2022-04-04T15:12:55-07:00 2021-06-30 990 2020-07-01 134228071 COMMUNITY HEALTH FREE CLINIC COMM 3193630416 947 14th Avenue SE Cedar Rapids IA 52401 Laura Wirth Treasurer 3193630416 2022-04-15 1 11 1 AAL2 2020 2022-09-23 18:48:47Z Laura Wirth 947 14th Avenue SE Cedar Rapids IA 52401 6714508 0 X WWW.COMMUNITYHFC.ORG X 2002 IA TO ALLEVIATE HUMAN PAIN AND SUFFERING BY PROVIDING ACCESS TO AND THE DELIVERY OF COMPASSIONATE HEALTHCARE. 15 15 18 125 0 0 5054445 6540587 0 0 51336 46785 0 0 5105781 6587372 0 0 0 0 341391 297867 0 0 76220 4696750 6015791 5038141 6313658 67640 273714 4244214 3533193 12732 0 4231482 3533193 TO ALLEVIATE HUMAN PAIN AND SUFFERING BY PROVIDING ACCESS TO AND THE DELIVERY OF COMPASSIONATE HEALTHCARE. 0 0 6073121 6540587 Provided Free Health Care Services, including medical, dental and vision care for underserved and uninsured individuals in need of health care. Approximately 106 new patients were seen per month. The total of new and existing individuals served during the year was 3,102 with over 15,052 services provided. The Community Health Free Clinic served individuals all over the East Central Iowa area. 0 0 0 6073121 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 4 0 0 18 1 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 CO FL IL MN MO NJ NV WA WI X MARTY MILLER 3192002540 715 10TH AVENUE SE CEDAR RAPIDS IA 52401 DARLENE SCHMIDT CEO 55.0 0 X 77939 0 0 BEN HOOVER President 1.0 0 X X 0 0 0 KAY JACKSON SECRETARY 1.0 0 X X 0 0 0 RO FOEGE DIRECTOR 1.0 0 X 0 0 0 SANDRA MCINTOSH DIRECTOR 1 0 X 0 0 0 JERRY TIEDT DIRECTOR 1.0 0 X 0 0 0 JOHN BANKS DIRECTOR 1 0 X X 0 0 0 DARLENE DAVERMANN-REID Vice President 1.0 0 X X 0 0 0 GREG DEWOLF DIRECTOR 1.0 0 X 0 0 0 JEANETTE WERLING DIRECTOR 1.0 0 X 0 0 0 Heather Smith Friedman Director 1.0 0 X 0 0 0 Sue Lowder Director 1 0 X 0 0 0 Dennis Naughton Director 1.0 0 X 0 0 0 Kevin Techau Director 1.0 0 X 0 0 0 Dave Muller Director 1.0 0 X 0 0 0 LAURA WIRTH TREASURER 1.0 0 X X 0 0 0 77939 0 0 0 0 0 0 0 230543 0 0 0 27850 6282194 5728582 6540587 0 26385 0 0 26385 0 0 0 0 0 0 0 0 0 0 147536 0 127136 0 20400 0 20400 0 0 20400 0 0 6587372 0 0 46785 77939 58454 15588 3897 198761 108538 58808 31415 21167 12775 5691 2701 14475 0 14475 0 6550 0 6550 0 19386 19386 33880 17355 13817 2708 37401 22572 10056 4773 28872 17425 7763 3684 59990 36205 16129 7656 15440 0 15440 0 Donated Goods 5601444 5601444 0 0 Medications 61093 61093 0 0 Medical Services 124194 124194 0 0 Other 13066 13066 0 0 6313658 6073121 164317 76220 278096 113022 234235 407810 219024 0 0 0 0 0 0 0 0 0 946896 0 8959 0 2070789 940466 1190335 1130323 0 0 0 0 1366669 1882038 4244214 3533193 12732 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12732 0 X 3611821 3097185 619661 436008 4231482 3533193 4244214 3533193 X 273714 191852 0 0 0 -1163855 X X 0 1 X 1 0 X 1481608 3761434 4234957 5054446 6540587 21073032 1481608 3761434 4234957 5054446 6540587 21073032 0 21073032 64077 29054 38643 35169 26385 193328 0 0 0 0 0 0 0 0 0 0 21266360 0 0.99091 0.98690 X Schedule A, Part II, Line 10 Gain on Sale of Capital Assets $20,400 comprised of Donated Stock 1,038 Gain and GCRCF Realized Gain of 19,362 for FYE 6/30/2021. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1067954 175000 230956 0 15069 6550 1452291 1081358 10000 -3598 0 13814 5992 1067954 1010118 40435 49560 0 12935 5280 1081898 749717 222211 55823 0 12611 5022 1010118 679386 4166 70450 0 0 4283 749719 0.694 0.306 0.00 1 0 0 27160 27160 0 1825079 728249 1096830 0 0 0 0 0 218550 212217 6333 0 0 0 0 1130323 Beneficial Interest in Assets Held at GCRCF 1452292 CSV of Life Insurance 26396 Certificates of Deposit 403350 1882038 0 Federal Tax Liability 0 0 X 1171229 191853 0 0 0 191853 979376 6550 5601446 5607996 6587372 705662 0 0 0 0 0 705662 6550 5601446 5607996 6313658 Schedule D, Part V, Line 4 The Clinic intends to use the earnings from the endowment funds for longterm financial support of the clinic and the capital for long term growth and capital reserves. Schedule D, Part X, Line 1 The organization is exempt from income taxes under section 501(c)(3) of the IRS tax code and a similar section of the IA income tax laws, which provides