2025-10-17T15:48:55-05:00 2025-02-28 410746749 CLIFTONLARSONALLEN LLP 2021 SPRING ROAD SUITE 200 OAK BROOK IL 60523 990 2024-03-01 421527584 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC COMM 3197532300 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 DIANE ROUSE CHIEF FINANCIAL OFFICER 3197532300 2025-10-13 1 0 CHRIS MANDERFIELD P01238973 6305738600 2025-10-13 2024 2025-03-06 01:10:19Z DIANE ROUSE 1706 W AGENCY ROAD WEST BURLINGTON IA 52655 32627191 0 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. 12 12 238 12 0 0 5735533 8664700 22902508 23476879 169259 443983 59458 10575 28866758 32596137 0 0 0 0 17138603 17374746 0 0 0 11725424 11155346 28864027 28530092 2731 4066045 31006238 33518468 7967938 6372522 23038300 27145946 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. 0 0 18315830 23456400 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 ANDDENTAL SCREENING, FAMILY PLANNING, HEALTH SCREENINGS, IMMUNIZATIONS, CASE MANAGEMENT, AND PHARMACIES. DURING THE FISCAL YEAR, THE HEALTH CENTERS HAD 18,255 DENTAL VISITS AND 53,111 MEDICAL VISITS (INCLUDES BEHAVIORAL HEALTH). 18315830 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 37 0 1 238 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X DIANE ROUSE 3197532300 1706 WEST AGENCY ROAD WEST BURLINGTON IA 52655 BARRY CORSON BOARD MEMBER 1.00 X 0 0 0 JOSEPH DOUGLASS BOARD MEMBER 1.00 X 0 0 0 CHUCK GRIFFIN BOARD MEMBER 1.00 X 0 0 0 DAVE HADEN BOARD MEMBER 1.00 X 0 0 0 DELANY RICHARDS BOARD MEMBER 1.00 X 0 0 0 JULIE SCHILLING SECRETARY 1.00 X X 0 0 0 DAVID SELMON BOARD MEMBER 1.00 X 0 0 0 CINDY SHARPE TREASURER 1.00 X X 0 0 0 SUZANNE SORENSEN BOARD MEMBER 1.00 X 0 0 0 WILLIAM STAATS VICE-CHAIRPERSON 1.00 X X 0 0 0 DAVID WITAKER BOARD MEMBER 1.00 X 0 0 0 JEFF STRAUSE CHAIRPERSON 1.00 X X 0 0 0 RHEA HARTLEY CHIEF MEDICAL OFFICER 40.00 X 358330 0 30117 DANIEL DUROSEAU CHIEF DENTAL OFFICER 40.00 X 278608 0 30921 ANTONIO FLORES TERM 81824 CEO 40.00 X 117902 0 14302 DIANE ROUSE CFO 40.00 X 181001 0 39890 WILLLIAM GRIMM CEO - AS OF 11/11/24 40.00 X 30335 0 2497 ERIC BOYUM PSYCHIATRIST 40.00 X 323455 0 46679 MARIA DUROSEAU PEDIATRICIAN 40.00 X 292692 0 924 RANDY ISAACS PEDIATRICIAN 40.00 X 283416 0 26308 SARA RODEFFER DENTIST 40.00 X 181159 0 43775 TESSA JOHNSON DENTIST 40.00 X 180624 0 42916 2227522 0 278329 28 0 1 0 ICON MEDICAL NETWORK 525 3RD ST SUITE 304 LAKE OSWEGO OR 97034 CONTRACTED PEDIATRIC SERVICES 520943 PAIN CENTERS OF IOWA 5515 UTICA RIDGE ROAD 600 DAVENPORT IA 52807 HEALTH SERVICES 297015 GAP RX 340B CONSULTANTS LLC 417 JADE DRIVE AUGUSTA GA 30907 MANAGER OF IN-HOUSE PHARMACIES 274129 FORVIS PO BOX 200870 DALLAS TX 75320 AUDITORS 135796 4 3363637 5301063 8664700 NET PATIENT REVENUE 624100 23148756 23148756 INCENTIVE REVENUE 624100 328123 328123 23476879 475037 475037 31054 -31054 -31054 -31054 MISCELLANEOUS REVENUE 900099 10575 10575 10575 32596137 23456400 0 475037 X 966176 966176 12702031 7957008 4745023 548266 305719 242547 2210671 1025650 1185021 947602 552568 395034 60462 60462 151645 151645 3084785 2721602 363183 289536 68018 221518 735481 179365 556116 134302 15999 118303 39284 4204 35080 294582 294582 955359 374114 581245 MEDICIAL SUPPLIES AND O 5409910 5111583 298327 28530092 18315830 10214262 0 447872 3307880 7584069 8497145 440344 5000 1847255 1982827 219881 190266 690143 444440 21551855 5962576 14769265 15589279 745973 787574 447828 382292 3813608 2331765 31006238 33518468 3874114 2146151 3676974 3953975 416850 272396 7967938 6372522 X 22030800 27140946 1007500 5000 23038300 27145946 31006238 33518468 4066045 41601 0 X 0 1 X 1 1 1 X 5415566 4481022 5224635 5735533 8664700 29521456 5415566 4481022 5224635 5735533 8664700 29521456 29521456 61533 101380 202056 169259 475037 1009265 10575 10575 30541296 0.96660 0.97720 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISC - 2024 AMOUNT: $ 10,575. