2019-01-14T17:16:05-06:00 2018-02-28 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2017-03-01 421527584 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC % RONALD KEMP COMM 3197532300 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 RONALD KEMP CEO 2018-07-10 true Krystal K Creach P01248198 4178658701 167.68.126.162 43032920190145000006 2019-01-14 P 35B2FEF9FD89B74F90B63698513A1BB518488CA1 BBF3045401044ADD935AFA0A61CC835ADE8D16A9 2017 2019-02-21 02:37:17Z RONALD KEMP 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 16111010 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. 11 11 150 13 0 0 2708922 3916957 10311536 12150675 4600 4053 -943 39325 13024115 16111010 0 0 0 0 7768676 8934476 0 0 0 4824246 5562574 12592922 14497050 431193 1613960 9453836 11487923 2823781 3243908 6630055 8244015 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 10304725 12150675 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 16,500 DENTAL VISITS AND 41,000 MEDICAL VISITS. 10304725 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 false true false false false false false false false false false false false false false false false false false true 34 0 true 150 true false false false false false false false false false false X 11 11 false false false false false false false true true false false true true true true true true true true false X RONALD KEMP 3197685858 1706 WEST AGENCY ROAD WEST BURLINGTON IA 52655 BARB BAKER CHAIR END 12/17, DIRECTOR 1.0 0.0 X X 0 0 0 BARRY CORSON TREASURER END 12/17, CHAIR 1.0 0.0 X X 0 0 0 CHUCK GRIFFIN DIRECTOR 1.0 0.0 X 0 0 0 JULIE SCHILLING DIRECTOR 1.0 0.0 X 0 0 0 KATHY VANCE DIRECTOR 1.0 0.0 X 0 0 0 DAVID WHITAKER DIRECTOR 1.0 0.0 X 0 0 0 JONI WALLER DIRECTOR END 03/17 1.0 0.0 X 0 0 0 JOYCE MARTIN DIRECTOR END 01/18 1.0 0.0 X 0 0 0 DENISE OSBORN DIRECTOR BEG 08/17 1.0 0.0 X 0 0 0 JASON STRANDBERG VICE CHAIR BEG 01/18 1.0 0.0 X X 0 0 0 BILL STAATS VICE CHAIR END 12/17, SEC. 1.0 0.0 X X 0 0 0 MICHAEL MAUZY JR SECRETARY END 12/17, TREASURER 1.0 0.0 X X 0 0 0 JEFFREY STRAUSE DIRECTOR BEG 01/18 1.0 0.0 X 0 0 0 RONALD KEMP CEO 40.0 0.0 X 125237 0 17370 DIANE ROUSE CFO 40.0 0.0 X 85481 0 23804 VANDHANA KISWANI-BARLEY CHIEF MEDICAL OFFICER 40.0 0.0 X 153612 0 16233 LUCAS LEMBURG CHIEF DENTAL OFFICER / DENTIST 40.0 0.0 X 151737 0 27330 MARK STROPE PHYSICIAN 40.0 0.0 X 208940 0 20240 ALAN ALEXANDER PEDIATRICIAN 40.0 0.0 X 205784 0 15813 TESSA JOHNSON DENTIST 40.0 0.0 X 142849 0 19240 JAMES DEMMEL PHYSICIAN 40.0 0.0 X 233007 0 32141 1306647 0 172171 13 false true false QUEST DIAGNOSTICS 12989 COLLECTIONS CENTER DRIVE CHICAGO IL 606930129 HEALTH SERVICES 252237 PAIN CENTERS OF IOWA 5515 UTICA RIDGE ROAD 600 DAVENPORT IA 52807 HEALTH SERVICES 204570 AUSTIN MAJOR GROUP 545 E JOHN CARPENTER FREEWAY SUITE IRVING TX 75062 HEALTH SERVICES 163954 TRI- STATE MEDICAL GROUP 1600 MORGAN STREET KEOKUK IA 52632 HEALTH SERVICES 111968 GREAT RIVER JANITORIAL 606 BROADWAY WEST BURLINGTON IA 52655 JANITORIAL SERVICES 108165 5 3542498 374459 3916957 NET PATIENT SERVICE REVENUE 624100 11979985 11979985 MEANINGFUL USE REVENUE 624100 119000 119000 OTHER REVENUE 624100 51690 51690 12150675 4053 4053 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GAIN ON INV IN EQUITY INVESTEE 900099 39325 39325 39325 16111010 12150675 43378 X 0 0 0 0 421737 169845 251892 0 6658493 5104761 1553732 259088 200574 58514 1097274 823713 273561 497884 372793 125091 0 17125 17125 74599 74599 0 0 0 1724719 897107 827612 2958 2958 389927 135192 254735 0 0 417957 282590 135367 37415 8511 28904 0 80985 80985 24251 24251 0 457263 316931 140332 79100 79100 MEDICAL SUPPLIES & DRUGS 1156086 1156086 BAD DEBT 