFLICT OF INTEREST. NO MEMBER OF THE BOARD OF DIRECTORS MAY VOTE ON ANY MATTER WHICH MAY DIRECTLY OR INDIRECTLY RESULT IN FINANCIAL OR OTHER GAIN TO THAT MEMBER, OR WHICH MAY CONFLICT WITH THAT MEMBER'S OBLIGATIONS TO ANOTHER ORGANIZATION'S BOARD OF DIRECTORS OR TO HIS OR HER EMPLOYER. PROVIDED THAT THE MEMBER OF THE BOARD OF DIRECTORS HAS FIRST DISCLOSED A CONFLICT OR POTENTIAL CONFLICT, AND ABSTAINS FROM VOTING IN THAT REGARD, HE OR SHE MAY PARTICIPATE IN DISCUSSIONS RELATING TO THAT MATTER. FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION REVIEW: ANNUALLY, PAY RANGES ARE REVIEWED AS PART OF THE BUDGETING PROCESS. COMPARABILITY DATA IS USED FROM FQHC SALARY SURVEY RESULTS FROM NACHC, IOWA PRIMARY CARE ASSOCIATION AND ILLINOIS PRIMARY CARE ASSOCIATION. IOWA WORKFORCE DEVELOPMENT SURVEY RESULTS FOR THE REGION ARE ALSO COMPARED. ANY PROPOSED CHANGES ARE TAKEN TO CHCSEIA'S PERSONNEL COMMITTEE, FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC EXCEPT IN CASES WHERE IT IS REQUIRED BY LAW. FINANCIAL STATEMENTS ARE ONLY RELEASED FOR ACTIVITIES THAT ARE DEEMED NECESSARY FOR BONA FIDE BUSINESS PURPOSES, SUCH AS LOANS, OR IN CASES WHERE IT IS REQUIRED BY LAW. FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:1240780 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1171929 FORM 990 PART IX LINE 11G DESCRIPTION:HIT EXPENSE TOTAL FEES:648369 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER CONTRACTUAL FEES TOTAL FEES:193277 FORM 990 PART IX LINE 11G DESCRIPTION:INTERPRETOR SERVICES TOTAL FEES:50397 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:47625