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: 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 306280 306280 18487789 3706374 14781415 58759 58759 0 2699027 2197443 501584 15589279 DUE FROM THIRD PARTY PAYERS 2319394 ROU ASSETS 12371 2331765 DEFERRED COMP 260026 CURRENT PORTION OF OPEARTING LEASE 4217 CURRENT PORTION OF FINANCING LEASE 8153 272396 X 32637738 41601 41601 32596137 0 32596137 28530092 0 28530092 0 28530092 PART X, LINE 2: THE ORGANIZATION IS TAX-EXEMPT UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND NOT A PRIVATE FOUNDATION AS DESCRIBED IN SECTION 509(A) FOR FEDERAL PURPOSES. THE ORGANIZATION IS ALSO TAX-EXEMPT UNDER IOWA STATUTES FOR STATE PURPOSES. CONSEQUENTLY, THE ORGANIZATION RECORDS NO PROVISION FOR INCOME TAXES. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. AS A RESULT OF THE APPLICATION OF THE STANDARD, THE ORGANIZATION HAS RECOGNIZED NO LIABILITY FOR UNRECOGNIZED TAX BENFITS. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. X 1 1 X X X 0 0 0 0 0 0 0 1 0 RHEA HARTLEY CHIEF MEDICAL OFFICER 315530 0 33670 0 9130 0 18038 0 12079 0 388447 0 0 0 ERIC BOYUM PSYCHIATRIST 313205 0 10250 0 0 0 16624 0 30055 0 370134 0 0 0 RANDY ISAACS PEDIATRICIAN 283416 0 0 0 0 0 0 0 26308 0 309724 0 0 0 DANIEL DUROSEAU CHIEF DENTAL OFFICER 268608 0 10000 0 0 0 520 0 30401 0 309529 0 0 0 MARIA DUROSEAU PEDIATRICIAN 292692 0 0 0 0 0 0 0 924 0 293616 0 0 0 SARA RODEFFER DENTIST 169739 0 11420 0 0 0 9737 0 34038 0 224934 0 0 0 TESSA JOHNSON DENTIST 178124 0 2500 0 0 0 9635 0 33281 0 223540 0 0 0 DIANE ROUSE CFO 155145 0 10000 0 15856 0 9492 0 30398 0 220891 0 0 0 PART I, LINE 1B THE ORGANIZATION OFFERS A WELLNESS PROGRAM TO ITS EMPLOYEES WHICH PROVIDES DIRECT REIMBURSEMENT OF UP TO $25 PER MONTH TOWARDS DOCUMENTED PARTICIPATION IN AN APPROVED HEALTH ACTIVITY. EMPLOYEES MUST SUBMIT PROOF OF PAYMENT FOR THE EMPLOYEE'S MEMBERSHIP FOR THE MONTH ALONG WITH PROOF OF ATTENDANCE OF AT LEAST THREE TIMES PER MONTH PART I, LINE 7 BONUS AMOUNTS PAID ARE BASED ON PRODUCTION LEVELS AND QUALITY MEASURES. X 488424 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE 4 OFFICERS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL HAVE ALL OF THE POWERS OF THE GOVERNING BOARD WHEN THE GOVERNING BOARD IS NOT IN SESSION AND SHALL GENERALLY PERFORM SUCH DUTIES AND EXERCISE SUCH POWERS AS MAY BE DELEGATED BY THE GOVERNING BOARD. SUCH ACTIONS SHALL BE REPORTED TO AND APPROVED BY THE GOVERNING BOARD AT THE NEXT REGULARLY SCHEDULED BOARD MEETING. IT IS THE DUTY OF THE EXECUTIVE COMMITTEE TO ANNUALLY EVALUATE THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER AND REPORT TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE FINANCE DEPARTMENT OF THE ORGANIZATION. PRIOR TO BEING FILED, THE RETURN IS REVIEWED BY THE ORGANIZATION'S CFO. IT IS THEN PROVIDED TO THE BOARD FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C 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 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). 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 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 OF 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 15 ANNUALLY, PAY RANGES ARE REVIEWED AS PART OF THE BUDGETING PROCESS. COMPARABILITY DATA IS USED FROM FQHC SALARY SURVEY RESULTS FROM NACHC, IOWA PRIMARY CARE ASSOCIATION AND ILLINOIS PRIMARY CARE ASSOCIATION. IOWA WORKFORCE DEVELOPMENT SURVEY RESULTS FOR THE REGION ARE ALSO COMPARED. ANY PROPOSED CHANGES ARE TAKEN TO CHCSEIA'S PERSONNEL COMMITTEE, FINANCE COMMITTEE AND BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 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 PURCHASED SERVICES AND PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,721,602. MANAGEMENT AND GENERAL EXPENSES 363,183. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,084,785.