SOUTHSIDE COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHSIDE COMMUNITY HEALTH SERVICES INC (EIN 23-7113799)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-14
- IRS object ID
- 202303189349305895
- 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 | 2023-11-14T11:04:42-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | 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 | 237113799 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHSIDE COMMUNITY HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SOUT | BusinessNameControlTxt |
| Phone | 6128212025 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4243 FOURTH AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55409 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANN CAZABAN | PersonNm |
| Person Title | EXECUTIVE DIRECTOR | PersonTitleTxt |
| Phone | 6128212025 | PhoneNum |
| Signature | 2023-08-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ANN | PersonFirstNm |
| Person Last | CAZABAN | 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 | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2023-08-16 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | 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 | ANN CAZABAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4243 FOURTH AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55409 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,458,189 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SOUTHSIDECHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1971 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HIGH QUALITY HEALTH CARE IN THE COMMUNITIES SERVED. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 133 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,963,359 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,233,956 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,591,309 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,215,954 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,754 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,279 | CYInvestmentIncomeAmt |
| PY Other Revenue | $14,625 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $11,571,047 | PYTotalRevenueAmt |
| CY Total Revenue | $11,458,189 | 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 | $6,986,736 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,198,924 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $64,055 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $64,055 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,492,583 | PYOtherExpensesAmt |
| CY Other Expenses | $3,772,505 | CYOtherExpensesAmt |
| PY Total Expenses | $10,479,319 | PYTotalExpensesAmt |
| CY Total Expenses | $11,035,484 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,091,728 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $422,705 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,106,552 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,837,894 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,080,357 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,388,994 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,026,195 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,448,900 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES BY DELIVERING EXCEPTIONAL CARE, REMOVING BARRIERS, AND PROMOTING HEALTHY LIFESTYLES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,823,967 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $1,388,294 | RevenueAmt |
| Desc | MEDICAL:SOUTHSIDE COMMUNITY HEALTH SERVICES, INCE (SCHS) IS A 501(C)(3) NONPROFIT ORGANIZATION AND IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) LOCATED IN SOUTH MINNEAPOLIS. SOUTHSIDE MEDICAL CURRENTLY PROVIDES FAMILY PRACTICE MEDICINE INCLUDING SPECIAL PROGRAMS FOR AT RISK POPULATIONS, FAMILY PLANNING, PRENATAL AND PEDIATRICS. WHILE THE MAJORITY OF PATIENTS COME FROM THE SOUTHSIDE OF MINNEAPOLIS, SCHS CONTINUES TO HAVE AN "ESSENTIAL COMMUNITY SAFETY NET PROVIDER" DESIGNATION FROM THE STATE OF MINNESOTA. IN 2022, SOUTHSIDE SERVICED 12,766 MEDICAL PATIENT VISITS (NOT INCLUDING COVID-19 VACCINE VISITS: 15,739). | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $3,888,816 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $3,827,660 | RevenueAmt |
| Desc | DENTAL:SOUTHSIDE DENTAL CLINIC CURRENTLY PROVIDES GENERAL DENTAL SERVICES FOR PEOPLE OF ALL AGES. SOUTHSIDE CURRENTLY OPERATES FOURTEEN DENTAL OPERATORIES. IN 2022, THE DENTAL CLINIC PROVIDED 17,893 VISITS. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | OUTREACH:SOUTHSIDE'S OUTREACH PROGRAM PROVIDES THE COMMUNITY WITH INNOVATIVE PROGRAMS, ACTIVITIES AND EDUCATIONAL OPPORTUNITIES DESIGNED TO IMPROVE HEALTH LITERACY AND ASSIST PEOPLE IN GETTING INVOLVED IN THEIR PERSONAL HEALTH CARE. IT HAS BEEN PROVIDED THAT THE EARLIER HEALTHY PRACTICES ARE ESTABLISHED, THE BETTER THE QUALITY OF LIFE FOR THE INDIVIDUAL. THESE PRACTICES CAN INCLUDE HEALTH DIET, CONSISTENT EXERCISE, AND MONITORING LIFESTYLE CHOICES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp (2 entries)
| DescDesc |
|---|
| BEHAVIORAL HEALTH:SOUTHSIDE OPERATES A BEHAVIORAL HEALTH PRACTICE THAT IS INTEGRATED INTO PRIMARY CARE AND SERVICES INCLUDE THERAPY, FAMILY SUPPORT, SUBSTANCE ABUSE, COPING WITH CHRONIC CONDITIONS, AND MORE. IN 2022 THE BEHAVIORAL HEALTH PRACTICE PROVIDED 2,920 SERVICES. |
