2023-10-03T13:27:36-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-01-01 237167576 LAKE SUPERIOR COMMUNITY HEALTH CENTER LAKE 2187221497 4325 GRAND AVE DULUTH MN 55807 JESSIE PETERSON CEO 2187221497 2023-10-02 1 JESSIE PETERSON 999009999 0 RYAN ENGEBRETSON P01585625 6123764500 2023-09-26 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z JESSIE PETERSON 4325 GRAND AVE DULUTH MN 55807 14478146 0 X WWW.LSCHC.ORG X 1972 MN 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. 15 15 143 20 0 0 4325742 5115599 9582713 9333410 527 -139771 93206 16008 14002188 14325246 0 0 0 0 8984995 8712019 0 0 9292 3643708 4562004 12628703 13274023 1373485 1051223 10917344 17499366 1374835 6910112 9542509 10589254 X TO IMPROVE ACCESS TO QUALITY HEALTH CARE FOR ALL. 0 0 4811495 0 4649320 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. 3292171 0 3181206 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. 794544 0 767763 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. 760762 0 735121 HEALTH CARE ACCESS OFFICE, INTEGRATED CARE COORDINATION, 340B PHARMACYPROGRAM 760762 0 735121 9658972 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 64 0 1 143 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN WI X KATRINA JAWORSKI 2187221497 2222 EAST 5TH STREET SUPERIOR WI 54880 KIM TERHAAR SECRETARY 1.00 X X 210 0 0 BOB LYMAN VICE CHAIR 1.00 X X 0 0 0 SHELLY MARQUARDT CHAIR 1.00 X X 0 0 0 ALECIA MCKAY-JONES TREASURER 1.00 X X 0 0 0 SONYA ALSTONE DIRECTOR 1.00 X 0 0 0 ALISON GONDIK DIRECTOR 1.00 X 0 0 0 PRINCESS KISOB DIRECTOR 1.00 X 280 0 0 JEDEDIAH JANSON DIRECTOR 1.00 X 0 0 0 CHRIS RUS DIRECTOR 1.00 X 0 0 0 DIANE HOLLIDAY-WELSH DIRECTOR 1.00 X 0 0 0 DYANI BRADDICK DIRECTOR 1.00 X 280 0 0 CINDY CAPIN DIRECTOR 1.00 X 0 0 0 TIMOTHY AUSMAN DIRECTOR 1.00 X 175 0 0 HEATHER MICHAELS DIRECTOR 1.00 X 315 0 0 HOLLY COMPO DIRECTOR 1.00 X 0 0 0 AMY LOWINDOWKSI DIRECTOR (THRU 3/22) 1.00 X 0 0 0 JESSIE PETERSON CEO 40.00 X 139132 0 20471 KATRINA JAWORSKI CFO 40.00 X 95394 0 13514 LEE HOMAN COO 40.00 X 86672 0 37606 CRYSTAL MEYER CHRO 40.00 X 100591 0 1714 EMILY ANDERSON PHYSICIAN / MEDICAL DIRECTOR 36.00 X 235011 0 28863 JACOB OESTREICH PHYSICIAN 32.00 X 174117 0 44687 JEFFREY BERTANI DDS 40.00 X 176245 0 18301 PRABHJOT ARRORA DDS/DENTAL DIRECTOR 40.00 X 179976 0 24431 YIN CAO DDS 40.00 X 192161 0 21326 1380559 0 210913 14 0 1 0 WILLIAM AND NAIRI STACK TRUST 3119 HILL AVE SUPERIOR WI 54880 RENT 656965 BENCO 295 CENTERPOINT BLVD PITTSTON PA 18640 DENTAL & MEDICAL SUPPLIES 555489 NOR MN BREAKWATER HEALTH NETWORK 1346 W ARROWHEAD RD DULUTH MN 55811 NETWORK HOSTING 386594 TRI-STATE LABS INC PO BOX 1148 SUPERIOR WI 54880 DENTAL LAB SERVICES 176746 HENRY SCHEIN INC DEPT CH 10241 PALASTINE IL 60055 DENTAL & MEDICAL SUPPLIES 152133 5 33702 4829256 252641 5115599 DENTAL SERVICE REVENUE 621300 4649320 4649320 MEDICAL SERVICE REVENUE 621110 3181206 3181206 BEHAVIORAL HEALTH REVENUE 621110 767763 767763 340B PROGRAM REVENUE 456110 708521 708521 HEALTH CARE ACCESS OFFICE 624100 26600 26600 9333410 13129 13129 152900 -152900 -152900 -152900 MISCELLANEOUS REVENUE 900099 16008 16008 16008 14325246 9333410 0 -123763 489605 489605 6613356 5689657 916402 7297 182995 153138 29603 254 868669 726942 140522 1205 557394 446362 110496 536 34318 34318 45925 45925 1055 1055 2593 2593 580684 409649 171035 64964 27878 37086 588730 233934 354796 368863 21715 347148 793738 381743 411995 21318 13715 7603 25464 17612 7852 345608 253390 92218 66169 1608 64561 340B CONTRACT FEES 391437 391100 337 REPAIRS & MAINTENANCE 359793 124448 235345 MEDICAL SUPPLIES 330774 322205 8569 BAD DEBT 303288 303288 237283 140588 96695 13274023 9658972 3605759 9292 1100 1100 7858897 6987657 354988 1251424 617874 485395 60110 120319 11900044 4083202 2024375 7816842 745753 0 90876 10917344 17499366 1219207 1129765 0 155628 148766 0 5631581 1374835 6910112 X 9442509 10489254 100000 100000 9542509 10589254 10917344 17499366 1051223 -4478 0 X X 0 1 X 1 1 1 X 2812592 2842836 4644922 4325742 5115599 19741691 2812592 2842836 4644922 4325742 5115599 19741691 370956 19370735 32666 39084 18564 527 13129 103970 19845661 39747937 0.97610 0.91640 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1055 1055 0 PART II-B, LINE 1: 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. 50000 50000 8065109 1505036 6560073 79044 13682 65362 3391281 2564484 826797 314610 314610 7816842 LEASE LIABILITY 5631581 5631581 14167787 -4478 -4478 14172265 2593 150388 152981 14325246 12968142 0 12968142 2593 303288 305881 13274023 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. X X 0 0 0 0 0 0 0 0 0 EMILY ANDERSON PHYSICIAN / MEDICAL DIRECTOR 233549 0 1462 0 0 0 10250 0 18613 0 263874 0 0 0 JACOB OESTREICH PHYSICIAN 172818 0 1299 0 0 0 10250 0 34437 0 218804 0 0 0 YIN CAO DDS 125337 0 66824 0 0 0 7061 0 14265 0 213487 0 0 0 PRABHJOT ARRORA DDS/DENTAL DIRECTOR 178893 0 1083 0 0 0 10250 0 14181 0 204407 0 0 0 JEFFREY BERTANI DDS 170321 0 5924 0 0 0 0 0 18301 0 194546 0 0 0 JESSIE PETERSON CEO 138820 0 312 0 0 0 6750 0 13721 0 159603 0 0 0 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.