2017-11-06T16:31:02-07:00 2017-06-30 990 2016-07-01 134228071 Community Health Free Clinic COMM 3193630416 947 14th Avenue SE Cedar Rapids IA 52401 Kevin Crist Treasurer 3193630416 2017-11-09 173.28.128.159 2016 2017-02-10 21:41:12Z Kevin Crist 947 14th Avenue SE Cedar Rapids IA 52401 1552903 0 X WWW.COMMUNITYHFC.ORG X 2002 IA TO ALLEVIATE HUMAN PAIN AND SUFFERING BY PROVIDING ACCESS TO AND THE DELIVERY OF COMPASSIONATE HEALTHCARE. 14 14 22 282 0 0 1259752 1481608 0 0 24862 31060 17112 40235 1301726 1552903 0 0 0 0 326849 331306 0 0 129458 922755 1118033 1249604 1449339 52122 103564 3432081 3582470 18407 17812 3413674 3564658 TO ALLEVIATE HUMAN PAIN AND SUFFERING BY PROVIDING ACCESS TO AND THE DELIVERY OF COMPASSIONATE HEALTHCARE. 0 0 1157936 0 0 PROVIDED FREE HEALTH CARE SERVICES, INCLUDING MEDICAL, DENTAL AND VISION FOR ANY UNDER-SERVED OR UNINSURED INDIVIDUAL IN NEED OF HEALTH CARE. APPROXIMATELY 161 NEW PATIENTS WERE SEEN PER MONTH. THE TOTAL OF NEW AND EXISTING INDIVIDUALS SERVED DURING THE YEAR WAS 4,563 WITH OVER 14,800 SERVICES PROVIDED. THE COMMUNITY HEALTH FREE CLINIC PROUDLY SERVICES INDIVIDUALS ALL OVER THE EAST CENTRAL IOWA AREA. 0 0 0 1157936 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 2 0 22 1 0 0 0 0 0 0 0 0 0 0 X 14 14 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 NY WA WI X MARTY MILLER 3192002540 715 10TH AVENUE SE CEDAR RAPIDS IA 52401 REED JAKSICH PRESIDENT 1 0 X X 0 0 0 SISTER SUSAN O'CONNOR SECRETARY 1 0 X X 0 0 0 MARK MARZ DDS VICE-PRESIDENT 1 0 X X 0 0 0 KEVIN CRIST TREASURER 1 0 X X 0 0 0 CATHY GULLICKSON DIRECTOR 1 0 X 0 0 0 GREG HAYES MD DIRECTOR 1 0 X 0 0 0 TAMI MITCHELL DIRECTOR 1 0 X 0 0 0 DAVID MORTON DIRECTOR 1 0 X 0 0 0 MICHAEL HALL DIRECTOR 1 0 X 0 0 0 RO FOEGE DIRECTOR 1 0 X 0 0 0 KAY JACKSON DIRECTOR 1 0 X 0 0 0 SANDRA MCINTOSH DIRECTOR 1 0 X 0 0 0 JERRY TIEDT DIRECTOR 1 0 X 0 0 0 BEN HOOVER DIRECTOR 1 0 X 0 0 0 DARLENE SCHMIDT CEO 55 0 X 72424 0 0 72424 0 0 0 0 0 0 0 290955 0 0 0 33311 1157342 715569 1481608 0 23842 0 0 23842 0 0 0 0 0 0 0 0 40235 0 0 0 40235 0 40235 0 0 40235 7218 0 0 0 7218 0 7218 0 0 7218 0 0 1552903 0 0 71295 0 0 0 0 0 0 0 0 71500 28600 25025 17875 0 0 0 0 236306 125681 53625 57000 0 0 0 0 0 0 0 0 23500 11784 6000 5716 0 0 0 0 0 0 0 0 12520 0 12520 0 0 0 0 0 0 0 4285 0 4285 0 0 0 0 0 9920 0 0 9920 36950 18112 13891 4947 35799 17943 9148 8708 0 0 0 0 34196 17140 8738 8318 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57791 28966 14767 14058 11681 0 11681 0 DONATED GOODS 715569 715569 0 0 MEDICATIONS 92937 92937 0 0 MEDICAL SERVICES 101926 101926 0 0 REGISTRATION FEES 2057 1031 526 500 2402 -1753 1739 2416 1449339 1157936 161945 129458 163534 127317 532159 430818 242081 242204 0 0 0 0 0 0 0 0 308179 313350 6236 19199 2045155 681980 1323194 1363175 0 0 0 0 0 0 0 0 856698 1086407 3432081 3582470 18407 17812 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18407 17812 X 2737792 2908685 357292 337383 318590 318590 3413674 3564658 3432081 3582470 103564 47426 -6 0 0 0 X 0 1 X 1 0 X 2856182 2462172 1448299 1259752 1481608 9508013 2856182 2462172 1448299 1259752 1481608 9508013 105533 9402480 26722 21551 18117 41612 64077 172079 39070 3183 1009 0 43262 9723354 0.96700 0.97789 X Schedule A, Part II, Line 10 GROSS RECEIPTS FROM FUNDRAISING EVENTS $0 FYE 6/30/17, $1,009 FYE 6/30/16, $3,183 FYE 6/30/15 AND $39,070 FYE 6/30/14. