2021-11-17T06:08:19-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 030445789 NATIVE AMERICAN COMMUNITY CLINIC NATI 6128728086 1213 E FRANKLIN AVENUE MINNEAPOLIS MN 554042923 DR ANTONY STATELY CEO 6128728086 2021-11-16 1 DR ANTONY STATELY 999009999 RYAN ENGEBRETSON P01585625 6123764500 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DR ANTONY STATELY 1213 E FRANKLIN AVENUE MINNEAPOLIS MN 554042923 9109228 0 X WWW.NACC-HEALTHCARE.ORG X 2002 MN PROMOTE WELLNESS OF BODY, MIND & SPIRIT & REGULAR HEALTH MAINTENANCE IN NATIVE AMERICAN FAMILIES. 9 9 115 0 0 0 3322817 5530356 3817137 3573761 8411 5111 0 0 7148365 9109228 0 0 0 0 5267213 6079889 0 0 0 2424608 2960203 7691821 9040092 -543456 69136 3287567 4996334 680865 2320496 2606702 2675838 X 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. 1 1 6463003 3355000 PROVIDES MEDICAL AND DENTAL CARE, REGULAR HEALTH MAINTENANCE, AND COUNSELING SERVICES TO NATIVE AMERICAN FAMILIES AND PATIENTS. THE ORGANIZATION HAD 19,690 VISITS DURING 2020. 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. 6463003 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 22 0 115 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 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 PATINA PARK BOARD CHAIR TIL 03/20 0.50 X X 0 0 0 JOSEPH HOBOT BOARD CHAIR 0.50 X X 0 0 0 CAROL KRUSH BOARD MEMBER 0.50 X X 0 0 0 B DON CROFUT TREASURER 0.50 X 0 0 0 JEAN FORSTER BOARD MEMBER 0.50 X 0 0 0 STEPHANIE GRAVES SECRETARY 0.50 X 0 0 0 LYLE IRON MOCCASIN VICE CHAIR 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 DR KARIE RABIE CMO 40.00 X 218279 0 22559 DR ANTONY STATELY CEO 40.00 X 184008 0 23787 SHERRY RINGBERG INTERIM CFO 35.00 X 0 0 0 LAURELLE MYHRA DIRECTOR OF BEHAVIORAL HEA 40.00 X 139874 0 20378 SHANNON FAHEY CIO 40.00 X 122720 0 19390 JENEATTA SINGH DIRECTOR OF FINANCE 40.00 X 96362 0 15645 GREGG HARRISON COO 40.00 X 110467 0 13177 TARA MCCULLOUGH NURSE PRACTIONER 40.00 X 106058 0 11785 TIMOTHY JANDRO PSYCOLOGIST 40.00 X 104080 0 2884 PHONG NGUYEN ADVANCED DENTAL THERAPIST 40.00 X 104246 0 8030 MARY RAUKER MEDICAL DOCTOR 40.00 X 100287 0 108 1286381 0 137743 9 0 1 0 NETGAIN 720 W ST GERMAIN ST 200 SAINT CLOUD MN 56301 IT SERVICES AND EQUIPMENT 192596 FOX ADVANCEMENT 12501 HUNTINGDON LN MINNETONKA MN 55305 CAPITAL CAMPAIGN 133400 2 4941666 588690 44160 5530356 PATIENT REVENUES 621400 3355000 3355000 218761 218761 3573761 5111 5111 9109228 3355000 0 223872 1132894 259255 873639 3936844 3477921 458923 74133 74133 600914 437535 163379 335104 252843 82261 120853 120853 677386 375881 301505 38265 36014 2251 382774 179136 203638 1433 1433 500703 375527 125176 131208 98406 32802 31902 7913 23989 PROGRAM & LAB SUPPLIES 743502 743502 REPAIRS AND MAINTENANCE 165926 73271 92655 CONTINUING EDUCATION 83300 83018 282 MN CARE TAX 41563 41563 41388 21218 20170 9040092 6463003 2577089 0 207307 1205430 1512361 1516047 1060760 1648326 48022 53542 2378141 1819804 444465 558337 14652 14652 3287567 4996334 680865 850196 400000 1070300 680865 2320496 X 2606702 2675838 2606702 2675838 3287567 4996334 69136 0 X 0 1 X 1 1 1 X 2221868 2672785 2693070 3322817 5530356 16440896 2221868 2672785 2693070 3322817 5530356 16440896 16440896 1520 2659 6165 8411 5111 23866 16464762 15695264 0.99860 0.99850 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1285047 983345 301702 1093094 836459 256635 558337 X 9109228 0 9109228 0 9109228 9040092 0 9040092 0 9040092 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 X 0 0 0 0 0 0 0 0 0 DR KARIE RABIE CMO 218279 0 0 0 0 0 0 0 22559 0 240838 0 0 0 DR ANTONY STATELY CEO 184008 0 0 0 0 0 0 0 23787 0 207795 0 0 0 LAURELLE MYHRA DIRECTOR OF BEHAVIORAL HEA 139874 0 0 0 0 0 0 0 20378 0 160252 0 0 0 X 332 44160 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 III, LINE 2 PROVIDED COVID-19 TESTING AND VACCINES. FORM 990, PART III, LINE 3 UNABLE TO PROVIDE DENTAL SERVICES FOR A PERIOD OF TIME AND ELIMATED THE STUDENT DENTAL MODEL. FORM 990, PART VI, SECTION A, LINE 1 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 3 THE ORGANIZATION CONTRACTED FLEX-ABLE SOLUTIONS, LLC TO PERFORM INTERIM CFO AND OTHER ACCOUNTING SERVICES. SHERRY RINGBERG RECEIVED COMPENSATION OF $171,745 FOR HER ROLE AS INTERIM CFO. THE ORGANIZATION PAID AN ADDITIONAL $3,332 TO FLEX-ABLE SOLUTIONS, LLC FOR OTHER ACCOUNTING SERVICES DURING THE YEAR. 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 2019. 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.