| EYE CLINIC:SOUTHSIDE VISION PROVIDES A FULL-SERVICE EYE CLINIC PROVIDING PRIMARY CARE OPTOMETRY TO A DIVERSE POPULATION. ITS SERVICES INCLUDE EYE EXAMS, DISTANCE VISION, NEAR VISION, DEPTH PERCEPTIONS, COLOR PERCEPTION, MUSCLE BALANCE, EYE COORDINATION, DIAGNOSIS AND TREATMENT OF EYE DISEASE (E.G., PINK EYE AND ALLERGIES), FRAMES AND LENSES, AND CONTACT LENSES. IN 2022 THE VISION PRACTICE PROVIDED 1,590 VISITS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $8,712,783 | 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 | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | 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 | Yes (1) | 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 | 34 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 133 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN PATRIKUS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6128212025 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4243 FOURTH AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55409 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 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 |
|---|---|---|---|---|---|---|---|
| ANGEL EVEN | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SHAUN ZEIG | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JAMES GALLAGHER | |||||||
| SECRETARY (THRU 07/2022) | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| D'WAYNE MORRIS | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MABY ALMIRON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| EMILY ANDERSON | |||||||
| DIRECTOR (THRU 05/2022) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KALEECA BIBLE | |||||||
| DIRECTOR (THRU 03/2022) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHELLE EVANS | |||||||
| DIRECTOR (THRU 07/2022) | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KRISTY GRAUME | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| YECTLI HUERTA | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JUAN LLERENA | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRIAN OSBERG | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARIKA REECE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATIE THOMPSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ANN CAZABAN | |||||||
| EXECUTIVE DIRECTOR | 40.00 | Yes (X) | $187,507 | $0 | $6,542 | ||
| MARK BUECHELE | |||||||
| CHIEF FINANCIAL OFFICER | 11.00 | Yes (X) | $103,421 | $0 | $0 | ||
| MOHIUDDIN QUADRI | |||||||
| DENTIST | 40.00 | $147,955 | $0 | $16,237 | Yes (X) | ||
| JAMES ADAMCZAK | |||||||
| DENTIST | 40.00 | $155,814 | $0 | $15,987 | Yes (X) | ||
| DANIEL GINGERICH-BOBERG | |||||||
| PHYSICIAN | 40.00 | $129,469 | $0 | $34,413 | Yes (X) | ||
| JANELLE KARLSRUD | |||||||
| DENTAL DIRECTOR | 40.00 | $151,754 | $0 | $6,169 | Yes (X) | ||
| BRIAN QUINLAN | |||||||
| DENTAL DIRECTOR | 40.00 | $182,349 | $0 | $16,510 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,058,269 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $95,858 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| GLORIMAR RIVERA | |||||
| 4243 FOURTH AVENUE SOUTH | MINNEAPOLIS | MN | 55409 | BILLING SERVICES | $306,109 |
| OCHIN | |||||
| 1881 SW NAITO PARKWAY | PORTLAND | OR | 97201 | EMR/PRACTICE MANAGEMENT SYSTEM | $280,755 |
| 4RMULA | |||||
| 275 EAST 4TH STREET SUITE 400 | ST PAUL | MN | 55101 | ARCHITECTURAL/DESIGN SERVICES | $232,819 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 775460 | CHICAGO | IL | 60677 | REFERENCE LAB SERVICES | $173,445 |
| LOFFLER | |||||
| PO BOX 1511 BIN 131511 | MINNEAPOLIS | MN | 55480 | IT SERVICES | $119,995 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,854,714 | GovernmentGrantsAmt |
| All Other Contributions | $379,242 | AllOtherContributionsAmt |
| Total Contributions | $6,233,956 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| DENTAL SERVICES | 621400 | $3,834,520 | $3,834,520 |
| MEDICAL SERVICES | 621400 | $1,360,416 | $1,360,416 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,018 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,018 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,215,954 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,279 | TotalRevenueColumnAmt |
| Exclusion | $8,279 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,458,189 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,215,954 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $8,279 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $297,470 | TotalAmt |
| Management And General | $297,470 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,884,823 | TotalAmt |
| Program Services | $5,141,427 | ProgramServicesAmt |
| Management And General | $743,396 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $154,390 | TotalAmt |
| Program Services | $129,690 | ProgramServicesAmt |
| Management And General | $24,700 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $336,374 | TotalAmt |
| Program Services | $335,143 | ProgramServicesAmt |
| Management And General | $1,231 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $525,867 | TotalAmt |
| Program Services | $440,526 | ProgramServicesAmt |
| Management And General | $85,341 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,330 | TotalAmt |
| Management And General | $6,330 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25 | TotalAmt |
| Management And General | $25 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366 | TotalAmt |
| Management And General | $366 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,055 | TotalAmt |
| Fundraising | $64,055 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,170,047 | TotalAmt |
| Program Services | $482,801 | ProgramServicesAmt |
| Management And General | $687,246 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,094 | TotalAmt |
