2023-08-14T10:05:11-05:00 2022-09-30 FORVIS LLP 201 N Illinois Street INDIANAPOLIS IN 46204 990 2021-10-01 351875364 Heart City Health Center Inc % DARIA SZTABA HEAR 5742930052 236 Simpson Ave Elkhart IN 46516 ESLEEN FULTZ CEO 5742930052 2023-08-15 true ESLEEN FULTZ 999009999 NICOLE B FISHBACK P01279475 3173834000 2023-08-15 3 2021 2023-04-26 12:10:37Z ESLEEN E FULTZ 236 SIMPSON AVE ELKHART IN 46516 17079308 false X WWW.HEARTCITYHEALTH.ORG X 1993 IN HEART CITY HEALTH CENTER, INC. IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) PROVIDING COMPREHENSIVE PRIMARY HEALTHCARE AND EDUCATION FOR THE ELKHART COMMUNITY. 10 10 191 0 69278 0 5187836 4690388 7874373 10028266 75259 106542 782656 635205 13920124 15460401 0 1500 0 0 8997889 10499782 0 0 0 4901067 5428919 13898956 15930201 21168 -469800 13371391 13300201 2137709 2915397 11233682 10384804 X HEART CITY HEALTH CENTER, INC. (HEART CITY) IS A NON-PROFIT, FEDERALLY QUALIFIED HEALTH CENTER (FQHC) PROVIDING AFFORDABLE, HIGH QUALITY, PRIMARY HEALTH, BEHAVIORAL HEALTH, DENTAL AND PHARMACEUTICAL CARE TO RESIDENTS OF ELKHART AND SURROUNDING COUNTIES. (SEE SCH O) false false 8230039 1500 8529231 HEART CITY HEALTH CENTER, INC. (HEART CITY) PROVIDES MEDICAL AND BEHAVIORAL HEALTHCARE IN THE AREA OF ADULTS AND PEDIATRICS TO THE PRIMARILY MEDICARE, MEDICAID, AND UNINSURED POPULATION OF ELKHART COUNTY. DURING THE YEAR ENDED SEPTEMEBER 30, 2022, HEART CITY PROVIDED 46,500 MEDICAL VISITS AND 5,000 BEHAVIORAL HEALTH VISITS TO 15,208 PATIENTS. 1548082 1499035 HEART CITY HEALTH CENTER, INC.'S (HEART CITY) LICENSED DENTISTS AND HYGIENISTS PROVIDE A LOW-COST OPTION FOR QUALITY GENERAL DENTISTRY SERVICES TO PEOPLE OF ALL AGES, INCOMES AND BACKGROUNDS, BUT PRIMARILY SERVES MEDICAID AND UNINSURED PATIENTS. THE DENTISTS AND HYGIENISTS SERVED 10,544 PATIENTS PROVIDING 7,717 VISITS. VARIOUS DENTAL SERVICES PROVIDED INCLUDE: EXAMINATIONS; TREATMENT PLANNING; CHILDREN'S DENTISTRY; CLEANING/DENTAL HYGIENE; EXTRACTIONS; FILLINGS; RADIOGRAPHS; AND PATIENT EDUCATION. 1600789 2244825 HEART CITY HAS AN ONSITE PHARMACY AT OUR SIMPSON STREET LOCATION WHICH PROVIDES CONVENIENT PRESCRIPTION SERVICES TO OUR PATIENTS AND THE COMMUNITY. PHARMACY FILLED 32,971 PRESCRIPTIONS AND SERVED 3,065 INDIVIDUAL PATIENTS. 11378910 true true false false false false false false false false true false false false true true true false false false false false false false false false false false false true false false false false false false false false true false false false false false false false false true 18 0 191 true true true false false false false false false false false false false false X 10 10 false false false false false false false true true false false false true true true true true true false false IN X DARIA SZTABA 5749701448 236 SIMPSON AVE ELKHART IN 46516 X ESLEEN E FULTZ CEO 40.0 0.0 X 237180 0 12153 