2022-09-14T12:36:39-05:00 2021-10-31 FORVIS LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2020-11-01 481302204 CRESCENT COMMUNITY HEALTH CENTER % GARY COLLINS CRES 5636902860 1690 ELM ST Suite 300 DUBUQUE IA 52001 GARY COLLINS CHIEF EXEC. OFFICER 4178658701 2022-08-09 true GARY COLLINS 999009999 Krystal K Creach P01248198 4178658701 3 2020 2023-04-26 12:10:37Z GARY COLLINS 1690 ELM ST300 DUBUQUE IA 52001 14952338 false X WWW.CRESCENTCHC.ORG X 2003 IA TO PROVIDE HIGH-QUALITY, RESPECTFUL, AND AFFORDABLE MEDICAL, BRAIN HEALTH & ORAL HEALTH TO THE TRI-STATES, INCLUDING PREVENTATIVE AND WELLNESS ACTIVITIES. SEE SCH O. 15 15 135 17 0 0 3663699 3421314 7837894 10667944 145189 101078 154299 734108 11801081 14924444 0 0 0 0 5310416 7468916 0 0 75955 4329408 5032188 9639824 12501104 2161257 2423340 18653889 22462792 5101471 5389359 13552418 17073433 X TO PROVIDE HIGH-QUALITY, RESPECTFUL AND AFFORDABLE MEDICAL, BRAIN HEALTH & ORAL HEALTH CARE TO THE TRI-STATES, INCLUDING PREVENTIVE AND WELLNESS ACTIVITIES. false false 3701787 4378599 DURING THE FISCAL YEAR THE HEALTH CARE CENTER PROVIDED MEDICAL SERVICES TO 3,985 PATIENTS. MEDICAL SERVICES PROVIDED INCLUDE: PHYSICALS, CHRONIC DISEASE MANAGEMENT, WELL CHILD EXAMS, ACUTE VISITS, AND OTHER PRIMARY HEALTHCARE. 2832974 4136141 DURING THE FISCAL YEAR THE HEALTH CARE CENTER PROVIDED DENTAL SERVICES TO 5,167 PATIENTS. DENTAL SERVICES PROVIDED INCLUDE: EXAMS, CLEANINGS, RESTORATIVES, X-RAYS, AND OTHER PRIMARY DENTAL CARE. 1014814 2153204 DURING THE FISCAL YEAR, THE HEALTH CARE CENTER PROVIDED BRAIN HEALTH SERVICES TO 1,154 PATIENTS. BRAIN HEALTH SERVICES INCLUDE: PSYCHIATRY, PSYCHOLOGY, COUNSELING, AND OTHER SERVICES. 7549575 true true false true false false false false false true true false false true false false true false false false false false false false false false false false false true false false false false false false false false true false false false false false false false false true 0 0 135 true false false false false false false false false false false false false false X 15 15 false false false false false false false true true false false true true true true true false true true false X GARY COLLINS 5636902860 1690 ELM ST SUTE 300 DUBUQUE IA 52001 DR MARCO ROUMAN CHIEF DENTAL OFFICER 40.0 0.0 X 210421 0 16009 DR LYDIA GOODSON DENTIST 40.0 0.0 X 177598 0 9158 HEATHER KRUSE CHIEF MEDICAL OFFICER 32.0 0.0 X 158115 0 5134 DR JEFFRY BREITBACH DENTIST 40.0 0.0 X 148812 0 8891 GARY COLLINS CHIEF EXECUTIVE OFFICER 40.0 0.0 X 138364 0 17861 DR KEVIN STINGLEY DENTIST 32.0 0.0 X 120552 0 18124 DR HEATHER RICKERTSEN PHARMACIST 40.0 0.0 X 112203 0 18821 BROOKE GOMEZ LOPEZ CHIEF OPERATING OFFICER 40.0 0.0 X 109227 0 16005 JENNIFER ZALAZNIK