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COOK AREA HEALTH SERVICES INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
COOK AREA HEALTH SERVICES INC (EIN 41-1344385)
Tax period
2020-06-01 to 2021-05-31
Filed
2021-11-02
IRS object ID
202133069349300028
Schema version
2020v4.0
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

FieldValueIRS element (for citing)
Return2021-11-02T07:34:51-07:00ReturnTs
Tax Period End2021-05-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN463893925PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Walker Giroux & Hahne LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1225 1st Street N Suite 2400AddressLine1Txt
CityVirginiaCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55792ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-06-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN411344385EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COOK AREA HEALTH SERVICES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCOOKBusinessNameControlTxt
Phone2183613127PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line120 FIFTH STREET SEAddressLine1Txt
CityCOOKCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55723ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKEITH HARVEYPersonNm
Person TitleCFOPersonTitleTxt
Signature2021-11-02SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKEITHPersonFirstNm
Person LastHARVEYPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonThomas KellyPreparerPersonNm
PTINP01240546PTIN
Phone2187494880PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
Federated Assurance LevelFAL1FederatedAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

US Address USAddress

FieldValueIRS element (for citing)
Address Line120 FIFTH STREET SEAddressLine1Txt
CityCOOKCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55723ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$16,944,371GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1979FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionTO PROVIDE MEDICAL, DENTAL & SUPPORTIVE SERVICES IN A REMOTE,RURAL AREA OF NORTHERN MINNESOTA. AS A FEDERALLY QUALIFIED HEALTH CENTER IN A REMOTE, RURAL AREA IT IS OUR GOAL TO BE CUSTOMER FOCUSED WITHOUT REGARD TO ECONOMIC STATUS OR ANY OTHER ARTIFICIAL BARRIER.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee173TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$4,982,571PYContributionsGrantsAmt
CY Contributions Grants$5,307,918CYContributionsGrantsAmt
PY Program Service Revenue$10,094,416PYProgramServiceRevenueAmt
CY Program Service Revenue$10,029,719CYProgramServiceRevenueAmt
PY Investment Income$4PYInvestmentIncomeAmt
CY Investment Income$2CYInvestmentIncomeAmt
CY Other Revenue$1,606,732CYOtherRevenueAmt
PY Total Revenue$15,076,991PYTotalRevenueAmt
CY Total Revenue$16,944,371CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,701,854PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,284,865CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,941,281PYOtherExpensesAmt
CY Other Expenses$4,286,915CYOtherExpensesAmt
PY Total Expenses$14,643,135PYTotalExpensesAmt
CY Total Expenses$16,571,780CYTotalExpensesAmt
PY Revenues Less Expenses$433,856PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$372,591CYRevenuesLessExpensesAmt
Total Assets BOY$7,755,073TotalAssetsBOYAmt
Total Assets EOY$6,544,540TotalAssetsEOYAmt
Total Liabilities BOY$3,881,013TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,297,889TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,874,060NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,246,651NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS TO PROVIDE MEDICAL, DENTAL & SUPPORTIVE SERVICES IN A REMOTE, RURAL AREA OF NORTHERN MINNESOTA. AS A FEDERALLY QUALIFIED HEALTH CENTER IN A REMOTE, RURAL AREA, IT IS OUR GOAL TO BE CUSTOMER FOCUSED WITHOUT REGARD TO ECONOMIC STATUS OR ANY OTHER ARTIFICIAL BARRIER. WE INTEND TO PROVIDE QUALITY PRIMARY CARE THAT MEETS THE NEEDS OF PEOPLE IN OUR DESIGNATED SERVICE AREA THROUGH COLLABORATIVE EFFORTS WITH CRITICAL ACCESS HOSPITALS, CARE