DR ESSAM MONTASIR MD/DO 40.0 0.0 X 204979 0 16991 DR MARY P MCMANMON ASSOCIATE MEDICAL DIRECTOR 40.0 0.0 X 204445 0 9035 DR DWAYNE E JOHNSON MD/DO 40.0 0.0 X 177760 0 16872 DR SHANNA KAUTZMAN MD/DO 40.0 0.0 X 179625 0 14969 DR CHRISTINE DANKWA MD/DO 40.0 0.0 X 168330 0 5060 LALAESHA BLACK COO 40.0 0.0 X 154851 0 7149 JEREN STEPP CFO 40.0 0.0 X 130649 0 13156 DR MEENAKSHI GUPTA CMO (END 5/20/22) 40.0 0.0 X 112352 0 4257 ANGELIA WASHINGTON TREASURER 1.0 0.0 X X 0 0 0 ANTHONY ENGLAND BOARD MEMBER 1.0 0.0 X 0 0 0 ARVIS DAWSON SECRETARY 1.0 0.0 X X 0 0 0 DELIA GRAJEDA BOARD MEMBER 1.0 0.0 X 0 0 0 ROBERT TAYLOR BOARD MEMBER 1.0 0.0 X 0 0 0 NANCY POIKONEN BOARD MEMBER 1.0 0.0 X 0 0 0 DANIEL WEDDINGTON BOARD MEMBER 1.0 0.0 X 0 0 0 NICOLE WILLIAMS BOARD MEMBER 1.0 0.0 X 0 0 0 BEATRICE PHILLIPS BOARD MEMBER 1.0 0.0 X 0 0 0 TARA MORRIS BOARD CHAIR 1.0 0.0 X X 0 0 0 1570171 0 99642 19 false true false BACON MEDICAL GROUP 710 NNILES AVE SOUTH BEND IN 46617 MEDICAL SERVICES 542942 ELKHART GENERAL HEALTH CARE SYSTEMS PO BOX 972651 DALLAS IN 753972651 CLINICAL/MEDICAL 206188 BE SMITH LLC 8801 Renner Blvd LENEXA KS 66219 CONTRUCTION SERVICES 313758 ATHENAHEALTH INC 311 Arsenal Street WATERTOWN MA 02472 EMR SERVICES 591502 MAPLETRONICS COMPUTERS INC PO BOX 136 GOSHEN IN 46527 IT SERVICES 220757 10 4372204 318184 266929 4690388 MEDICAL SERVICES 624100 8491199 8491199 DENTAL SERVICES 624100 1499035 1499035 MEDICAL RECORDS 624100 3496 3496 MISCELLANEOUS REVENUE 900099 34536 34536 10028266 73514 73514 0 0 42065 250 9287 0 32778 250 33028 33028 0 0 0 0 0 0 2244825 1609620 635205 565927 69278 0 15460401 10594193 69278 106542 X 1500 1500 0 0 0 635032 635032 0 8355971 5759619 2596352 85351 58831 26520 785456 541401 244055 637972 439742 198230 0 39251 39251 91067 91067 0 0 16003 16003 2334885 2236222 98663 244107 167728 76379 495569 246541 249028 337042 231585 105457 0 470261 233951 236310 40383 5941 34442 0 260536 38328 222208 57189 39295 17894 0 583402 404356 179046 79400 79400 BAD DEBT 234431 234431 0 DUES & SUBSCRIPTIONS 76259 52398 23861 EMPLOYEE RELATIONS 45467 31241 14226 LICENSES 15730 15314 416 7937 5454 2483 15930201 11378910 4551291 0 6300 12600 2525385 2675474 783154 298140 1406757 2408648 0 0 0 0 0 0 463794 463732 27883 44326 8886160 3614877 5761800 5271283 2367689 2097369 28629 28629 0 0 0 0 0 0 13371391 13300201 858445 1059842 0 0 0 0 0 0 0 0 0 0 1256328 1835805 0 0 22936 19750 2137709 2915397 X 11233682 10384804 0 0 11233682 10384804 13371391 13300201 -469800 -368078 -11000 X false true X true true true X 3357530 3423672 5563602 5187836 4690388 22223028 5513713 6611487 6764406 9951155 12120716 40961477 0 0 0 8871243 10035159 12328008 15138991 16811104 63184505 0 0 0 63184505 77205 81784 81690 59514 73514 373707 60781 77191 41551 179523 77205 81784 142471 136705 115065 553230 0 0 8948448 10116943 12470479 15275696 16926169 63737735 