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 679386 4166 70450 0 0 4285 749717 682540 20500 -6944 0 12684 4026 679386 714455 500 -14590 0 12631 5194 682540 643514 500 86748 0 12145 4162 714455 633854 550 75182 0 61783 4289 643514 0.5751 0.4249 0.00 1 0 0 31040 31040 0 1795565 523625 1271940 0 0 0 0 0 218550 158355 60195 0 0 0 0 1363175 BENEFICIAL INTEREST IN ASSETS HELD BY COMMUNITY FOUNDATION 749717 CASH SURRENDER VALUE OF LIFE INSURANCE 22267 LONG-TERM CERTIFICATES OF DEPOSIT 314423 1086407 0 0 X 2926448 47426 1330404 0 0 1377830 1548618 4285 0 4285 1552903 2775464 1330410 0 0 0 1330410 1445054 4285 0 4285 1449339 Schedule D, Part V, Line 4 CHFC INTENDS TO USE THE EARNINGS FROM THE ENDOWMENT FUNDS FOR LONG-TERM FINANCIAL SUPPORT OF THE CLINIC. 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. X 451641 715569 FMV 0 0 1 0 Schedule M, Part I, Line 20 COLUMN B - IS AN ESTIMATED QUANTITY OF MEDICINES DONATED. Form 990, Part VI, Section B, Line 11b THE FEDERAL FORM 990 IS PREPARED BY A VOLUNTEER AND THEN REVIEWED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM AS WELL AS THE COMMUNITY HEALTH FREE CLINIC'S(CHFC) BOARD TREASURER AND DIRECTOR OF FINANCE; 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 JULY OF EACH YEAR, THE CEO/CLINIC EXECUTIVE DIRECTOR (CED) DRAFTS A LIST OF ANNUAL GOALS & OBJECTIVES AND PROVIDES IT TO THE PRESIDENT OF THE BOARD OF DIRECTORS(BOD). THE BOD REVIEWS THE GOALS & OBJECTIVES AT THE ANNUAL BEGINNING OF THE FISCAL YEAR MEETING IN JULY. ANY MODIFICATIONS SUGGESTED ARE INCORPORATED AS APPROPRIATE AND THE BENCHMARK FOR THE FISCAL YEAR IS FINALIZED IN JUNE (END OF FISCAL YEAR). CEO/CED PROVIDES THE PRESIDENT OF THE BOD WITH A DOCUMENT THAT DETAILS HIS/HER PERFORMANCE AGAINST THE ANNUAL GOALS & OBJECTIVES APPROVED IN THE PRIOR JULY. AFTER A FACE-TO-FACE REVIEW WITH THE CEO/CED, THE PRESIDENT OF THE BOD ASSIGNS THE PERFORMANCE REVIEW AN OVERALL GRADE OF (A) FAILS TO MEET EXPECTATIONS;(B) MEETS EXPECTATIONS OR (C) EXCEEDS EXPECTATIONS. DURING JUNE AND JULY THE PRESIDENT OF THE BOD CALLS UPON ONE OR MORE BUSINESSES IN THE AREA TO LEARN WHAT COMPARABLE SALARY AND WAGE CHANGES ARE BEING CONSIDERED IN THE AREA FOR THE NEXT FISCAL YEAR AND DETERMINES THE SPECIFIC SALARY CHANGES APPROPRIATE FOR CHFC BASED UPON THE CEO/CED'S PERFORMANCE, PROGRESS OF THE ORGANIZATION AND BUDGETARY CONSTRAINTS (NORMALLY STATED AS X% TO Y% INCREASE). THE BOARD PRESIDENT SEEKS CONCURRENCE OF THE EXECUTIVE COMMITTEE (WITHOUT THE INVOLVEMENT OF THE CEO/CED) FOR THE OVERALL GRADE AND SUGGESTED SALARY INCREASE. THE CEO/CED'S OVERALL GRADE AND SALARY INCREASE ARE VOTED ON BY THE BOD. THE SPECIFICS OF THE SALARY INCREASE ARE NOT DOCUMENTED IN THE BOARD MEETING MINUTES TO PROVIDE THE CEO/CED WITH CONFIDENTIALITY. THE PRESIDENT'S COMMUNICATION WITH THE EXECUTIVE COMMITTEE AND THE FOLLOW-UP COMMUNICATION WITH THE TREASURER ARE SUFFICIENT DOCUMENTATION. SALARY CHANGES BECOME EFFECTIVE THE FIRST DAY OF THE FISCAL YEAR. . FORM 990, PART VI, SECTION B, LINE 15B - THERE IS NO PROCESS FOR DETERMINING COMPENSATION OF THE CHFC'S OTHER OFFICERS OR KEY EMPLOYEES AS CHFC DOES NOT HAVE ANY OTHER EMPLOYEES THAT MEET THE DEFINITION OF EITHER POSITION. 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.