| Management And General | $14,094 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,916 | TotalAmt |
| Program Services | $401,550 | ProgramServicesAmt |
| Management And General | $4,366 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $509,087 | TotalAmt |
| Program Services | $489,683 | ProgramServicesAmt |
| Management And General | $19,404 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $265,613 | TotalAmt |
| Program Services | $150,043 | ProgramServicesAmt |
| Management And General | $115,570 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,180 | TotalAmt |
| Program Services | $7,289 | ProgramServicesAmt |
| Management And General | $25,891 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,990 | TotalAmt |
| Program Services | $19,668 | ProgramServicesAmt |
| Management And General | $99,322 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,829 | TotalAmt |
| Program Services | $3,749 | ProgramServicesAmt |
| Management And General | $24,080 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $396,136 | TotalAmt |
| Program Services | $314,452 | ProgramServicesAmt |
| Management And General | $81,684 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,898 | TotalAmt |
| Program Services | $7,789 | ProgramServicesAmt |
| Management And General | $11,109 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROGRAM SUPPLIES | $446,243 | $445,703 | $540 |
| BAD DEBT EXPENSE | $178,902 | $178,902 | |
| MN PROVIDER TAXES | $158,600 | $158,600 | |
| DUES & SUBSCRIPTIONS | $18,920 | $2,439 | $16,481 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,329 | TotalAmt |
| Program Services | $3,329 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,035,484 | TotalAmt |
| Program Services | $8,712,783 | ProgramServicesAmt |
| Management And General | $2,258,646 | ManagementAndGeneralAmt |
| Fundraising | $64,055 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,243 | BOYAmt |
| EOY | $781,492 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,751,754 | BOYAmt |
| EOY | $2,060,033 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $142,779 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $465,193 | BOYAmt |
| EOY | $443,319 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,073 | BOYAmt |
| EOY | $65,331 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,674,756 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,351,331 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,205,289 | BOYAmt |
| EOY | $1,323,425 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $21,515 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,106,552 | BOYAmt |
| EOY | $4,837,894 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $622,201 | BOYAmt |
| EOY | $954,864 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $458,156 | BOYAmt |
| EOY | $413,668 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $20,462 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,080,357 | BOYAmt |
| EOY | $1,388,994 | 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 | $3,026,195 | BOYAmt |
| EOY | $3,448,900 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,026,195 | BOYAmt |
| EOY | $3,448,900 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,106,552 | BOYAmt |
| EOY | $4,837,894 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $422,705 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,226,004 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,327,833 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $5,625,759 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,963,359 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $6,233,956 | CurrentTaxYearAmt |
| Total | $25,376,911 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,981,110 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,096,391 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,965,507 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,591,309 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,215,954 | CurrentTaxYearAmt |
| Total | $23,850,271 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,207,114 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,424,224 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,591,266 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,554,668 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,449,910 | CurrentTaxYearAmt |
| Total | $49,227,182 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $49,227,182 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $1,754 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,279 | CurrentTaxYearAmt |
| Total | $10,033 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $1,754 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,279 | CurrentTaxYearAmt |
| Total | $10,033 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $48,611 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $47,489 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,769 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $14,625 | CurrentTaxYearMinus1YearAmt |
| Total | $129,494 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,255,725 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $9,471,713 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,610,035 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $11,571,047 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $11,458,189 | CurrentTaxYearAmt |
| Total | $49,366,709 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99720 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99510 | PublicSupportPY509Pct |
| Investment Income CY | 0.00020 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