NURSE PRACTITIONER 40.0 0.0 X 114439 0 5610 JENNIFER STEINES CFO END 8/2021 40.0 0.0 X 67776 0 15649 DOUG JAEGER CFO BEG 9/2021 40.0 0.0 X 30139 0 654 ANN DECKER BOARD CHAIR 2.0 0.0 X X 0 0 0 BOB SHAFER BOARD MEMBER BEG 7/2021 2.0 0.0 X 0 0 0 CHRIS WILLIAMS BOARD SECRETARY 2.0 0.0 X X 0 0 0 DAN WHITE BOARD MEMBER BEG 7/2021 2.0 0.0 X 0 0 0 DEB HICKMON BOARD MEMBER 2.0 0.0 X 0 0 0 GARY RUNDE BOARD MEMBER END 8/2021 2.0 0.0 X 0 0 0 JIM MILLER BOARD MEMBER END 5/2021 2.0 0.0 X 0 0 0 JOHN MCANDREW BOARD MEMBER BEG 8/2021 2.0 0.0 X 0 0 0 LYNEE ROBSON BOARD TREASURER 2.0 0.0 X X 0 0 0 MARY ROSE CORRIGAN BOARD PAST CHAIR 2.0 0.0 X X 0 0 0 MATTHEW SCHMID BOARD MEMBER 2.0 0.0 X 0 0 0 MAXINE TONE BOARD MEMBER 2.0 0.0 X 0 0 0 MIKE MUENCH BOARD VICE CHAIR 2.0 0.0 X X 0 0 0 ROBIN KENNICKER BOARD MEMBER 2.0 0.0 X 0 0 0 RONELLE CLARK BOARD MEMBER BEG 7/2021 2.0 0.0 X 0 0 0 STAN SAMSON BOARD MEMBER 2.0 0.0 X 0 0 0 STEPHANIE MARTIN BOARD MEMBER 2.0 0.0 X 0 0 0 1387646 0 131916 11 false true false 0 2984624 436690 53128 3421314 NET PATIENT SERVICE REVENUE 624100 10540050 10540050 OTHER REVENUE 624100 127894 127894 10667944 128972 128972 0 0 0 0 0 27894 -27894 -27894 -27894 0 0 0 0 0 0 0 0 0 Gain/(Loss) on Equity in Investment 900099 195485 195485 Realized Gain on Pooled Investment 900099 538623 538623 734108 14924444 10667944 835186 X 0 0 0 0 785354 163249 622105 0 5392817 3888150 1451169 53498 140404 110242 30162 687319 406258 268604 12457 463022 310357 152665 0 3022 3022 84663 84663 0 0 77483 77483 1471413 1022851 448562 67071 67071 485015 91022 383993 10000 419782 419782 0 9758 8017 1741 9597 9597 0 78525 33749 44776 212523 212523 0 550629 77987 472642 54410 9476 44934 MEDICAL SUPPLIES & DRUGS 1364908 1364908 LICENSES, DUES, SUBSCRIPTIONS 98562 36984 61578 RECRUITING & RETENTION 44827 26325 18502 12501104 7549575 4875574 75955 2105634 2416457 1220973 1177643 572172 523648 2198873 3249924 0 0 0 0 0 0 120739 94213 121674 91220 7673180 1781280 5712423 5891900 5611793 7297710 0 0 259608 455093 0 0 730000 1264984 18653889 22462792 737116 1082342 0 0 159655 0 0 0 0 0 0 0 0 0 4204700 4307017 0 0 5101471 5389359 X 13224457 16922321 327961 151112 13552418 17073433 18653889 22462792 2423340 1097675 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false true false true false false false SCHEDULE C, PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) AND TO THE IOWA PRIMARY CARE ASSOCIATION (IOWA PCA). A PORTION OF THESE DUES MAY BE ATTRIBUTABLE TO LOBBYING PURPOSES. 