COMMUNITY HEALTH FREE CLINIC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTH FREE CLINIC (EIN 13-4228071)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2012-11-14
- IRS object ID
- 201213199349302691
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T11:07:57-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1715 1ST AVENUE SE | AddressLine1 |
| City | CEDAR RAPIDS | City |
| State | IA | State |
| ZIP Code | 52402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 134228071 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH FREE CLINIC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 3193772651 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 947 14TH AVENUE SE | AddressLine1 |
| City | CEDAR RAPIDS | City |
| State | IA | State |
| ZIP Code | 52401 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICIA BARNES | Name |
| Title | TREASURER | Title |
| Phone | 3193630416 | Phone |
| Date Signed | 2012-11-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID LITTLE | Name |
| PTIN | P01480921 | PTIN |
| Phone | 3193632697 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | PATRICIA BARNES | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 947 14TH AVENUE SE | AddressLine1 |
| City | CEDAR RAPIDS | City |
| State | IA | State |
| ZIP Code | 52401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2975018 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.COMMUNITYHFC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH CARE TO THE UNINSURED AND UNDER-SERVED OF EAST CENTRAL IOWA THROUGH MODEL COMMUNITY PARTNERSHIPS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 44 | TotalNbrEmployees |
| Total Nbr Volunteers | 455 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 3167212 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2943234 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 14536 | InvestmentIncomePriorYear |
| Investment Income Current Year | 31784 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3181748 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2975018 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 503567 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 532872 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 15681 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 19050 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 70892 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2408049 | OtherExpensePriorYear |
| Other Expenses Current Year | 2277426 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2927297 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2829348 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 254451 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 145670 | RevenuesLessExpensesCY |
| Total Assets BOY | 3180185 | TotalAssetsBOY |
| Total Assets EOY | 3287951 | TotalAssetsEOY |
| Total Liabilities BOY | 47296 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 33513 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3132889 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3254438 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE HEALTH CARE TO THE UNINSURED AND UNDER-SERVED OF EAST CENTRAL IOWA THROUGH MODEL COMMUNITY PARTNERSHIPS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2537658 | Expense |
| Description | PROVIDED FREE HEALTH CARE SERVICES, INCLUDING MEDICAL, DENTAL, AND VISION FOR ANY UNDER-SERVED OR UNINSURED INDIVIDUAL IN NEED OF HEALTH CARE. APPROXIMATELY 360 NEW PATIENTS WERE SEEN PER MONTH. THE AVERAGE TOTAL OF NEW AND EXISTING INDIVIDUALS SERVICED DURING THE YEAR WAS 29,300. NOW OFFERING A HISPANIC CLINIC ON THE THIRD SATURDAY OF THE MONTH. COMMUNITY HEALTH FREE CLINIC PROUDLY SERVICES INDIVIDUALS ALL OVER THE EAST CENTRAL IOWA AREA. | Description |
| Total Program Service Expense | 2537658 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 44 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | AZ | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | CO | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | FL | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | NJ | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | NY | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | MO | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | WA | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | IL | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUSAN RUSSELL DIRECTOR OF FINANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3192211585 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 10TH AVE SE | AddressLine1 |
| City | CEDAR RAPIDS | City |
| State | IA | State |
| ZIP Code | 52401 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| AMY JOHNSON BOYLE | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JAMES FLYNN JR MD | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| GREG HAYES | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MARK MARZ | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| THOMAS MCINTOSH | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| SISTER SUSAN O'CONNOR | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| MICHAEL SUNDALL | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DALE TODD | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| BRANDT WORLEY | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| REX ENO | ||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | X |
| DAVID MULLER MD | ||||||
| VICE-PRESIDENT | 1.00 | X | 0 | 0 | 0 | X |
| MICHELLE NIERMANN | ||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X |
| PATRICIA BARNES | ||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X |
| DARLENE SCHMIDT | ||||||
| CEO | 55.00 | 60699 | 0 | 0 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 60699 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 311167 | FederatedCampaigns |
| Government Grants | 21183 | GovernmentGrants |
| All Other Contributions | 2610884 | AllOtherContributions |
| Noncash Contributions | 1763714 | NoncashContributions |
| Total Contributions | 2943234 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14305 | TotalRevenueColumn |
| Exclusion | $14,305 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 17479 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 17479 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17479 | TotalRevenueColumn |
