2014-05-13T16:31:12-05:00 2013-09-30 201430448 Christensen Brozek Faltys PC PO Box 1264 Norfolk NE 68702 990 2012-10-01 470833378 Norfolk Community Health Care Clinic In NORF 4026447314 110 N 16th Street Suite 16 Norfolk NE 68701 Kathleen Nordby 4026447314 2014-04-03 1 Danny Fuerhoff CPA P00026845 4023711160 2012 2015-11-30 17:44:51Z Kathleen Nordby 110 N 16th Street Suite 16 Norfolk NE 68701 2752534 0 X N/A X 1999 NE Provide medical, behavioral and dental services that are affordable, accessible and patient focused. 10 10 50 0 0 0 1436220 1596091 1374542 1154232 2109 2211 562 0 2813433 2752534 0 0 0 0 1528212 1675415 0 0 188273 968359 1010255 2496571 2685670 316862 66864 1073509 1337920 130294 327840 943215 1010080 Providing high quality medical, behavioral, and dental services that are affordable, accessible, and patient focused. 0 0 1873078 1154232 The organization provides medical, dental and behavioral health services to the poor and uninsured or under-insured of our community. Our target population is this population within Madison County but we do not deny services to anyone based on their geographic location or ability to pay. In 2012 we saw 4,442 unduplicated patients for a total of 18,448 encounters. Of this population 51% were uninsured, 25% were either Medicaid or Medicare and the rest had private insurance. 1873078 1 1 0 0 0 0 0 0 0 0 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 1 0 0 0 0 0 0 0 0 0 0 1 0 0 50 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X The Organization 4026447314 110 N 16th Street Suite 16 Norfolk NE 68701 Kathy Nordby 40.00 X 92637 0 0 Karen Weidner 4.00 X 0 0 0 Joe Mtika 8.00 X X 0 0 0 Brenda Jones 4.00 X X 0 0 0 Doug Witte 4.00 X X 0 0 0 Pat Samuels 1.00 X 0 0 0 Betty Froehlich 1.00 X X 0 0 0 Gretchen Forsell 1.00 X 0 0 0 Josh Moenning 1.00 X 0 0 0 Linda Haack 1.00 X 0 0 0 Mavis Hatcliff 1.00 X 0 0 0 92637 0 0 0 0 0 0 0 58000 1536150 1941 1596091 Patient revenue 621110 1154232 1154232 1154232 2211 2211 2752534 1154232 0 2211 92500 55500 27750 9250 1320450 792270 396135 132045 21521 12913 6456 2152 125536 75321 37661 12554 115408 69245 34622 11541 380 190 152 38 20523 20523 222898 197491 22500 2907 15756 3151 788 11817 78786 68023 8503 2260 16827 15144 1683 63072 56668 6404 14007 5603 7003 1401 29556 14778 13300 1478 58 58 63850 31925 31925 25935 21089 4095 751 Dental, Medical & Pharm 172462 172462 Bad debt expense 157596 157596 Lab fees 105478 105478 Repairs & maintenance 14015 14015 9056 4216 4761 79 2685670 1873078 624319 188273 652986 422034 25311 94087 149732 188477 2074 3415 236429 93890 146973 142539 96433 60490 0 426878 1073509 1337920 130294 165078 31667 0 131095 130294 327840 X 943215 999880 10200 943215 1010080 1073509 1337920 X 66864 1 X X 0 1 X 1 1 1 X 1194995 1289989 1339916 1436220 1596091 6857211 1194995 1289989 1339916 1436220 1596091 6857211 6857211 3578 2957 2785 2109 2211 13640 144 562 706 6871557 4934569 0.99790 0.99670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 122712 27385 95327 113717 66505 47212 142539 Construction in progress 426878 426878 X 2799664 47130 47130 2752534 0 2752534 2732800 47130 47130 2685670 0 2685670 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Organization files required income tax returns in the U.S. federal jurisdiction. With few exceptions, the Organization is no longer subject to U.S. federal income tax examinations by tax authorities for years before 2008. The Organization has concluded no material uncertain tax positions have been taken on any open tax returns. For the current year the Organization believes all tax positions are fully supportable by existing Federal law and related interpretations and there are no uncertain tax positions to consider. Kathy Nordby Executive Director 131095 Executive Director Kathy Nordby's spouse is an officer with Bank of the West. Norfolk Community Health Care Clinic has a loan agreement with the bank. 0 Form 990, Part VI, Section B, line 11 A copy of the Form 990 is provided to the board for review before it is filed. Form 990, Part VI, Section B, line 12c A new conflict of interest policy is distributed and signed annually by board members. The policy clearly states the board members responsibility to disclose existing known conflicts at that time and disclose future conflicts or potential/perceived conflicts at the time any new situation or decision may warrant such disclosure. Form 990, Part VI, Section B, line 15 There is a study to compare pay from like organizations across the nation and midwest. We also include consideration of the local market for other health care or health delivery agencies locally that we compete with for staff. Form 990, Part VI, Section C, line 19 The Organization's governing documents are made available to the public upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Rounding 1. Form 990, Part XI, Line 2c This process has not changed from the prior year.