LAKE SUPERIOR COMMUNITY HEALTH CENTER: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- LAKE SUPERIOR COMMUNITY HEALTH CENTER (EIN 23-7167576)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-10-03
- IRS object ID
- 202312769349301266
- Schema version
- 2022v5.0
- 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) |
|---|---|---|
| Return | 2023-10-03T13:27:36-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S 6TH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237167576 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKE SUPERIOR COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 2187221497 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4325 GRAND AVE | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55807 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JESSIE PETERSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 2187221497 | PhoneNum |
| Signature | 2023-10-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JESSIE | PersonFirstNm |
| Person Last | PETERSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN ENGEBRETSON | PreparerPersonNm |
| PTIN | P01585625 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2023-09-26 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JESSIE PETERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4325 GRAND AVE | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55807 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,478,146 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LSCHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | AS A COMMUNITY HEALTH CENTER, WE ARE DEDICATED TO PROVIDING CARE TO EVERYONE IN NEED, REGARDLESS OF INSURANCE OR ABILITY TO PAY.WE SEEK TO IMPROVE ACCESS TO QUALITY HEALTH CARE FOR ALL BY PROVIDING ACCESS TO QUALITY MEDICAL, DENTAL, AND BEHAVIORAL HEALTH CARE. DELIVERING COMPREHENSIVE, INTEGRATED AND COST-EFFECTIVE CARE AND STRIVE TO CREATE A BETTER WORLD BY GUIDING INDIVIDUALS, FAMILIES AND COMMUNITIES TO IMPROVED HEALTH AND WELL-BEING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 143 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,325,742 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,115,599 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,582,713 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $9,333,410 | CYProgramServiceRevenueAmt |
| PY Investment Income | $527 | PYInvestmentIncomeAmt |
| CY Investment Income | -$139,771 | CYInvestmentIncomeAmt |
| PY Other Revenue | $93,206 | PYOtherRevenueAmt |
| CY Other Revenue | $16,008 | CYOtherRevenueAmt |
| PY Total Revenue | $14,002,188 | PYTotalRevenueAmt |
| CY Total Revenue | $14,325,246 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,984,995 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,712,019 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $9,292 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,643,708 | PYOtherExpensesAmt |
| CY Other Expenses | $4,562,004 | CYOtherExpensesAmt |
| PY Total Expenses | $12,628,703 | PYTotalExpensesAmt |
| CY Total Expenses | $13,274,023 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,373,485 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,051,223 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,917,344 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,499,366 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,374,835 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,910,112 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,542,509 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,589,254 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO IMPROVE ACCESS TO QUALITY HEALTH CARE FOR ALL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,811,495 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $4,649,320 | RevenueAmt |
| Desc | DENTAL - LAKE SUPERIOR COMMUNITY HEALTH CENTER PROVIDES PRIMARY DENTAL CARE FOR LOW INCOME UNINSURED, UNDERINSURED, AND PUBLIC PROGRAM ENROLLED COMMUNITY MEMBERS. THIS CARE INCLUDES OFFICE EXAMINATIONS, CLEANINGS, FLUORIDE TREATMENTS, X-RAYS, SEALANTS, RESTORATION, ROUTINE EXTRACTIONS, PARTIALS, DENTURES, ROOT CANALS, AND CROWNS. IN 2022, THE CENTER SERVED 7,172 PATIENTS WITH 15,895 VISITS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,292,171 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,181,206 | RevenueAmt |
| Desc | MEDICAL - LAKE SUPERIOR COMMUNITY HEALTH CENTER PROVIDES PRIMARY CLINICAL MEDICAL CARE FOR LOW INCOME UNINSURED, UNDERINSURED AND PUBLIC PROGRAM ENROLLED COMMUNITY MEMBERS. THIS CARE INCLUDES ACUTE CARE, MANAGEMENT OR CHRONIC DISEASE, PREVENTATIVE CARE, ASSISTED REFERRALS AND MENTAL HEALTH COUNSELING. IN 2022, THE CENTER SERVED 3,283 PATIENTS WITH 9,622 IN-PERSON VISITS AND 1,637 VIRTUAL VISITS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $794,544 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $767,763 | RevenueAmt |
| Desc | MEDICAL SOCIAL WORK & ALCOHOL AND OTHER DRUG ABUSE - LAKE SUPERIOR COMMUNITY HEALTH CENTER PROVIDES MEDICAL SOCIAL WORK SERVICES FOR LOW INCOME COMMUNITY MEMBERS. THESE SERVICES INCLUDE ELIGIBILITY SCREENING, APPLICATION ASSISTANCE, AND ADVOCACY FOR THOSE SEEKING ENROLLMENT IN PUBLIC HEALTH COVERAGE PROGRAMS SERVICES ALSO INCLUDE BASIC SOCIAL WORK ASSISTANCE SUCH AS COUNSELING, ADVOCACY, AND ASSISTED REFERRALS. IN 2022, THE CENTER SERVED 388 PATIENTS WITH 2,371 IN-PERSON VISITS AND 3,498 VIRTUAL VISITS IN BEHAVIORAL HEALTH AND 145 PATIENTS WITH 866 IN-PERSON VISITS IN AND 154 VIRTUAL VISITS IN SUBSTANCE USE DISORDER. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $760,762 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $735,121 | RevenueAmt |