income tax exemptions for corporations organized and operated exclusively for religious, charitable, or educational purposes. The IRS has not classified the organization as a private foundation. The organization files informational returns in the Federals jurisdiction and follows the standard of evaluating uncertain tax positions. The organization has determined that it was not required to record a liablility for uncertain tax postions. Schedule D, Part X, Line 2 THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR SECTION OF THE IOWA INCOME TAX LAW, WHICH PROVIDES INCOME TAX EXEMPTION FOR CORPORATIONS ORGANIZED AND OPERATED EXCLUSIVELY FOR RELIGIOUS, CHARITABLE, OR EDUCATIONAL PURPOSES. THE IRS HAS NOT CLASSIFIED THE ORGANIZATION AS A PRIVATE FOUNDATION. THE ORGANIZATION FILES INFORMATION RETURNS IN THE U.S. FEDERAL JURISDICTION AND FOLLOWS THE STANDARD FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAS DETERMINED THAT IT WAS NOT REQUIRED TO RECORD A LIABILITY RELATED TO UNCERTAIN TAX POSITIONS. Schedule D, Part XI, Line 4b Other $5,601,446 is the amount of donated medications. Donated medications are not included in the audited revenue and expenses of the statement of revenue and expenses and changes in net assets. They are included in a separate independent supplementary schedule of donated goods and services. Donated services are also not included in the audited financals. Schedule D, Part XII, Line 4b Donated medications $5,601,466 are not included in the audited financials statement of income and expense and change in net assets. These are instead stated in an independent schedule of donated goods and services provided by the clinic with no audit opinion. Donated services are also excluded from the audited finanicials. X 2 127136 FMV X 120 5601446 FMV 0 0 1 0 Schedule M, Part I, Line 9 Line 9 Col B is the number of Donors in this category. Schedule M, Part I, Line 20 Line 20 col b Is an estimate of the number of donations in this category. Form 990, Part VI, Section B, Line 11b THE FEDERAL FORM 990 IS PREPARED BY THE CLINIC'S DIRECTOR OF FINANCE AND THEN REVIEWED BY THE CHFC BOARD TREASURER; ANY NECESSARY CHANGES ARE THEN MADE TO THE RETURN. 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 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 OR INTEREST ARISE. STATEMENTS ARE RETAINED BY THE EXECUTIVE DIRECTOR IN CHFC'S OFFICE. Form 990, Part VI, Section B, Line 15 IN APRIL OF EACH YEAR A BUDGET IS PREPARED FOR THE FOLLOWING FISCAL YEAR BY THE DIRECTOR OF FINANCE, CEO AND COO INCORPORATING NEW GOALS FOR THE FOLLOWING YEAR, NEW PROGRAMS ETC, INCLUDING EMPLOYEE WAGE INCREASES FOR BOTH SALARIED AND HOURLY EMPLOYEES. A BUDGET OF THE PROJECTED INCOME AND EXPENSES, CAPITAL EXPENDITURES IS PRESENTED ALONG WITH A BUDGET NARRATIVE THAT LISTS SIGNIFICANT ITEMS AND EXPLANATIONS OR REASONS FOR EACH CATEGORY OF INCOME/EXPENSE. THESE ARE PRESENTED TO FIRST THE FINANCE COMMITTEE, ANY REQUESTED CHANGES ARE MADE AND THEN THE FINAL BUDGET IS PRESENTED TO THE FULL BOARD FOR APPROVAL. ANY WAGE INCREASES ARE EFFECTIVE JULY 1 OF THE BUDGETED YEAR. 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. Form 990, Part XI, Line 9 CHFC change from accrual basis to a modified cash basis accounting effective with June 30 2021 statements. All accruals, prepaids, receivables, payables and inventory were netted to equity/net assets. which resulted in a decrease in net assets of $1,163,852. Effective with this change - donated services and donated medications are reported on a separate schedule of donated goods and services provided by the clinic. Form 990, Part XII, Line 1 The Clinic change its method of Accounting from Accrual basis to Modified Cash basis effective 6/30/2021 to better accommodate end of year audit of inventory, donated goods and annual audit. Schedule B, Part I For contributions greater than 2% test. GCRCF - consists of Quarton Fund and other Donor Advised Funds managed by GCRCF and designated for benefit of CHFC. Total contributions 153,646. NovoNordisk supplies insulin and other brand name prescription medicines samples. Total 3,655,821 SafeNet supplies prescription medications. Total 724,051.