CENTERS, SPECIALISTS, ASSOCIATIONS, FOUNDATIONS AND OTHER APPROPRIATE OR AVAILABLE OPPORTUNITIES. OUR CORE VALUE IS THE CARE OF FAMILIES, FRIENDS AND VISITORS WHO RESIDE IN OR TRAVEL THROUGH OUR REGION BY ASSISTING TO IMPROVE THEIR HEALTH. THIS CARE IS PROVIDED AT OUR MEDICAL CLINICS IN BIGFORK, BIG FALLS, COOK, FLOODWOOD,NORTHOME, AND TOWER MN AND AT OUR DENTAL CLINICS IN COOK, FLOODWOOD, AND TOWER, MN. CARE IS ALSO PROVIDED THROUGH CONTRACTS WITH BIGFORK VALLEY AND COOK HOSPITALS AND THEIR ASSOCIATED NURSING HOMES AS WELL AS AT NORTHOME CAREMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$8,289,884ExpenseAmt
Revenue$6,688,718RevenueAmt
DescPROVIDE MEDICAL SERVICES, 30,488 ENCOUNTERSDesc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$3,643,681ExpenseAmt
Revenue$3,341,001RevenueAmt
DescPROVIDE DENTAL SERVICES, 13,963 ENCOUNTERSDesc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$433,009ExpenseAmt
DescPROVIDE OTHER HEALTH SERVICES, 1,577 ENCOUNTERSDesc
FieldValueIRS element (for citing)
Total Program Service Expenses$12,366,574TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee173EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Form8282 Filed0Form8282FiledCnt
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKEITH HARVEYPersonNm
Phone2183613135PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line120 FIFTH STREET SEAddressLine1Txt
CityCOOKCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55723ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
ERIC ELLEBY
PHYSICIAN40.000.00$374,118$0$28,509
MATTHEW HOLMES
PHYSICIAN40.000.00$368,356$0$28,509
NICHOLAS VIDOR
PHYSICIAN40.000.00$324,212$0$18,800
ERIC SCRIVNER
PHYSICIAN40.000.00$264,745$0$27,530
JEFFREY SCRIVNER
MEDICAL DIRECTR40.000.00$256,627$0$18,345
MICHAEL HOLMES
CEO40.000.00$126,980$0$15,483Yes (X)
KEITH HARVEY
CFO40.000.00$108,285$0$8,608Yes (X)
WENDE NELSON
Vice President1.000.00$0$0$0Yes (X)Yes (X)
GAIL BLACKMER
SEC'Y/TREASURER1.500.00$0$0$0Yes (X)Yes (X)
KAREN LORENZEN
Director1.000.00$0$0$0Yes (X)
RICHARD HANSON
Director1.000.00$0$0$0Yes (X)
MARIAN SWANG
Director1.000.00$0$0$0Yes (X)
ROBERT WALKER
DIRECTOR1.000.00$0$0$0Yes (X)
WILLIAM H TIBBETTS
President2.000.00$0$0$0Yes (X)Yes (X)
STEPHANIE BURCKHARDT
DIRECTOR1.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,823,323TotalReportableCompFromOrgAmt
Total Other Compensation$145,784TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MAYO COLLABORATIVE SERVICES
PO BOX 9146MINNEAPOLISMN55480COVID-19 TESTING$245,193
PATTERSON DENTAL SUPPLY
28244 NETWORK PLACECHICAGOIL60673DENTAL SUPPLIES$204,509
BIGFORK VALLEY HOSPITAL
PO BOX 258BIGFORKMN56628LEASES/LABS$210,640
BREAKWATER HEALTH NETWORK
404 WEST SUPERIOR STREET STE 227DULUTHMN55802CLINICAL/BUS/PAT SVC$190,431
HENRY SCHEIN
DEPT CH 10241PALATINEIL60055MED/DENTAL SUPPLIES$195,544
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Government Grants$5,189,067GovernmentGrantsAmt
All Other Contributions$118,851AllOtherContributionsAmt
Total Contributions$5,307,918TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescMEDICAL & DENTAL REVENUEDesc
Business621110BusinessCd
Total Revenue Column$10,029,719TotalRevenueColumnAmt
Related Or Exempt Func Income$10,029,719RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$10,029,719TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2TotalRevenueColumnAmt
Exclusion$2ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescDEBT FORGIVENESSDesc
Business621110BusinessCd
Total Revenue Column$1,606,732TotalRevenueColumnAmt
Related Or Exempt Func Income$1,606,732RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,606,732OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$16,944,371TotalRevenueColumnAmt
Related Or Exempt Func Income$11,636,451RelatedOrExemptFuncIncomeAmt
Exclusion$2ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$260,864TotalAmt
Management And General$260,864ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,859,820TotalAmt
Program Services$7,873,307ProgramServicesAmt
Management And General$1,986,513ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$434,592TotalAmt