| Exclusion | $17,479 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2975018 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $31,784 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61597 | Total |
| Program Services | 24639 | ProgramServices |
| Management And General | 21559 | ManagementAndGeneral |
| Fundraising | 15399 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 433540 | Total |
| Program Services | 356415 | ProgramServices |
| Management And General | 58346 | ManagementAndGeneral |
| Fundraising | 18779 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37735 | Total |
| Program Services | 29007 | ProgramServices |
| Management And General | 6113 | ManagementAndGeneral |
| Fundraising | 2615 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13995 | Total |
| Management And General | 13995 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19050 | Total |
| Fundraising | 19050 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3241 | Total |
| Management And General | 3241 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1534 | Total |
| Fundraising | 1534 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 157276 | Total |
| Program Services | 63363 | ProgramServices |
| Management And General | 87023 | ManagementAndGeneral |
| Fundraising | 6890 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14646 | Total |
| Program Services | 11271 | ProgramServices |
| Management And General | 2364 | ManagementAndGeneral |
| Fundraising | 1011 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63081 | Total |
| Program Services | 48547 | ProgramServices |
| Management And General | 10180 | ManagementAndGeneral |
| Fundraising | 4354 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15030 | Total |
| Management And General | 15030 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| DONATED GOODS | 1763714 | 1763714 |
| MEDICATIONS | 128830 | 128830 |
| MEDICAL SERVICES | 65818 | 65818 |
| DONATED INVENTORY ADJ. | 32002 | 32002 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18259 | Total |
| Program Services | 14052 | ProgramServices |
| Management And General | 2947 | ManagementAndGeneral |
| Fundraising | 1260 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2829348 | Total |
| Program Services | 2537658 | ProgramServices |
| Management And General | 220798 | ManagementAndGeneral |
| Fundraising | 70892 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59364 | BOY |
| EOY | 69933 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 301885 | BOY |
| EOY | 552492 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 364812 | BOY |
| EOY | 208877 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 267051 | BOY |
| EOY | 235049 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4086 | BOY |
| EOY | 4187 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2005556 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 525330 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1540150 | BOY |
| EOY | 1480226 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 642837 | BOY |
| EOY | 737187 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3180185 | BOY |
| EOY | 3287951 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47296 | BOY |
| EOY | 33513 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47296 | BOY |
| EOY | 33513 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2527859 | BOY |
| EOY | 2622863 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 314040 | BOY |
| EOY | 335035 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 290990 | BOY |
| EOY | 296540 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3132889 | BOY |
| EOY | 3254438 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3180185 | BOY |
| EOY | 3287951 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 145670 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -24121 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 874393 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1882342 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3050743 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3167212 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2943234 | CurrentTaxYear |
| Total | 11917924 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 874393 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1882342 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3050743 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3167212 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2943234 | CurrentTaxYear |
| Total | 11917924 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 59935 | AmountsSubstContributorsTotal |
| Public Support Total170 | 11857989 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 24520 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 17140 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 15285 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 14056 | CurrentTaxYearMinus1Year |
| Current Tax Year | 14305 | CurrentTaxYear |
| Total | 85306 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 12003230 | TotalSupport |
| Public Support Pertcentage170 | 0.98790 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.98770 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 387335 | BeginningOfYearBalance |
| Contributions | 247581 | Contributions |
| Investment Earnings Or Losses | 2179 | InvestmentEarningsOrLosses |
| Administrative Expenses | 3241 | AdministrativeExpenses |
| End Of Year Balance | 633854 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 301409 | BeginningOfYearBalance |
| Contributions | 28948 | Contributions |
| Investment Earnings Or Losses | 54125 | InvestmentEarningsOrLosses |
| Administrative Expenses | 2853 | AdministrativeExpenses |
| End Of Year Balance | 387335 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 239667 | BeginningOfYearBalance |
| Contributions | 34491 | Contributions |
| Investment Earnings Or Losses | 30009 | InvestmentEarningsOrLosses |
| Administrative Expenses | 2758 | AdministrativeExpenses |
| End Of Year Balance | 301409 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 313438 | BeginningOfYearBalance |
| Contributions | 1198 | Contributions |
| Investment Earnings Or Losses | -72630 | InvestmentEarningsOrLosses |
| Administrative Expenses | 2339 | AdministrativeExpenses |
| End Of Year Balance | 239667 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.53220 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.46780 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1761717 | OtherCostOrOtherBasis |
