2012-03-26T11:15:40-05:00 2011-09-30 Christensen Brozek Faltys PC PO Box 1264 Norfolk NE 68702 990 2010-10-01 470833378 Norfolk Community Health Care Clinic In NORF 4026447314 110 N 16th Street Suite 16 Norfolk NE 68701 Kathleen Nordby 4026447314 2012-03-10 1 Danny Fuerhoff CPA 4023711160 2010 2016-02-24 21:20:13Z Kathleen Nordby 110 N 16th Street Suite 16 Norfolk NE 68701 2702977 0 X N/A X 1999 NE To provide access to quality primary health care and education on healthy living to all. 11 11 38 0 0 0 1289989 1339916 768356 1360132 2957 2785 0 144 2061302 2702977 0 0 0 0 753790 1506819 0 0 178915 1231232 1050173 1985022 2556992 76280 145985 625590 793342 145225 166990 480365 626352 To provide access to quality care and education on healthy living to all individuals in northeast Nebraska. 0 0 1798187 1360276 The organization provides medical services to the poor and uninsured or under-insured. The clinic seen patients from 18 different zip codes and had a total of 13,950 encounters/visits with a total 3,782 patients during 2010. Of this, they had 54% uninsured patients, 18% Medicaid patients, 6% Medicare patients and 22% private insurance patients. 1798187 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 6 0 1 38 1 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X The Organization 4026447314 110 N 16th Street Suite 16 Norfolk NE 68701 Kathy Nordby 10.00 X 0 64409 0 Kim Kwapnioski 40.00 X 69187 0 0 Karen Weidner 8.00 X X 0 0 0 Joe Mtika 4.00 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 0 0 0 Mavis Hatcliff 1.00 X 0 0 0 Gretchen Forsell 1.00 X 0 0 0 Jeanne Reigle 1.00 X 0 0 0 Marcus Rios 1.00 X 0 0 0 Josh Moenning 1.00 X 0 0 0 69187 64409 0 0 0 0 0 0 37500 1259041 43375 1339916 Patient revenue 621110 1360132 1360132 1360132 2785 2785 Miscellaneous income 900099 144 144 144 2702977 1360276 0 2785 81777 49066 24533 8178 1083274 649965 324982 108327 69277 41566 20783 6928 173434 109017 48313 16104 99057 59434 29717 9906 6047 2419 2419 1209 22110 22110 166751 147595 13016 6140 21760 4352 1088 16320 246917 234936 9961 2020 53260 47934 5326 12336 1234 9868 1234 28369 2837 24114 1418 56700 28350 28350 9139 6571 2017 551 Bad debt expense 299929 299929 Lab fees 83160 83160 Repairs & maintenance 18446 18446 Repairs & maintenance 6914 6914 Association dues 6379 6379 11956 11376 580 2556992 1798187 579890 178915 207658 332702 86708 186116 1200 1200 185268 44320 161706 140948 168318 132376 625590 793342 145225 166990 145225 166990 X 480365 591852 34500 480365 626352 625590 793342 X 145985 2 X X 0 1 1 X 1 1 X 107502 90100 1194995 1289989 1339916 4022502 107502 90100 1194995 1289989 1339916 4022502 4022502 4313 3000 3578 2957 2785 16633 1304 2463 144 3911 4043046 2552411 0.99490 0.99000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 62555 29206 33349 122713 15114 107599 140948 2702977 2556992 145985 2 2 145987 2741836 38859 38859 2702977 0 2702977 2595851 38859 38859 2556992 0 2556992 Description of Uncertain Tax Positions Under FIN 48: Part X: In July 2006, the Financial Accounting Standards Board (FASB) issued FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Taxes - an interpretation of FASB Accounting Standards Codification (ASC) 740, Income Taxes. FIN 48 attempts to set out a consistent framework for preparers to use to determine the appropriate level of tax reserve to maintain for uncertain tax positions. This interpretation of ASC 740 uses a two-step approach wherein tax benefit is recognized if a position is more-likely-than-not to be sustained. The amount of the benefit is then measured to be the highest tax benefit which is greater than 50% likely to be realized. FIN 48 also sets out disclosure requirements to enhance transparency of an entity's tax reserves. The Organization adopted the current accounting standard related to unrecognized tax benefits on October 1, 2009. The Organization files required income tax returns in the U.S. federal jurisdiction and various states. With few exceptions, the Organization is no longer subject to U.S. federal, state and local income tax examinations by tax authorities for years before 2006. As a result of the implementation of FIN 48, 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 in accordance with FIN 48. Part XI, Line 8 - Other Adjustments: Rounding 2. 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 Any conflicts of interest are discussed among the board. A conflict of interest form must be completed and signed by each board member annually. 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 5: Rounding 2. Total to Form 990, Part XI, Line 5: 2. Form 990, Part XI, Line 2c This process has not changed from the prior year. This return is being filed between March 1, 2012, and March 30, 2012, as directed by the IRS in Notice 2012-4, because electronic filing was not available January 1, 2012 through February 29, 2012. We request that penalties be waived because it would be inequitable to impose a penalty on us due to the unusual circumstances requiring us to delay the filing of this return.