2023-11-06T16:23:56-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-01-01 030445789 NATIVE AMERICAN COMMUNITY CLINIC NATI 6128728086 1213 E FRANKLIN AVENUE MINNEAPOLIS MN 554042923 DR ANTONY STATELY CEO 6128728086 2023-10-31 1 DR ANTONY STATELY 999009999 0 RYAN ENGEBRETSON P01585625 6123764500 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DR ANTONY STATELY 1213 E FRANKLIN AVENUE MINNEAPOLIS MN 554042923 13300905 0 X WWW.NACC-HEALTHCARE.ORG X 2002 MN PROMOTE WELLNESS OF BODY, MIND & SPIRIT & REGULAR HEALTH MAINTENANCE IN NATIVE AMERICAN FAMILIES. 17 17 129 10 0 0 11875208 7288913 4570577 6000868 7043 11124 0 0 16452828 13300905 0 0 0 0 6882412 8796190 0 0 0 3529475 3923821 10411887 12720011 6040941 580894 10466816 11559278 1750037 2261605 8716779 9297673 TO PROMOTE WELLNESS AND REGULAR HEALTH MAINTENANCE IN NATIVE AMERICAN FAMILIES, TO DECREASE HEALTH DISPARITY IN THE NATIVE AMERICANS IN THE METRO AREA, AND TO PROVIDE ACCESS TO QUALITY CARE REGARDLESS OF ABILITY TO PAY. 0 0 9141194 0 5889405 PROVIDES MEDICAL, DENTAL, BEHAVIORAL HEALTH AND CHEMICAL HEALTH SERVICES TO NATIVE AMERICAN FAMILIES AND PATIENTS. THE ORGANIZATION HAD 19,897 VISITS DURING 2022. IN ADDITION THE ORGANIZATION PROVIDES CARE TO PATIENTS, WHO MEET CERTAIN CRITERIA UNDER THE ORGANIZATIONS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE ORGANIZATION BELIEVES THE UNDERSERVED ARE THOSE PERSONS WHO ARE UNABLE THROUGH PRIVATE RESOURCES, EMPLOYER SUPPORT OR PUBLIC AID TO PROVIDE PAYMENT FOR HEALTH CARE SERVICES OR THOSE UNABLE TO GAIN ACCESS TO HEALTH RELATED CARE BECAUSE OF LIMITED RESOURCES, INADEQUATE EDUCATION, OR DISCRIMINATION. BECAUSE THE ORGANIZATION DOES NOT PURSUE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. 9141194 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 27 0 1 129 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JENNY SINGH 6128435995 1213 EAST FRANKLIN AVENUE MINNEAPOLIS MN 55404 JOE HOBOT BOARD - CHAIR 0.50 X X 0 0 0 LYLE IRON MOCCASIN BOARD VICE CHAIR 0.50 X X 0 0 0 B DON CROFUT BOARD TREASURER 0.50 X X 0 0 0 STEPHANIE GRAVES BOARD SECRETARY 0.50 X X 0 0 0 CAROL KRUSH BOARD MEMEBER 0.50 X 0 0 0 JEAN FORSTER BOARD MEMEBER 0.50 X 0 0 0 VALERIE LARSEN BOARD MEMBER 0.50 X 0 0 0 ANNA YOUNGERMAN BOARD MEMBER 0.50 X 0 0 0 ROBERT BLAKE BOARD MEMBER 0.50 X 0 0 0 JILL FISH BOARD MEMBER 0.50 X 0 0 0 RICHARD MASUR BOARD MEMBER 0.50 X 0 0 0 LAUREN GILCHRIST BOARD MEMBER 0.50 X 0 0 0 NICHOLE SUBOLA BOARD MEMBER 0.50 X 0 0 0 JOE BEAULIEU BOARD MEMBER 0.50 X 0 0 0 CHARLA SHEFFIELD BOARD MEMBER 0.50 X 0 0 0 AARON ROBINSON BOARD MEMBER 0.50 X 0 0 0 COLLEEN MCDONALD BOARD MEMBER 0.60 X 0 0 0 DR KARIE RABIE CMO 40.00 X 206926 0 30173 DR ANTONY STATELY CEO 40.00 