2022-11-11T14:35:37-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-01-01 030445789 NATIVE AMERICAN COMMUNITY CLINIC NATI 6128728086 1213 E FRANKLIN AVENUE MINNEAPOLIS MN 554042923 DR ANTONY STATELY CEO 6128728086 2022-11-09 1 DR ANTONY STATELY 999009999 RYAN ENGEBRETSON P01585625 6123764500 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DR ANTONY STATELY 1213 E FRANKLIN AVENUE MINNEAPOLIS MN 554042923 16452828 0 X WWW.NACC-HEALTHCARE.ORG X 2002 MN PROMOTE WELLNESS OF BODY, MIND & SPIRIT & REGULAR HEALTH MAINTENANCE IN NATIVE AMERICAN FAMILIES. 11 11 119 12 0 0 5530356 11875208 3573761 4570577 5111 7043 0 0 9109228 16452828 0 0 0 0 6079889 6882412 0 0 0 2960203 3529475 9040092 10411887 69136 6040941 4996334 10466816 2320496 1750037 2675838 8716779 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 7968013 4490909 PROVIDES MEDICAL AND DENTAL CARE, REGULAR HEALTH MAINTENANCE, AND COUNSELING SERVICES TO NATIVE AMERICAN FAMILIES AND PATIENTS. THE ORGANIZATION HAD 21,201 VISITS DURING 2021. IN ADDITION, THE ORGANIZATION PROVIDES CARE TO PATIENTS, WHO MEET CERTAIN CRITERIA UNDER THE ORGANIZATION'S 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 COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. 7968013 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 36 0 1 119 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 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 DR KARIE RABIE CMO 40.00 X 216151 0 25540 DR ANTONY STATELY CEO 40.00 X 199032 0 24926 PHONG NGUYEN ADVANCED DENTAL THERAPIST 40.00 X 124350 0 12002 GREGG HARRISON COO 40.00 X 120486 0 21751 JENEATTA SINGH DIRECTOR OF FINANCE 40.00 X 115580 0 18563 GAIL MASON BEHAVIORAL HEALTH DIRECTOR 40.00 X 112382 0 8738 SHANNON KLINGELHULTZ CIO 40.00 X 104189 0 21986 TARA MCCULLOUGH NURSE PRACTIONER 40.00 X 101775 0 12143 EMILY PIETIG DENTAL DIRECTOR 40.00 X 100608 0 6038 JOSEPH HOBOT BOARD CHAIR 0.50 X X 0 0 0 LYLE IRON MOCCASIN VICE CHAIR 0.50 X X 0 0 0 B DON CROFUT TREASURER 0.50 X X 0 0 0 STEPHANIE GRAVES SECRETARY 0.50 X X 0 0 0 CAROL KRUSH DIRECTOR 0.50 X 0 0 0 JEAN FORSTER DIRECTOR 0.50 X 0 0 0 VALERIE LARSEN DIRECTOR 0.50 X 0 0 0 ANNA YOUNGERMAN DIRECTOR 0.50 X 0 0 0 ROBERT BLAKE DIRECTOR 0.50 X 0 0 0 JILL FISH DIRECTOR 0.50 X 0 0 0 RICHARD MASUR DIRECTOR 0.50 X 0 0 0 1194553 0 151687 9 0 1 0 FOX ADVANCEMENT 12501 HUNTINGDON LN MINNETONKA MN 55305 CAPITAL CAMPAIGN 151400 NETGAIN 720 W ST GERMAIN ST 200 SAINT CLOUD MN 56301 IT SERVICES AND EQUIPMENT 121735 VISULATIONS 7440 MINTWOOD LANE SPRING TX 77379 IT SERVICES AND EQUIPMENT 119098 3 9052989 2822219 25819 11875208 PATIENT REVENUES 621400 4490909 4490909 OTHER REVENUE 900099 79668 79668 4570577 7043 7043 16452828 4490909 0 86711 X 989324 494662 494662 4680740 4107065 573675 91183 69699 21484 705938 538029 167909 415227 338408 76819 63439 63439 38000 38000 1229850 1187523 42327 52865 1579 51286 86558 52601 33957 11213 10924 289 434894 302728 132166 812 812 13621 13621 477600 21192 456408 54793 3219 51574 PROGRAM & LAB SUPPLIES 809796 655219 154577 REPAIRS AND MAINTENANCE 109058 25356 83702 MN CARE TAX 51996 51996 CONTINUING EDUCATION 50949 46805 4144 44031 22196 21835 10411887 7968013 2443874 0 1205430 2601844 1516047 1518818 104319 1648326 1718610 53542 27352 6780977 2297404 558337 4483573 14652 12300 4996334 10466816 850196 638615 461422 400000 400000 1070300 250000 2320496 1750037 X 2675838 8716779 2675838 8716779 4996334 10466816 6040941 0 X X 0 1 X 1 1 1 X 2672785 2693070 3322817 5530356 11875208 26094236 2672785 2693070 3322817 5530356 11875208 26094236 26094236 2659 6165 8411 5111 7043 29389 26123625 17517033 0.99890 0.99860 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 38000 38000 0 PART II-B, LINE 1: LEGISLATIVE REPRESENTATION 2935000 2935000 1236529 268810 967719 1546493 1127251 419242 1062955 901343 161612 4483573 X 16452828 0 16452828 0 16452828 10411887 0 10411887 0 10411887 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 216151 0 0 0 0 0 0 0 25540 0 241691 0 0 0 DR ANTONY STATELY CEO 199032 0 0 0 0 0 0 0 24926 0 223958 0 0 0 X 315 25819 FAIR MARKET VALUE 0 0 0 PART I, LINE 30B: SCHEDULE M, PART I, COLUMN (B): PART I REPORTS THE NUMBER OF CONTRIBUTIONS 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 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 1,187,523. MANAGEMENT AND GENERAL EXPENSES 42,327. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,229,850. FORM 990, PART XII, LINE 2C: THE INDEPENDENT AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.