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 | $366 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $366 | 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 | 4% OF MNACHC MEMBERSHIP DUES FOR THE YEAR GO TOWARDS LOBBYING AND OTHER ADVOCACY ON BEHALF OF MEMBERS. THESE EFFORTS TEND TO ADVOCATE ON THE BEHALF OF THE MEMBERS THE STATE LEGISLATURE REGARDING THE MINNESOTA HEALTH DEPARTMENT FQHC SUBSIDY AND OTHER LEGISLATIVE ISSUES AROUND MEDICAID REIMBURSEMENT AS WELL AS OTHER TOPICS THAT IMPACT COMMUNITY HEALTH CENTERS IN THE STATE. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $130,543 | OtherCostOrOtherBasisAmt |
| Book Value | $130,543 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,289,188 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,029,692 | DepreciationAmt |
| Book Value | $259,496 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $315,603 | OtherCostOrOtherBasisAmt |
| Depreciation | $315,603 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,468,312 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,006,036 | DepreciationAmt |
| Book Value | $462,276 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $471,110 | OtherCostOrOtherBasisAmt |
| Book Value | $471,110 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,323,425 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LEASE LIABILITY | Desc |
| Amt | $20,462 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $20,462 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $11,279,287 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$178,902 | OtherRevenueAmt |
| Revenue Not Reported | -$178,902 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,458,189 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,458,189 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,856,582 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,856,582 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $178,902 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $178,902 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,035,484 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -178,902. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 178,902. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Email Solicitations | Yes (X) | EmailSolicitationsInd |
| Phone Solicitations | Yes (X) | PhoneSolicitationsInd |
| Solicitation Of Non Govt Grants | Yes (X) | SolicitationOfNonGovtGrantsInd |
| Solicitation Of Govt Grants | Yes (X) | SolicitationOfGovtGrantsInd |
| Agrmt Prof Fundraising Acty | Yes (1) | AgrmtProfFundraisingActyInd |
Fundraiser Activity Info FundraiserActivityInfoGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | ActivityActivityTxt | Fundraiser Control Of FundsFundraiserControlOfFundsInd | Gross ReceiptsGrossReceiptsAmt | Retained By ContractorRetainedByContractorAmt | Net To OrganizationNetToOrganizationAmt |
|---|---|---|---|---|---|---|---|---|
| BLASEG FUNDRAISING | ||||||||
| 8086 EAST LAKE CARLOS DRIVE NE | CARLOS | MN | 56319 | FUNDRAISING CONSULTING FOR CAPITAL CAMPAIGN FOR NEW BUILDING | 0 | $0 | $45,100 | -$45,100 |
| NONPROFIT FUNDRAISING PARTNERS LLC | ||||||||
| 1711 VAN HISE AVENUE | MADISON | WI | 53726 | FUNDRAISING CONSULTING FOR CAPITAL CAMPAIGN FOR NEW BUILDING | 0 | $0 | $18,955 | -$18,955 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Retained By Contractors | $64,055 | TotalRetainedByContractorsAmt |
| Total Net To Organization | -$64,055 | TotalNetToOrganizationAmt |
| Licensed States | MN | LicensedStatesCd |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRIAN QUINLAN | ||||||||||||||
| DENTAL DIRECTOR | $182,349 | $0 | $0 | $0 | $0 | $0 | $6,364 | $0 | $10,146 | $0 | $198,859 | $0 | $0 | $0 |
| ANN CAZABAN | ||||||||||||||
| EXECUTIVE DIRECTOR | $187,507 | $0 | $0 | $0 | $0 | $0 | $6,350 | $0 | $192 | $0 | $194,049 | $0 | $0 | $0 |
| JAMES ADAMCZAK | ||||||||||||||
| DENTIST | $155,814 | $0 | $0 | $0 | $0 | $0 | $6,444 | $0 | $9,543 | $0 | $171,801 | $0 | $0 | $0 |
| MOHIUDDIN QUADRI | ||||||||||||||
| DENTIST | $147,955 | $0 | $0 | $0 | $0 | $0 | $6,091 | $0 | $10,146 | $0 | $164,192 | $0 | $0 | $0 |
| DANIEL GINGERICH-BOBERG | ||||||||||||||
| PHYSICIAN | $129,469 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $34,413 | $0 | $163,882 | $0 | $0 | $0 |
| JANELLE KARLSRUD | ||||||||||||||
| DENTAL DIRECTOR | $151,754 | $0 | $0 | $0 | $0 | $0 | $6,070 | $0 | $99 | $0 | $157,923 | $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 | A DRAFT OF FORM 990 IS PRESENTED TO THE EXECUTIVE COMMITTEE FOR REVIEW AND QUESTIONS. ONCE APPROVED BY THE COMMITTEE, FORM 990 WILL BE FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE REQUIRED TO BE UPDATED ANNUALLY FOR ALL BOARD MEMBERS AND EMPLOYEES. ANY CONFLICT OF INTEREST MUST BE IMMEDIATELY DISCLOSED TO THE EXECUTIVE DIRECTOR IN WRITING. NO MEMBER OF THE BOARD MAY VOTE ON MATTERS ON ANY AREA WHERE THEY MAY RECEIVE FINANCIAL GAIN, OR WHICH MAY CONFLICT WITH MEMBER OBLIGATIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE DIRECTOR REVIEWS AND APPROVES THE COMPENSATION OF THE OTHER OFFICERS USING A MARKET SURVEY CONDUCTED BY AN OUTSIDE HR CONSULTANT. THE EXECUTIVE COMMITTEE USED EXECUTIVE SALARY SURVEYS FOR COMPARABILITY PURPOSES TO UPDATE THE EXECUTIVE DIRECTOR'S COMPENSATION. THE DECISION OF THE EXECUTIVE COMMITTEE WAS ALSO REVIEWED AND APPROVED BY THE FULL BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 265,007. MANAGEMENT AND GENERAL EXPENSES 687,246. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 952,253. LAB FEES: PROGRAM SERVICE EXPENSES 217,794. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 217,794. |