Program Services$349,958ProgramServicesAmt
Management And General$84,634ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,070,267TotalAmt
Program Services$843,799ProgramServicesAmt
Management And General$226,468ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$659,322TotalAmt
Program Services$514,271ProgramServicesAmt
Management And General$145,051ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$704,372TotalAmt
Program Services$415,075ProgramServicesAmt
Management And General$289,297ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,349,562TotalAmt
Program Services$1,056,996ProgramServicesAmt
Management And General$292,566ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$671,800TotalAmt
Program Services$2,234ProgramServicesAmt
Management And General$669,566ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$679,878TotalAmt
Program Services$662,684ProgramServicesAmt
Management And General$17,194ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$86,377TotalAmt
Program Services$66,997ProgramServicesAmt
Management And General$19,380ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$75,883TotalAmt
Program Services$65,005ProgramServicesAmt
Management And General$10,878ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,913TotalAmt
Management And General$1,913ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$96,667TotalAmt
Program Services$79,587ProgramServicesAmt
Management And General$17,080ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$103,173TotalAmt
Program Services$80,555ProgramServicesAmt
Management And General$22,618ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
DENTAL LABORATORY$164,701$164,701
RECRUITMENT$161,841$657$161,184
BAD DEBT EXPENSE$110,631$110,631
OSHA COMPLIANCE AND SAFETY$80,117$80,117

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$16,571,780TotalAmt
Program Services$12,366,574ProgramServicesAmt
Management And General$4,205,206ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,517,165BOYAmt
EOY$1,747,169EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,903BOYAmt
EOY$2,108EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$41,856BOYAmt
EOY$324,069EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,123,840BOYAmt
EOY$1,139,867EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$34,853BOYAmt
EOY$157,172EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$5,832,101LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,657,946LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$3,035,456BOYAmt
EOY$3,174,155EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$7,755,073BOYAmt
EOY$6,544,540EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,728,457BOYAmt
EOY$1,856,715EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$545,824BOYAmt
EOY$441,174EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$1,606,732BOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,881,013BOYAmt
EOY$2,297,889EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,874,060BOYAmt
EOY$4,246,651EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,874,060BOYAmt
EOY$4,246,651EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,755,073BOYAmt
EOY$6,544,540EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$372,591ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteefalseAuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,429,685CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,715,879CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,717,466CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,982,571CurrentTaxYearMinus1YearAmt
Current Tax Year$5,307,918CurrentTaxYearAmt
Total$21,153,519TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,429,685CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,715,879CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,717,466CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,982,571CurrentTaxYearMinus1YearAmt
Current Tax Year$5,307,918CurrentTaxYearAmt
Total$21,153,519TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$0SubstantialContributorsTotAmt