0.99132 0.99120 0.00868 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 213700 213700 2522479 571475 1951004 480217 200373 279844 1507004 915799 591205 4162760 1927230 2235530 5271283 0 DRUGS AND PHARMACEUTICALS HELD 19750 19750 16451509 -368078 1609620 1241542 15209967 16003 234431 250434 15460401 17289387 1609620 1609620 15679767 16003 234431 250434 15930201 SCHEDULE D, PART X, LINE 2 ASC 740: 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 & XII, LINE 2(D) OTHER RECONCILING ITEMS: COST OF GOODS SOLD-PHARMACY: $1,609,620 SCHEDULE D,PART XI & XII, LINE 4(B) OTHER RECONCILING ITEMS: BAD DEBT: $234,431 X false true X X X false false false false false false false true false ESLEEN E FULTZ CEO 237180 0 0 0 0 0 0 0 12153 0 249333 0 LALAESHA BLACK COO 150858 0 3993 0 0 0 0 0 7149 0 162000 0 DR CHRISTINE DANKWA MD/DO 166470 0 1860 0 0 0 0 0 5060 0 173390 0 DR DWAYNE E JOHNSON MD/DO 175764 0 1996 0 0 0 0 0 16872 0 194632 0 DR ESSAM MONTASIR MD/DO 203130 0 1849 0 0 0 0 0 16991 0 221970 0 DR MARY P MCMANMON ASSOCIATE MEDICAL DIRECTOR 202631 0 1814 0 0 0 0 0 9035 0 213480 0 DR SHANNA KAUTZMAN MD/DO 177784 0 1841 0 0 0 0 0 14969 0 194594 0 SCHEDULE J, PART 1, LINE 1A GROSS-UP PAYMENTS: THE ORGANIZATION PROVIDED FOR THE GROSS UP OF BONUS PAYMENTS TO OFFICERS AND HIGHEST COMPENSATED EMPLOYEES, WHICH WAS INCLUDED IN THE INDIVIDUALS' TAXABLE COMPENSATION. SCHEDULE J,PART I,LINE 1B WRITTEN POLICY REGARDING PAYMENT/REIMBURSEMENT: THE ORGANIZATION DOES NOT FOLLOW A WRITTEN POLICY REGARDING THE GROSS-UP PAYMENTS PROVIDED TO OFFICERS AND HIGHEST COMPENSATED EMPLOYEES, HOWEVER THESE PAYMENTS ARE APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. SCHEDULE J, PART I, LINE 7 NONFIXED PAYMENTS: THE BONUS PAYMENTS ARE BASED ON LENGTH OF SERVICE FOR THE YEAR TO WHICH THE BONUS RELATES AND POSITION HELD. BONUS IS PAID ONLY IF PAYMENT RECEIVED FROM MANAGED CARE ENTITY FOR MEETING TARGETS. THE BOARD OF DIRECTORS DETERMINES WHETHER IT IS TO BE SHARED WITH EMPLOYEES EACH YEAR. THE EXECUTIVE BOARD MEMBERS ALSO DECIDE THE ANNUAL BONUS FOR THE CEO AS PART OF THE PERFORMANCE EVALUATION. THE BONUS IS A PERCENTAGE OF THE EXISTING COMPENSATION, NOT BASED ON THE COMPENSATION WITH RAISE. THE BONUS IS BASED ON NATIONAL COMPENSATION PACKAGE REPORTS AND PERFORMANCE OF THE CEO. OPTIONS FOR THE BONUS ARE LISTED ON THE EVALUATION AS WELL AS AN OPTION FOR NO BONUS. THE EXECUTIVE COMMITTEE AGREE ON THE AMOUNT AND FILE THEIR DECISION WITH EVALUATION AND RAISE INFORMATION WITH HEART CITY HEALTH'S ATTORNEY, BARNES & THORNBURG. X 25 266929 MARKET VALUE false true false SCH M, PART I EXPLANATIONS OF REPORTING METHOD FOR NUMBER OF CONTRIBUTIONS: DRUGS AND MEDICAL SUPPLIES ARE REPORTED BY THE NUMBER OF CONTRIBUTIONS FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION: HEART CITY HEALTH CENTER OFFERS A SLIDING FEE SCALE BASED ON INCOME AND FAMILY