X 186607 0 30704 GREGG HARRISON COO 40.00 X 118316 0 26784 JENEATTA SINGH FINANCE OFFICER 40.00 X 114745 0 24159 SHANNON KLINGELHULTZ CIO 40.00 X 110003 0 25895 STACEY MARTINEZ MEDICAL DIRECTOR 40.00 X 105806 0 27057 GAIL MASON BEHAVIORAL HEALTH DIRECTOR 40.00 X 111278 0 10347 EMILY PIETIG DENTAL DIRECTOR 40.00 X 166857 0 28126 VALERIE NORRIS PEDIATRICIAN 30.00 X 129357 0 10966 PHONG NGUYEN ADVANCED DENTAL THERAPIST 40.00 X 119748 0 15737 1369643 0 229948 11 0 1 0 HEALTHPARTNERS PO BOX 772648 DETROIT MI 48277 EMPLOYEE HEALTH BENEFIT 1132879 JP MCDONALD CONSTRUCTION 701 DECATUR AVE N SUITE 202 GOLDEN VALLEY MN 55427 CONTRACTOR FOR CONSTRUCTION 486153 FUTURE BENEFITS OF AMERICA 11177 US-70 201 ARLINGTON TN 38002 401K CONTRIBUTIONS - EMPLOYEE AND EMPLOY 437384 VISUALUTIONS 7440 MINTWOOD LANE SPRING TX 77379 IT 231502 FOX ADVANCEMENT 12501 HUNTINGDON LN MINNETONKA MN 55305 CAPITAL CAMPAIGN FUNDRAISING 143319 8 5695634 1593279 232425 7288913 PATIENT REVENUES 621400 5889405 5889405 OTHER REVENUE 900099 111463 111463 6000868 11124 11124 13300905 5889405 0 122587 X 1128802 564401 564401 6008036 4981781 1026255 111923 87758 24165 934916 782809 152107 612513 480266 132247 7686 7686 52211 52211 38000 38000 1424201 373280 1050921 79458 53072 26386 150610 67051 83559 209984 119951 90033 15028 15028 526343 394757 131586 66774 5000 61774 PROGRAM & LAB SUPPLIES 1013660 1013660 REPAIRS AND MAINTENANCE 157460 29704 127756 MN CARE TAX 74255 74255 MISCELLANEOUS EXPENSE 50478 43509 6969 57673 31940 25733 12720011 9141194 3578817 0 2601844 2373726 1518818 1524230 104319 334453 1718610 2340605 27352 87733 7363514 2569176 4483573 4794338 12300 104193 10466816 11559278 638615 1017787 461422 532258 400000 368500 250000 250000 0 93060 1750037 2261605 X 8716779 9297673 8716779 9297673 10466816 11559278 580894 0 X 0 1 X 1 1 1 X 2693070 3322817 5530356 11875208 7288913 30710364 2693070 3322817 5530356 11875208 7288913 30710364 30710364 6165 8411 5111 7043 11124 37854 30748218 20559011 0.99880 0.99890 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 38000 38000 0 PART II-B, LINE 1: LEGISLATIVE REPRESENTATION 2935000 2935000 1236529 591383 645146 2047001 1344433 702568 1144984 633360 511624 4794338 SHORT TERM LEASE LIABILITY 58399 LONG TERM LEASE LIABILITY 34661 93060 X 13300905 0 13300905 0 13300905 12720011 0 12720011 0 12720011 PART X, LINE 2: THE ORGANIZATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE FEDERAL INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX PROVISIONS. THE IMPLEMENTATION OF THE ACCOUNTING STANDARDS REGARDING UNCERTAIN TAX PROVISIONS HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS OR AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. X X X 0 