| Depreciation | 303533 | Depreciation |
| Book Value | 1458184 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 243839 | OtherCostOrOtherBasis |
| Depreciation | 221797 | Depreciation |
| Book Value | 22042 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 1480226 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BENEFICIAL INTEREST IN COMMUNITY FOUNDATION | 633854 |
| ASSETS HELD FOR SALE | 3000 |
| LONG TERM CD | 100333 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 737187 | TotalBookValueOtherAssets |
| Total Revenue | 2975018 | TotalRevenue |
| Total Expenses | 2829348 | TotalExpenses |
| Excess Or Deficit For Year | 145670 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -24121 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -24121 | TotalAdjustments |
| Excess Or Deficit Per FS | 121549 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 6743563 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -24121 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 3795907 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 3771786 | RevenueNotRptdF990 |
| Revenue Subtotal | 2971777 | RevenueSubtotal |
| Investment Expenses Not Included | 3241 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 3241 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2975018 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 6622014 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 3795907 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 3795907 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2826107 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 3241 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 3241 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2829348 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | CHFC INTENDS TO USE THE EARNINGS FROM CHFC'S ENDOWMENT FUNDS FOR LONG TERM FINANCIAL SUPPORT OF THE CLINIC. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE ORGANIZATION HAS DETERMINED THAT IT WAS NOT REQUIRED TO RECORD A LIABILITY RELATED TO UNCERTAIN TAX POSITIONS. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Email Solicitations | X | EmailSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Individual | JEAN BJORSETH | NameOfIndividual |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 10TH AVE SE | AddressLine1 |
| City | CEDAR RAPIDS | City |
| State | IA | State |
| ZIP Code | 52401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | GRANTWRITING | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 205979 | GrossReceipts |
| Amount Retained By Contractor | 19206 | AmountRetainedByContractor |
| Net To Organization | 186929 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 205979 | TotalGrossReceipts |
| Total Retained By Contractors | 19206 | TotalRetainedByContractors |
| Total Net To Organization | 186929 | TotalNetToOrganization |
| Licensed States | AZ | LicensedStates |
| Licensed States | CO | LicensedStates |
| Licensed States | FL | LicensedStates |
| Licensed States | MN | LicensedStates |
| Licensed States | NJ | LicensedStates |
| Licensed States | NY | LicensedStates |
| Licensed States | WA | LicensedStates |
| Licensed States | IL | LicensedStates |
| Licensed States | NC | LicensedStates |
| Licensed States | WI | LicensedStates |
| Licensed States | MO | LicensedStates |
Form990 Schedule G Part IV Form990ScheduleGPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | GRANTWRITING EXPENSES | Identifier |
| Return Reference | SCHEDULE G, PART I, LINE 2B | ReturnReference |
| Explanation | GRANTWRITING FEES PAID TO CONTRACTOR - $19,050. REIMBURSEMENTS OF EXPENSES TOTALED $156. REIMBURSEMENTS ARE BASED ON RECEIPTS SUBMITTED FOR EXPENSES PAID. | Explanation |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSupplies
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1075021 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 1763714 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of8283 Received | 0 | NumberOf8283Received |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 1 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: | Identifier |
| Return Reference | PART I, COLUMN (B): | ReturnReference |
| Explanation | LINE 20 IS ESTIMATED QUANTITY OF MEDICINES DONATED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | AFTER THE PUBLIC AUDIT FIRM PREPARES A DRAFT OF THE FEDERAL FORM 990, THE DIRECTOR OF FINANCE AND TREASURER REVIEW THE DRAFT AND MAKE ANY CHANGES IF NECESSARY. FEDERAL FORM 990 IS MARKED DRAFT UNTIL APPROVED BY THE CHFC BOARD OF DIRECTORS. 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 COMMUNITY HEALTH FREE CLINIC (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 OF INTEREST ARISE. STATEMENTS ARE RETAINED BY THE EXECUTIVE DIRECTOR OF CHFC IN THE CLINIC'S OFFICE. | |
| FORM 990, PART VI, SECTION B, LINE 15A | IN JULY OF EACH YEAR, THE CEO/CLINIC EXECUTIVE DIRECTOR DRAFTS A LIST OF ANNUAL GOALS & OBJECTIVES AND PROVIDES IT TO THE PRESIDENT OF THE BOARD. THE BOARD OF DIRECTORS REVIEWS THE GOALS AND OBJECTIVES AT THE ANNUAL BEGINNING OF 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/CLINIC EXECUTIVE DIRECTOR PROVIDES THE PRESIDENT OF THE BOARD WITH A DOCUMENT THAT DETAILS HIS/HER PERFORMANCE AGAINST THE ANNUAL GOALS AND OBJECTIVES APPROVED IN THE PRIOR JULY. AFTER A FACE-TO-FACE REVIEW WITH THE CEO/CLINIC EXECUTIVE DIRECTOR, THE PRESIDENT OF THE BOARD 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 BOARD 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/CLINIC EXECUTIVE DIRECTOR'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/CLINIC EXECUTIVE DIRECTOR) FOR THE OVERALL GRADE AND SUGGESTED SALARY INCREASE. THE CEO/CLINIC EXECUTIVE DIRECTOR'S OVERALL GRADE AND SALARY INCREASE ARE VOTED ON BY THE BOARD OF DIRECTORS. THE SPECIFICS OF THE SALARY INCREASE ARE NOT DOCUMENTED IN BOARD MEETING MINUTES TO PROVIDE THE CEO/CLINIC EXECUTIVE DIRECTOR 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 FISCAL DAY OF THE YEAR. FORM 990, PART VI, SECTION B, LINE 15B: THERE IS NOT A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS OR KEY EMPLOYEES BECAUSE THEY DO NOT HAVE ANY EMPLOYEES THAT MEET THE DEFINITION OF THE 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. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -24,121. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. | AUDIT OVERSIGHT COMMITTEE |