6020183 761913 5258270 1644366 101937 624999 8631 8631 5891900 EST AMT DUE FROM 3RD PARTY 1090000 OTHER RECEIVABLES 174984 1264984 16149379 1097675 245027 1342702 14806677 77483 40284 117767 14924444 12451515 27894 27894 12423621 77483 77483 12501104 SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12: $ 245,027 NET ASSETS RELEASED FROM RESTRICTION SCHEDULE D, PART XI, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ (27,894) LOSS ON DISPOSAL OF FIXED ASSETS 68,178 TEMPORARILY RESTRICTED CONTRIBUTIONS ---------- $ 40,284 SCHEDULE D, PART XII, LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ (27,894) LOSS ON DISPOSAL OF FIXED ASSETS X X X X false false false false false false false false false GARY COLLINS CHIEF EXECUTIVE OFFICER 135298 0 25 0 3041 0 4369 0 13492 0 156225 0 0 0 HEATHER KRUSE CHIEF MEDICAL OFFICER 158065 0 50 0 0 0 5134 0 0 0 163249 0 0 0 DR MARCO ROUMAN CHIEF DENTAL OFFICER 210396 0 25 0 0 0 6703 0 9306 0 226430 0 0 0 DR JEFFRY BREITBACH DENTIST 148787 0 25 0 0 0 0 0 8891 0 157703 0 0 0 DR LYDIA GOODSON DENTIST 177573 0 25 0 0 0 0 0 9158 0 186756 0 0 0 X 1 51898 FMV X GIFT CARD 1 1230 FMV false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTIONS: THE NUMBER OF CONTRIBUTIONS WAS DETERMINED BY THE NUMBER OF CONTRIBUTORS. FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: CRESCENT COMMUNITY HEALTH CENTER IS A LOCAL MEDICAL AND DENTAL CLINIC PROVIDING BASIC (PRIMARY) MEDICAL, ORAL AND BRAIN HEALTH CARE. OUR DOCTORS, DENTISTS, NURSE PRACTITIONERS, DENTAL HYGIENISTS AND OTHER STAFF OFFER HIGH-QUALITY AND AFFORDABLE CARE TO ANYONE NEEDING A MEDICAL AND/OR DENTAL HOME. OUR PHILOSOPHY IS TO MAKE YOU, THE PATIENT, THE CENTER OF CARE AND A PARTNER IN YOUR TREATMENT. THE COST OF OUR SERVICES FOR UNINSURED PATIENTS ARE FIGURED ON A SLIDING FEE SCALE AND DISCOUNTED BASED UPON THE HOUSEHOLD INCOME AND SIZE. WE SERVE INDIVIDUALS AND FAMILIES WHO ARE UNINSURED, UNDERINSURED AND THOSE WITH VARIOUS TYPES OF INSURANCE. PATIENTS FROM ANY AREA ARE WELCOMED TO OUR PRACTICE. VALUE STATEMENTS ACCESSIBILITY: WE BELIEVE ALL INDIVIDUALS, REGARDLESS OF ABILITY TO PAY, SHOULD HAVE ACCESS TO QUALITY HEALTHCARE SERVICES. COLLABORATION: WE BELIEVE COLLABORATION AND AFFILIATION WITH OTHER PROVIDERS/AGENCIES WILL STRENGTHEN OUR PROGRAM WITH REGARD TO LEVELS OF CARE AND BREADTH OF SERVICES. DIVERSITY AND DIGNITY: WE VALUE DIVERSITY AND BELIEVE IN THE DIGNITY OF EACH PERSON. QUALITY: WE BELIEVE THAT THE HIGHEST STANDARD OF CARE SHOULD BE AVAILABLE FOR ALL. WE EXIST TO ENHANCE AND PROMOTE THE HEALTH AND WELL BEING OF EVERYONE THROUGH EDUCATION, PREVENTION AND TREATMENT. ADVOCACY: WE WILL REPRESENT THE PEOPLE WE SERVE AND PROMOTE THE RIGHT OF EVERYONE TO RECEIVE THE HIGHEST QUALITY HEALTH CARE AVAILABLE. SERVICE: WE BELIEVE EVERY ASPECT OF OUR SERVICES PROVIDED BY A CARING STAFF SHOULD REFLECT THAT MEETING THE NEEDS OF EACH PATIENT IS PARAMOUNT TO THE DIGNITY OF EACH PERSON. SUPPORT: WE BELIEVE INDIVIDUALS AND