SIZE FOR THE UNINSURED, UNDER-INSURED AND ALSO ACCEPT MEDICAID, MEDICARE AND SOME PRIVATE INSURANCES. HEART CITY IS COMMITTED TO REDUCING HEALTH DISPARITIES AMONG RESIDENTS BY PROVIDING PROFESSIONAL AND RESPECTFUL SERVICE TO ELKHART AND SURROUNDING COUNTIES THROUGH EDUCATION AND HIGH QUALITY PRIMARY MEDICAL CARE FOR THOSE IN NEED AND EXPERIENCING BARRIERS TO TRADITIONAL HEALTH CARE. THE MAJORITY OF HEART CITY'S PATIENTS ARE AT 100% OR BELOW THE FEDERAL POVERTY GUIDELINES, AND ALMOST 50% OF PATIENTS ARE UNDER THE AGE OF 18. HEART CITY IS ONE OF THE FEW SITES IN THE ELKHART AREA THAT PROVIDES SERVICES TO MEDICAID PATIENTS AND THE UNINSURED POPULATION. FORM 990, PART VI, LINE 1A DELEGATE BROAD AUTHORITY TO A COMMITTEE: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE FOLLOWING OFFICERS OF THE CORPORATION, ALL OF WHOM SHALL HAVE THE RIGHT TO VOTE: CHAIRPERSON, VICE CHAIR, SECRETARY AND TREASURER. THE CHIEF EXECUTIVE OFFICER SHALL BE A NON-VOTING MEMBER OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE THE FOLLOWING GENERAL AUTHORITY; THE EXECUTIVE COMMITTEE SHALL BE COMPROMISED EXCLUSIVELY OF BOARD MEMBERS AND SHALL ACT FOR THE CORPORATION IN THE INTERIM PERIODS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS ONLY WITH RESPECT TO MATTERS OF AN URGENT NATURE AND THEN TO THE MAXIMUM EXTENT FEASIBLE, IN COMPLIANCE WITH THE ESTABLISHED POLICIES AND EXPRESSED POSITIONS OF THE BOARD. ANY SUCH ACTIONS BY THE EXECUTIVE COMMITTEE ON BEHALF OF THE CORPORATION SHALL REQUIRE RATIFICATION AT THE FOLLOWING REGULAR OR SPECIAL MEETING WHERE A QUORUM IS PRESENT. THE CHAIRPERSON OF THE BOARD OF DIRECTORS OR ANY THREE (3) EXECUTIVE COMMITTEE MEMBERS CONVENES. SAID WRITTEN NOTICE SHALL BE DELIVERED TO THE REMAINING MEMBERS OF THE EXECUTIVE COMMITTEE. A MAJORITY OF THE OFFICERS PRESENT AND IN PERSON, SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF EXECUTIVE COMMITTEE BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODY: THE ORGANIZATION'S FORM 990 IS REVIEWED IN DETAIL BY THE EXECUTIVE MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: AN ANNUAL CONFLICT OF INTEREST FORM IS FILLED OUT BY EACH BOARD MEMBER. ALL OTHER EMPLOYEES SIGN THE CODE OF CONDUCT POLICY AT THE TIME OF HIRE WHICH COVERS CONFLICTS OF INTEREST. THE CEO AND THE BOARD LIAISON REVIEW THE CONFLICT OF INTEREST FORMS TO DETERMINE IF ANY POTENTIAL CONFLICT OF INTEREST EXISTS. IF A POTENTIAL CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE CEO AND EXECUTIVE COMMITTEE OF THE BOARD, CONSISTING OF THE CHAIR, VICE CHAIR, SECRETARY AND TREASURER, MEET TO DISCUSS WHETHER ANY ACTUAL CONFLICTS OF INTEREST EXIST. ALTHOUGH NO CONFLICTS HAVE BEEN NOTED IN THE PAST, IF A CONFLICT OF INTEREST WAS TO ARISE, RESTRICTIONS WOULD BE IMPOSED AND THE BOARD MEMBER WOULD BE REQUIRED TO EXCUSE THEMSELVES FROM ANY DISCUSSIONS AND/OR VOTES RELATED TO THE CONFLICTING