836622 836622 RECRUITING & RETENTION 171811 171811 LICENSES, DUES, SUBSCRIPTIONS 91756 91756 14497050 10304725 4192325 0 142416 203297 1314007 688021 145592 256412 1193768 1301319 0 0 0 0 0 0 163235 232679 168741 182833 10409406 3343000 5436960 7066406 0 0 0 0 20222 59547 0 0 868895 1497409 9453836 11487923 1376813 1407817 0 0 0 209183 0 0 0 0 0 0 1074452 1201589 0 0 372516 425319 2823781 3243908 X 6605055 7994270 25000 249745 0 0 6630055 8244015 9453836 11487923 1613960 X false true X true true true X 2483034 2793614 2187729 2708922 3916957 14090256 0 0 2483034 2793614 2187729 2708922 3916957 14090256 0 14090256 2888 3414 2501 4600 4053 17456 0 0 14107712 47989932 0.99876 0.99880 X 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 5906434 1532944 4373490 247361 152055 95306 1641981 1136451 505530 2389687 521550 1868137 7066406 DUE FROM THIRD PARTY PAYERS 1000000 OTHER RECEIVABLES 72090 457(B) ASSETS 425319 1497409 0 DEFERRED COMPENSATION 425319 425319 14270729 -811622 -811622 15082351 1028659 1028659 16111010 13660428 13660428 836622 836622 14497050 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 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VII, LINE 12: $( 836,622) BAD DEBT EXPENSE 25,000 NET ASSETS RELEASED --------- $( 811,622) SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 249,745 TEMPORARILY RESTRICTED CONTRIBUTIONS 778,914 GRANTS FOR ACQUISITION OF EQUIPMENT ---------- $ 1,028,659 SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 836,622 BAD DEBT EXPENSE X true true X X false false false false false false false true false LUCAS LEMBURG CHIEF DENTAL OFFICER / DENTIST 137717 0 14020 0 0 0 7718 0 19612 0 179067 0 0 0 MARK STROPE PHYSICIAN 198583 0 10357 0 0 0 10517 0 9723 0 229180 0 0 0 ALAN ALEXANDER PEDIATRICIAN 202258 0 3526 0 0 0 10318 0 5495 0 221597 0 0 0 TESSA JOHNSON DENTIST 137174 0 5675 0 0 0 0 0 19240 0 162089 0 0 0 JAMES DEMMEL PHYSICIAN 225119 0 7888 0 0 0 11838 0 20303 0 265148 0 0 0 VANDHANA KISWANI-BARLEY CHIEF MEDICAL OFFICER 149773 0 0 0 3839 0 6317 0 9916 0 169845 0 0 0 SCHEDULE J, PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: THE ORGANIZATION OFFERS A WELLNESS PROGRAM TO ITS EMPLOYEES WHICH PROVIDES DIRECT REIMBURSEMENT OF UP TO $25 PER MONTH AFTER THE EMPLOYEES HAVE USED THE GYM OR WEIGHT WATCHERS PROGRAM THREE TIMES DURING THE MONTH. EMPLOYEE MUST SHOW DOCUMENTATION OF PAYMENT OF FEES AND ATTENDANCE. IF ATTENDANCE IS LESS THAN THREE TIMES A MONTH, NO PAYMENT IS MADE. SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: THE BONUSES PAID TO LUCAS LEMBURG, MARK STROPE, ALAN ALEXANDER, TESSA JOHNSON AND JAMES DEMMEL ARE BASED ON PRODUCTION LEVELS. INCLUDED IN BONUS AMOUNTS FOR MARK STROPE IS A $5,000 RETENTION BONUS. 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 SPECIAL 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). THE 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 A 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 AND 15B COMPENSATION REVIEW: DURING FISCAL YEAR 2018, THE CEO, CFO, AND BOARD APPROVED RATES USING SALARY SURVEYS FOR COMPARABLE POSITIONS FORM THE IAPCA, ILPHCA, NACHC, IOWA WORKFORCE AND OTHER SOURCES. 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:984514 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:337133 FORM 990 PART IX LINE 11G DESCRIPTION:HIT EXPENSES TOTAL FEES:289738 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY TOTAL FEES:56382 FORM 990 PART IX LINE 11G DESCRIPTION:INTERPRETER SERVICES TOTAL FEES:45810 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED MAINTENANCE TOTAL FEES:9149 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING SERVICES TOTAL FEES:1993