FAMILIES ARE SUCCESSFUL WITH COMMUNITY SUPPORT, AND OUR COMMUNITIES CAN AND SHOULD WORK TOGETHER FOR THE NEEDS OF ALL IN THE TRI-STATE AREA. FORM 990, PART III, LINE 4 PROGRAM SERVICES: THE ORGANIZATION PROVIDES PRIMARY HEALTHCARE SERVICES BY PHYSICIANS AND ALLIED HEALTH PROFESSIONALS, ORAL HEALTH SERVICES BY DENTISTS AND DENTAL HYGIENISTS, DIAGNOSTIC LABORATORY SERVICES DIAGNOSTIC X-RAY SERVICES, PREVENTIVE HEALTH SERVICES, PATIENT CASE MANAGEMENT, PHARMACY SERVICES, REFERRALS FOR OB, MENTAL HEALTH, AND SUBSTANCE ABUSE SERVICES, PREVENTIVE AND RESTORATIVE DENTAL SERVICES, AND TRANSLATION SERVICES. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO BYLAWS: THE FOLLOWING SIGNIFICANT CHANGES WERE MADE TO THE ORGANIZATION'S BYLAWS: -THE BOARD OF DIRECTORS SHALL CONSIST OF NO MORE THAN TWENTY FIVE DIRECTORS, PREVIOUSLY 15. -THE IMMEDIATE PAST BOARD CHAIR WILL REMAIN AS AN OFFICER, ALSO SERVING ON THE EXECUTIVE COMMITTEE, UNTIL THEY ARE REPLACED AS THE IMMEDIATE PAST CHAIR BY THE THEN CURRENT CHAIR. -ANY PROPOSED AMENDMENTS TO THE BYALWS MUST HAVE BEEN SUBMITTED IN WRITING TO THE BOARD MEMBERS AT LEAST SEVEN, PREVIOUSLY FIFTEEN, DAYS PRIOR TO THE DATE OF THE MEETING AT WHICH A VOTE WILL BE TAKEN. -AN ARTICLE OF DISSOLUTION WAS ADDED TO THE BYALWS, PROVIDING UPON THE DISSOLUTION OF THE CORPORATION, THE BOARD OF DIRECTORS SHALL, AFTER PAYING OR MAKING PROVISIONS FOR THE PAYMENT OF ALL OF THE LIABILITIES OF THE CORPORATION, DISPOSE OF ALL OF THE ASSETS OF THE CORPORATION EXCLUSIVELY FOR THE PURPOSES OF THE CORPORATION IN SUCH A MANNER OR TO SUCH ORGANIZATION OR ORGANIZATIONS OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, RELIGIOUS OR SCIENTIFIC PURPOSES AS SUCH AT THE TIME QUALIFY AS AN EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986 (OR THE CORRESPONDING PROVISIONS OF ANY FUTURE UNITED STATES INTERNAL REVENUE CODE) AS THE BOARD OF DIRECTORS SHALL DETERMINE. ANY SUCH ASSETS NOT SO DISPOSED OF SHALL BE DISPOSED OF BY THE DISTRICT COURT OF THE COUNTY IN WHICH THE PRINCIPAL OFFICE OF THE CORPORATION IS THEN LOCATED, EXCLUSIVELY FOR SUCH PURPOSES OR TO SUCH ORGANIZATION OR ORGANIZATIONS AS SAID DISTRICT COURT SHALL DETERMINE WHICH ARE ORGANIZED EXCLUSIVE FOR SUCH DESIGNATED PURPOSES. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, THE FORM 990 IS FIRST REVIEWED BY THE FINANCE DIRECTOR OF THE ORGANIZATION. IT IS THEN SUBMITTED TO THE FINANCE COMMITTEE FOR REVIEW AND THEN TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: BOARD MEMBERS SHALL PROVIDE FULL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST, INCLUDING COMPLETING AN INITIAL CONFLICT OF POTENTIAL OR ACTUAL INTEREST STATEMENT WHEN APPOINTED, AND COMPLETING A CONFLICT OF POTENTIAL OR ACTUAL INTEREST