| Desc | HEALTH CARE ACCESS OFFICE, INTEGRATED CARE COORDINATION, 340B PHARMACYPROGRAM | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $760,762 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $735,121 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $9,658,972 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 64 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 143 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATRINA JAWORSKI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2187221497 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2222 EAST 5TH STREET | AddressLine1Txt |
| City | SUPERIOR | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54880 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KIM TERHAAR | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $210 | $0 | $0 | |
| BOB LYMAN | |||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHELLY MARQUARDT | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ALECIA MCKAY-JONES | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SONYA ALSTONE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ALISON GONDIK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PRINCESS KISOB | |||||||
| DIRECTOR | 1.00 | Yes (X) | $280 | $0 | $0 | ||
| JEDEDIAH JANSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS RUS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DIANE HOLLIDAY-WELSH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DYANI BRADDICK | |||||||
| DIRECTOR | 1.00 | Yes (X) | $280 | $0 | $0 | ||
| CINDY CAPIN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TIMOTHY AUSMAN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $175 | $0 | $0 | ||
| HEATHER MICHAELS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $315 | $0 | $0 | ||
| HOLLY COMPO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AMY LOWINDOWKSI | |||||||
| DIRECTOR (THRU 3/22) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JESSIE PETERSON | |||||||
| CEO | 40.00 | Yes (X) | $139,132 | $0 | $20,471 | ||
| KATRINA JAWORSKI | |||||||
| CFO | 40.00 | Yes (X) | $95,394 | $0 | $13,514 | ||
| LEE HOMAN | |||||||
| COO | 40.00 | Yes (X) | $86,672 | $0 | $37,606 | ||
| CRYSTAL MEYER | |||||||
| CHRO | 40.00 | Yes (X) | $100,591 | $0 | $1,714 | ||
| EMILY ANDERSON | |||||||
| PHYSICIAN / MEDICAL DIRECTOR | 36.00 | $235,011 | $0 | $28,863 | Yes (X) | ||
| JACOB OESTREICH | |||||||
| PHYSICIAN | 32.00 | $174,117 | $0 | $44,687 | Yes (X) | ||
| JEFFREY BERTANI | |||||||
| DDS | 40.00 | $176,245 | $0 | $18,301 | Yes (X) | ||
| PRABHJOT ARRORA | |||||||
| DDS/DENTAL DIRECTOR | 40.00 | $179,976 | $0 | $24,431 | Yes (X) | ||
| YIN CAO | |||||||
| DDS | 40.00 | $192,161 | $0 | $21,326 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,380,559 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $210,913 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| WILLIAM AND NAIRI STACK TRUST | |||||
| 3119 HILL AVE | SUPERIOR | WI | 54880 | RENT | $656,965 |
| BENCO | |||||
| 295 CENTERPOINT BLVD | PITTSTON | PA | 18640 | DENTAL & MEDICAL SUPPLIES | $555,489 |
| NOR MN BREAKWATER HEALTH NETWORK | |||||
| 1346 W ARROWHEAD RD | DULUTH | MN | 55811 | NETWORK HOSTING | $386,594 |
| TRI-STATE LABS INC | |||||
| PO BOX 1148 | SUPERIOR | WI | 54880 | DENTAL LAB SERVICES | $176,746 |
| HENRY SCHEIN INC | |||||
| DEPT CH 10241 | PALASTINE | IL | 60055 | DENTAL & MEDICAL SUPPLIES | $152,133 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $33,702 | FederatedCampaignsAmt |
| Government Grants | $4,829,256 | GovernmentGrantsAmt |
| All Other Contributions | $252,641 | AllOtherContributionsAmt |
| Total Contributions | $5,115,599 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| DENTAL SERVICE REVENUE | 621300 | $4,649,320 | $4,649,320 |
| MEDICAL SERVICE REVENUE | 621110 | $3,181,206 | $3,181,206 |
| BEHAVIORAL HEALTH REVENUE | 621110 | $767,763 | $767,763 |
| 340B PROGRAM REVENUE | 456110 | $708,521 | $708,521 |
| HEALTH CARE ACCESS OFFICE | 624100 | $26,600 | $26,600 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $9,333,410 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,129 | TotalRevenueColumnAmt |
| Exclusion | $13,129 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $152,900 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$152,900 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$152,900 | TotalRevenueColumnAmt |
| Exclusion | -$152,900 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $16,008 | TotalRevenueColumnAmt |
| Exclusion | $16,008 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $16,008 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,325,246 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $9,333,410 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$123,763 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $489,605 | TotalAmt |
| Management And General | $489,605 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,613,356 | TotalAmt |
| Program Services | $5,689,657 | ProgramServicesAmt |
| Management And General | $916,402 | ManagementAndGeneralAmt |
| Fundraising | $7,297 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,995 | TotalAmt |
| Program Services | $153,138 | ProgramServicesAmt |
| Management And General | $29,603 | ManagementAndGeneralAmt |