Public Support Total170$21,153,519PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$62CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$4CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4CurrentTaxYearMinus1YearAmt
Current Tax Year$2CurrentTaxYearAmt
Total$75TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$30,000CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$40,000CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$71,694CurrentTaxYearMinus2YearsAmt
Current Tax Year$1,606,732CurrentTaxYearAmt
Total$1,605,038TotalAmt
FieldValueIRS element (for citing)
Total Support$22,758,632TotalSupportAmt
Gross Receipts Rltd Activities$48,605,495GrossReceiptsRltdActivitiesAmt
Public Support CY1700.92950PublicSupportCY170Pct
Public Support PY1701.00000PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$19,500OtherCostOrOtherBasisAmt
Book Value$19,500BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,839,642OtherCostOrOtherBasisAmt
Depreciation$891,892DepreciationAmt
Book Value$1,947,750BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,613,732OtherCostOrOtherBasisAmt
Depreciation$666,457DepreciationAmt
Book Value$947,275BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,340,777OtherCostOrOtherBasisAmt
Depreciation$1,099,597DepreciationAmt
Book Value$241,180BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$18,450OtherCostOrOtherBasisAmt
Book Value$18,450BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$3,174,155TotalBookValueLandBuildingsAmt
Total Rev Etc Audited Fincl Stmt$16,944,371TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$16,944,371RevenueSubtotalAmt
Total Revenue Per Form990$16,944,371TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$16,571,780TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$16,571,780ExpensesSubtotalAmt
Total Expenses Per Form990$16,571,780TotalExpensesPerForm990Amt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
ERIC ELLEBY
PHYSICIAN$374,118$16,800$11,709$402,627
ERIC SCRIVNER
PHYSICIAN$264,745$15,821$11,709$292,275
JEFFREY SCRIVNER
MEDICAL DIRECTR$256,627$16,345$2,000$274,972
MATTHEW HOLMES
PHYSICIAN$368,356$16,800$11,709$396,865
NICHOLAS VIDOR
PHYSICIAN$324,212$16,800$2,000$343,012

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonDR MATTHEW HOLMESPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionCEO'S SONRelationshipDescriptionTxt
Transaction$398,367TransactionAmt
TransactionWAGES AND BENEFITSTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 11b: Form 990 Review ProcessTHE 990 IS PROVIDED TO THE BOARD OF DIRECTORS UPON RECEIPT FROM THE PREPARER. THE COPY WAS INCLUDED WITH THE STANDARD MATERIALS (MEETING MINUTES, FINANCIAL REPORTS, ETC.) PROVIDED TO THE BOARD PRIOR TO THEIR MONTHLY MEETING.
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsCAHS REQUIRES ANNUAL REPORTING FROM ALL DIRECTORS AND KEY EMPLOYEES REGARDING ANY CONFLICTS OF INTEREST WITH RELATED ORGANIZATIONS AND VENDORS WITH WHOM THE ORGANIZATION TRANSACTS BUSINESS. CAHS MONITORS DISCLOSURES PROVIDED TO ANY AFFIRMATIVE REPONSES.
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top ManagementTHE BOARD'S FINANCE COMMITTEE CONDUCTS AN ANNUAL COMPENSATION REVIEW OF CAHS KEY EMPLOYEES USING SALARY SURVEYS FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, THE MN DEPT. OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, AND OTHER AVAILABLE SALARY SURVEYS. THE COMMITTEE DOCUMENTS EACH EMPLOYEE'S COMPENSATION RELATIVE TO SURVEY DATA AND SUBSTANTIATES REASONS FOR SUBSTANTIAL VARIANCES FROM AVAILABLE DATA.
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesTHE BOARD'S FINANCE COMMITTEE CONDUCTS AN ANNUAL COMPENSATION REVIEW OF CAHS KEY EMPLOYEES USING SALARY SURVEYS FROM THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, THE MN DEPT. OF EMPLOYMENT AND ECONOMIC DEVELOPMENT, AND OTHER AVAILABLE SALARY SURVEYS. THE COMMITTEE DOCUMENTS EACH EMPLOYEE'S COMPENSATION RELATIVE TO SURVEY DATA AND SUBSTANTIATES REASONS FOR SUBSTANTIAL VARIANCES FROM AVAILABLE DATA.
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableNO DOCUMENTS AVAILABLE TO THE PUBLIC.