STATEMENT AT LEAST ANNUALLY (JANUARY EACH YEAR THEREAFTER. BOARD MEMBERS ARE REQUIRED TO DISCLOSE POTENTIAL AND/OR ACTUAL CONFLICTS OF INTEREST PRIOR TO SPECIFIC BOARD DECISIONS. THE BOARD CHAIRPERSON MAY ASK PERSONS WITH POTENTIAL CONFLICTS TO NOT PARTICIPATE IN DISCUSSIONS AT THE BOARD MEETINGS IF AN ISSUE BEFORE THE BOARD IS SENSITIVE TO ALLEGATIONS OF CONFLICT. NO EMPLOYEE, OFFICER OR AGENT SHALL PARTICIPATE IN THE SELECTION, AWARD OR ADMINISTRATION OF A CONTRACT SUPPORTED BY FEDERAL FUNDS IF A REAL OR APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. SUCH A CONFLICT WOULD ARISE WHEN THE EMPLOYEE, OFFICER, OR AGENT, 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 AN AWARD. THE OFFICERS, EMPLOYEES AND AGENTS OF THE RECIPIENT SHALL NEITHER SOLICIT NOR ACCEPT GRATUITIES, FAVORS, OR ANYTHING OF MONETARY VALUE FROM CONTRACTORS, OR PARTIES TO SUB-AGREEMENTS. HOWEVER, RECIPIENTS MAY SET STANDARDS FOR SITUATIONS IN WHICH THE FINANCIAL INTEREST IS NOT SUBSTANTIAL OR THE GIFT IS AN UNSOLICITED ITEM OF NOMINAL VALUE. THE STANDARDS OF CONDUCT SHALL PROVIDE FOR DISCIPLINARY ACTIONS TO BE APPLIED FOR VIOLATIONS OF SUCH STANDARDS BY OFFICERS, EMPLOYEES OR AGENTS OF THE RECIPIENTS. FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION REVIEW: THE COMPENSATION OF THE ORGANIZATION'S CEO, OTHER OFFICERS, AND KEY EMPLOYEES WAS REVIEWED BY THE PERSONNEL COMMITTEE OF THE BOARD OF DIRECTORS USING COMPARATIVE DATA FROM THE IOWA WORKFORCE DEVELOPMENT FOR DUBUQUE COUNTY. IN ADDITION TO COMPARATIVE DATA FROM VARIOUS NATIONAL WEBSITES SUCH AS SIMPLYHIRED.COM, SALARYLIST.COM, AND INDEED.COM, AS WELL AS THE HEALTH ASSOCIATIONS OF THE IOWA PRIMARY CARE ASSOCIATION AND THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. THE REVIEW PROCESS WAS DOCUMENTED IN THE COMMITTEE'S MINUTES AND OCCURRED DURING NUMEROUS MEETINGS IN FISCAL YEAR 2020. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC TO BE VIEWED ON-SITE OR TO BE MAILED UPON WRITTEN REQUEST. FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT PHARMACY TOTAL FEES:774940 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT OTHER ADMINISTRATION TOTAL FEES:341897 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT OTHER MEDICAL TOTAL FEES:157171 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT HOUSEKEEPING TOTAL FEES:84581 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT PHYSICIAN TOTAL FEES:50091 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LAB TOTAL FEES:38241 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT DATA COMMUNICATION TOTAL FEES:22084 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT RADIOLOGY TOTAL FEES:1484 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT OTHER DENTAL TOTAL FEES:924