| Fundraising | $254 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $868,669 | TotalAmt |
| Program Services | $726,942 | ProgramServicesAmt |
| Management And General | $140,522 | ManagementAndGeneralAmt |
| Fundraising | $1,205 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $557,394 | TotalAmt |
| Program Services | $446,362 | ProgramServicesAmt |
| Management And General | $110,496 | ManagementAndGeneralAmt |
| Fundraising | $536 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,318 | TotalAmt |
| Management And General | $34,318 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,925 | TotalAmt |
| Management And General | $45,925 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,055 | TotalAmt |
| Management And General | $1,055 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,593 | TotalAmt |
| Management And General | $2,593 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $580,684 | TotalAmt |
| Program Services | $409,649 | ProgramServicesAmt |
| Management And General | $171,035 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,964 | TotalAmt |
| Program Services | $27,878 | ProgramServicesAmt |
| Management And General | $37,086 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $588,730 | TotalAmt |
| Program Services | $233,934 | ProgramServicesAmt |
| Management And General | $354,796 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $368,863 | TotalAmt |
| Program Services | $21,715 | ProgramServicesAmt |
| Management And General | $347,148 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $793,738 | TotalAmt |
| Program Services | $381,743 | ProgramServicesAmt |
| Management And General | $411,995 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,318 | TotalAmt |
| Program Services | $13,715 | ProgramServicesAmt |
| Management And General | $7,603 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,464 | TotalAmt |
| Program Services | $17,612 | ProgramServicesAmt |
| Management And General | $7,852 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $345,608 | TotalAmt |
| Program Services | $253,390 | ProgramServicesAmt |
| Management And General | $92,218 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,169 | TotalAmt |
| Program Services | $1,608 | ProgramServicesAmt |
| Management And General | $64,561 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| 340B CONTRACT FEES | $391,437 | $391,100 | $337 |
| REPAIRS & MAINTENANCE | $359,793 | $124,448 | $235,345 |
| MEDICAL SUPPLIES | $330,774 | $322,205 | $8,569 |
| BAD DEBT | $303,288 | $303,288 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,283 | TotalAmt |
| Program Services | $140,588 | ProgramServicesAmt |
| Management And General | $96,695 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,274,023 | TotalAmt |
| Program Services | $9,658,972 | ProgramServicesAmt |
| Management And General | $3,605,759 | ManagementAndGeneralAmt |
| Fundraising | $9,292 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,100 | BOYAmt |
| EOY | $1,100 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,858,897 | BOYAmt |
| EOY | $6,987,657 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $354,988 | BOYAmt |
| EOY | $1,251,424 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $617,874 | BOYAmt |
| EOY | $485,395 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,110 | BOYAmt |
| EOY | $120,319 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,900,044 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,083,202 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,024,375 | BOYAmt |
| EOY | $7,816,842 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $745,753 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $90,876 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,917,344 | BOYAmt |
| EOY | $17,499,366 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,219,207 | BOYAmt |
| EOY | $1,129,765 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $155,628 | BOYAmt |
| EOY | $148,766 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $5,631,581 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,374,835 | BOYAmt |
| EOY | $6,910,112 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,442,509 | BOYAmt |
| EOY | $10,489,254 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100,000 | BOYAmt |
| EOY | $100,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,542,509 | BOYAmt |
| EOY | $10,589,254 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,917,344 | BOYAmt |
| EOY | $17,499,366 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,051,223 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,478 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,812,592 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,842,836 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,644,922 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,325,742 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,115,599 | CurrentTaxYearAmt |
| Total | $19,741,691 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,812,592 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,842,836 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,644,922 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,325,742 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,115,599 | CurrentTaxYearAmt |
| Total | $19,741,691 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $370,956 | SubstantialContributorsTotAmt |