0 0 0 0 0 0 0 0 DR KARIE RABIE CMO 206926 0 0 0 0 0 0 0 30173 0 237099 0 0 0 DR ANTONY STATELY CEO 186607 0 0 0 0 0 0 0 30704 0 217311 0 0 0 EMILY PIETIG DENTAL DIRECTOR 166857 0 0 0 0 0 0 0 28126 0 194983 0 0 0 X 391 232425 FAIR MARKET VALUE 0 0 0 0 PART I, COLUMN (B): PART I REPORTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE OFFICERS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE AFFAIRS, DAY TO DAY OPERATIONS AND GENERAL BUSINESS OF THIS CORPORATION. THE EXECUTIVE COMMITTEE IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS AND PROVIDES REPORTS TO THE BOARD OF DIRECTORS AT ITS REGULAR MEETINGS AND AS THE BOARD OF DIRECTORS OTHERWISE DETERMINES. IF NO CEO IS EMPLOYED, THE EXECUTIVE COMMITTEE ASSUMES THE ROLES AND RESPONSIBILITIES OF THE CEO. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED THEIR BYLAWS TO INCLUDE THE FOLLOWING UPDATES: -SECTION 3.9 BY MAIL BALLOT SHOULD BE DELETED -SECTION 3.1 STATES 51% OF BOARD MEMBERS NEED TO BE PATIENTS AT THE CLINIC. DR. STATELY EXPLAINED TO NEW BOARD MEMBERS THAT THE REQUIREMENT IS TO HAVE A VISIT AT NACC. FLU SHOTS AND OTHER PREVENTATIVE CARE COUNTS -SECTION 3.1 HEALTH CARE INDUSTRY: DEFINED AS PEOPLE WHO ARE LICENSED INDIVIDUALS THAT CURRENTLY PROVIDE CARE TO PATIENTS FORM 990, PART VI, SECTION B, LINE 11B BOTH THE MANAGEMENT AND BOARD OF DIRECTORS OF NATIVE AMERICAN COMMUNITY CLINIC REVIEWED THE FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS. IF A DIRECTOR HAS AN ACTUAL OR POTENTIAL CONFLICT, THEY ARE REQUIRED TO DISCLOSE THE MATERIAL FACTS TO THE BOARD OF DIRECTORS WHO DETERMINE IF A CONFLICT EXISTS. AN INTERESTED PERSON MAY NOT VOTE ON ANY MATTERS RELATED TO AN ACTUAL OR POTENTIAL CONFLICT. IN ADDITION, THE INTERESTED PERSON IS NOT COUNTED IN DETERMINING THE PRESENCE OF A QUORUM. THE MINUTES OF THE MEETING REFLECT THE DISCLOSURE MADE, THE INTERESTED PERSON'S ABSTENTION FROM VOTING, AND WHETHER A QUORUM WAS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 FOR OFFICERS, KEY EMPLOYEES AND HIGHEST PAID INDIVIDUALS, COMPENSATION WAS DETERMINED BY RESEARCHING THE RANGE OF SALARIES FOR COMPARABLE POSITIONS IN SIMILAR CLINICAL SETTINGS. COMPENSATION WAS BASED ON THE AVERAGE IN EACH SALARY RANGE. SINCE NATIVE AMERICAN COMMUNITY CLINIC IS A NOT-FOR-PROFIT ORGANIZATION, PHYSICIANS' SALARIES ARE BELOW-MARKET, BUT ARE IN LINE WITH COMPARABLE POSITIONS IN SIMILAR ORGANIZATIONS. BOARD APPROVAL FOR ALL EMPLOYEES WAS BASED ON RESEARCH FINDINGS AND NATIVE AMERICAN COMMUNITY CLINIC BUDGET ALLOWANCE. THIS RESEARCH WAS LAST PERFORMED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 373,280. MANAGEMENT AND GENERAL EXPENSES 1,050,921. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,424,201.