ISSUE. FORM 990, PART VI, SECTION B, LINE 15A PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL: COMPENSATION FOR THE ORGANIZATION'S CEO IS DETERMINED BY THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE BASED ON A PERFORMANCE EVALUATION AND INTERVIEW WITH THE CEO. EACH EXECUTIVE BOARD MEMBER COMPLETES AN EVALUATION, AND THEN THE EXECUTIVE COMMITTEE REPORTS THE FINDINGS AND ANY CHANGES IN COMPENSATION TO THE CEO AND IT IS SENT TO THE HEART CITY HEALTH'S ATTORNEY. ANY CHANGES IN COMPENSATION ARE BASED ON COMPILED NATIONAL BENCHMARKING SALARY REPORTS. THIS PROCESS HAS BEEN PERFORMED ANNUALLY IN THE PAST. HOWEVER A REVIEW AND COMPENSATION CHANGE HAS NOT OCCURRED SINCE THE LAST ONE ON SEPTEMBER OF 2022. THE EVALUATION AND REVIEW PROCESS IS SIGNED BY THE EXECUTIVE BOARD COMMITTEE AND IS DOCUMENTED AND ON FILE WITH HEART CITY HEALTH'S ATTORNEY, BARNES AND THORNBURG. FORM 990, PART VI, SECTION B, LINE 15B PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES: THE ORGANIZATION'S CEO COMPLETES AN ANNUAL PERFORMANCE EVALUATION FOR THE CFO; BASED ON THE OUTCOME OF THE PERFORMANCE EVALUATION AND THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) SALARY SURVEYS, THE CFO'S COMPENSATION IS REVIEWED AND ADJUSTED AS NECESSARY. THE ORGANIZATION'S CEO ALSO COMPLETES AN ANNUAL PERFORMANCE EVALUATION FOR THE CMO; BASED ON THE OUTCOME OF THE PERFORMANCE EVALUATION AND GENERAL COMPENSATION GUIDELINES SET BY THE BOARD, THE CMO'S EMPLOYMENT CONTRACT IS UPDATED AS NECESSARY. THESE PERFORMANCE EVALUATIONS AND COMPENSATION/EMPLOYMENT CONTRACT UPDATES WERE LAST COMPLETED DURING THE FISCAL YEAR ENDED SEPTEMBER 2022. FORM 990, PART VI, SECTION C, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990 PART IX LINE 11G DESCRIPTION:LAB SERVICES TOTAL FEES:10146 FORM 990 PART IX LINE 11G DESCRIPTION:DENTAL LABS TOTAL FEES:24308 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - BEHAVIOR TOTAL FEES:4800 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - PHARMACY TOTAL FEES:33691 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - MEDICAL TOTAL FEES:518928 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - EHR / PM TOTAL FEES:263784 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES - SECURITY TOTAL FEES:9618 FORM 990 PART IX LINE 11G DESCRIPTION:INTERPRETING SERVICES TOTAL FEES:158100 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - CONSULTING TOTAL FEES:98663 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - PAYROLL TOTAL FEES:25197 FORM 990 PART IX LINE 11G DESCRIPTION:TELEPHONE SERVICE TOTAL FEES:134590 FORM 990 PART IX LINE 11G DESCRIPTION:CLAIMS PROCESSING TOTAL FEES:11037 FORM 990 PART IX LINE 11G DESCRIPTION:EMPLOYEE UNIFORMS TOTAL FEES:18772 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:973473 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED SERVICES- CHARTSPAN TOTAL FEES:49778