| Public Support Total170 | $19,370,735 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $32,666 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $39,084 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,564 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $527 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,129 | CurrentTaxYearAmt |
| Total | $103,970 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $19,845,661 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $39,747,937 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97610 | PublicSupportCY170Pct |
| Public Support PY170 | 0.91640 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $1,055 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,055 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS A MEMBER OF THE WISCONSIN PRIMARY HEALTH CARE ASSOCIATION (WPHCA) AND THE MINNESOTA ASSOCIATION OF COMMUNITY HEALTH CENTERS (MNACHC). A PART OF THE MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS FOR LOBBYING EXPENDITURES. THE ORGANIZATIONS IN THEIR RESPECTIVE STATES ADVOCATE TO ENSURE THAT THE VOICE OF THEIR MEMBERS AND THEIR PATIENTS ARE HEARD LEGISLATIVELY IN ADDITION TO THE MANY OTHER NON-LOBBYING BENEFITS PROVIDED. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $50,000 | OtherCostOrOtherBasisAmt |
| Book Value | $50,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,065,109 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,505,036 | DepreciationAmt |
| Book Value | $6,560,073 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $79,044 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,682 | DepreciationAmt |
| Book Value | $65,362 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,391,281 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,564,484 | DepreciationAmt |
| Book Value | $826,797 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $314,610 | OtherCostOrOtherBasisAmt |
| Book Value | $314,610 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $7,816,842 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LEASE LIABILITY | Desc |
| Amt | $5,631,581 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,631,581 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $14,167,787 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$4,478 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$4,478 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,172,265 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $2,593 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $150,388 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $152,981 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,325,246 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,968,142 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,968,142 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $2,593 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $303,288 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $305,881 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,274,023 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 303,288. GAIN/LOSS ON SALE OF PROPERTY -152,900. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 303,288. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EMILY ANDERSON | ||||||||||||||
| PHYSICIAN / MEDICAL DIRECTOR | $233,549 | $0 | $1,462 | $0 | $0 | $0 | $10,250 | $0 | $18,613 | $0 | $263,874 | $0 | $0 | $0 |
| JACOB OESTREICH | ||||||||||||||
| PHYSICIAN | $172,818 | $0 | $1,299 | $0 | $0 | $0 | $10,250 | $0 | $34,437 | $0 | $218,804 | $0 | $0 | $0 |
| YIN CAO | ||||||||||||||
| DDS | $125,337 | $0 | $66,824 | $0 | $0 | $0 | $7,061 | $0 | $14,265 | $0 | $213,487 | $0 | $0 | $0 |
| PRABHJOT ARRORA | ||||||||||||||
| DDS/DENTAL DIRECTOR | $178,893 | $0 | $1,083 | $0 | $0 | $0 | $10,250 | $0 | $14,181 | $0 | $204,407 | $0 | $0 | $0 |
| JEFFREY BERTANI | ||||||||||||||
| DDS | $170,321 | $0 | $5,924 | $0 | $0 | $0 | $0 | $0 | $18,301 | $0 | $194,546 | $0 | $0 | $0 |
| JESSIE PETERSON | ||||||||||||||
| CEO | $138,820 | $0 | $312 | $0 | $0 | $0 | $6,750 | $0 | $13,721 | $0 | $159,603 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE CEO AND DIRECTOR OF FINANCE. FOLLOWING THEIR REVIEW, IT IS REVIEWED BY THE FINANCE COMMITTEE WHICH MAKES A RECOMMENDATION TO THE FULL BOARD OF DIRETORS TO APPROVE. THE BOARD OF DIRECTORS ISSUE FINAL APPROVAL PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATIONS'S BOARD OF DIRECTORS CONDUCT AN ANNUAL REVIEW AND DECLARATION OF THE CONFLICT OF INTEREST POLICY. AT THE TIME OF A CONFLICT, THE INTERESTED DIRECTOR MUST FULLY DISCLOSE TO THE REST OF THE BOARD OF DIRECTORS ANY POTENTIAL CONFLICT OF INTEREST. THE REMAINING BOARD OF DIRECTORS THEN AUTHORIZE, APPROVE, OR RATIFY THE CONTRACT OR TRANSACTION IN GOOD FAITH BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE DIRECTORS (WITHOUT INCLUDING THE INTERESTED DIRECTOR) AT A MEETING WHICH THERE IS A QUORUM WITHOUT COUNTING THE INTERESTED DIRECTOR. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION REVIEWS MARKET DATA AND SALARY SURVEYS ON AN ANNUAL BASIS. THIS DATA IS REVIEWED BY THE EXECUTIVE TEAM AND WAGE DECISIONS FOR THE UPCOMING YEAR ARE MADE AS PART OF THE BOARDS APPROVAL OF THE ANNUAL BUDGET. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2022. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND STATEMENTS AVAILABLE UPON REQUEST AT THE CENTER'S ADMINISTRATIVE OFFICES IN DULUTH, MN. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS FOR SELECTION AND OVERSIGHT OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |