2019-07-22T08:48:12-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-10-01 237156236 WEST SIDE COMMUNITY HEALTH SERVICES INC WEST 6516027500 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 REUBEN MOORE CEO 6516027500 2019-07-10 1 RYAN ENGEBRETSON P01585625 6123764500 67.137.57.251 2019-07-10 12:38:45 CD P 9E4ACA9A3A5583693B49D79FC84C6D308F7C5743 E168BB59A4AC1B98DF6FDFCBC72C1446FCA85D8B 2017 2019-02-21 02:37:17Z REUBEN MOORE 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 33206256 0 X WWW.MNCARE.ORG X 1972 MN WSCHS PROVIDES MULTILINGUAL, MULTICULTURAL AND COMPREHENSIVE HEALTH CARE IN URBAN NEIGHBORHOODS, SCHOOLS, PUBLIC HOUSING AND HOMELESS SHELTERS. 14 14 402 22 0 11610 10412033 10963762 22846332 21595551 81047 162496 1005320 484447 34344732 33206256 220463 201721 0 0 20676150 23829017 0 0 0 11133870 11617786 32030483 35648524 2314249 -2442268 23623152 21403467 7150056 7372639 16473096 14030828 X WEST SIDE COMMUNITY HEALTH SERVICES' MISSION IS STRENGTHENING THE WELL-BEING OF OUR COMMUNITY THROUGH HEALTH CARE FOR ALL. 0 0 20499476 201721 13478979 THE ORGANIZATION PROVIDES COMPREHENSIVE HEALTH CARE AND SOCIAL SERVICES WITH BILINGUAL/BICULTURAL STAFF ON A SLIDING FEE SCALE. SERVICES INCLUDE PRIMARY, SPECIALTY, PREVENTIVE, URGENT CARE, COMPLEMENTARY, PHARMACY, DENTAL, OB/GYN, MENTAL HEALTH, SOCIAL AND WRAP-AROUND SERVICES SUCH AS TRANSPORTATION AND ASSISTANCE WITH HEALTH PLAN ENROLLMENT. WE ARE PROUD TO SERVE OVER 35,000 PATIENTS EACH YEAR. WE SERVE THE DIVERSE ST. PAUL METRO AREA COMMUNITY - PARTICULARLY THE LATINO AND HMONG POPULATIONS, ST. PAUL PUBLIC HOUSING RESIDENTS, THE HOMELESS, AND ADOLESCENTS - IN A SERVICE AREA THAT INCLUDES A SIGNIFICANT PORTION OF THE CITY OF ST. PAUL AND RAMSEY COUNTY. 4913935 0 3495203 THE ORGANIZATION PROVIDES PREVENTIVE, RESTORATIVE, AND EMERGENCY DENTAL SERVICES TO OVER 5,500 PATIENTS AT TWO CLINICS. WEST SIDE DENTAL CLINIC AND EAST SIDE FAMILY DENTAL CLINIC.OUR BRIGHT SMILES DENTAL PROGRAM IS A PARTNERSHIP WITH THE GREATER TWIN CITIES UNITED WAY & THE KNIGHT FOUNDATION. SERVICES ARE APPROVED FOR CHILDREN IN RAMSEY & DAKOTA COUNTIES. THE PARTNERSHIP FOR IMPROVING CHILDREN'S ORAL HEALTH IN RAMSEY COUNTY STRIVES TO IMPROVE THE ORAL HEALTH OF DISADVANTAGED POPULATIONS THROUGH COMMUNITY OUTREACH, EDUCATION & DENTAL SERVICES. BRIGHT SMILES STRIVES TO ENSURE THAT LATINO CHILDREN HAVE ACCESS TO DENTAL CARE & FAMILIES ARE EDUCATED ON EFFECTIVE ORAL HEALTH PRACTICES. THERE IS NO CHARGE FOR THESE SERVICES. 4184594 0 4621369 THE ORGANIZATION PROVIDES MEDICATION DISPENSING SERVICE AND MEDICATION THERAPY MANAGEMENT (MTM). MTM GOES BEYOND THE STANDARD COUNSELING ASSOCIATED WITH RECEIVING A NEW PRESCRIPTION, WORKING DIRECTLY WITH DOCTORS TO ENSURE THAT ALL MEDICATION NEEDS ARE BEING MET. UNINSURED PATIENTS RECEIVE SLIDING SCALE DISCOUNTS BASED UPON INCOME AND LOWER PRICED DRUGS. WHEN PRICES STILL REMAIN TOO HIGH, PHARMACISTS AID PATIENTS IN RECEIVING MEDICATION THROUGH MANUFACTURER PATIENT ASSISTANCE PROGRAMS, WHICH PROVIDES FREE MEDICATION TO QUALIFYING UNINSURED PATIENTS, OR THROUGH THE DISPENSING OF SAMPLE MEDICATION. 0 0 0 ADDITIONAL PROGRAM SERVICES THE ORGANIZATION PROVIDES AT ITS CLINICS INCLUDE - ADOLESCENT HEALTH CARE SERVICES - DIABETES CARE - EVICTION PREVENTION - FAMILY PLANNING & PREGNANCY TESTING - FAMILY SUPPORT & MENTAL HEALTH COUNSELING - HEALTH EDUCATION - HIV CARE - NUTRITION SERVICES - PRENATAL CARE - SENIOR HEALTHCARE - WELL CHILD CARE AND IMMUNIZATIONS - WOMEN'S HEALTH - AND, WOMEN'S, INFANTS, AND CHILDREN (WIC) PROGRAM. 0 0 0 29598005 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 44 0 402 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X BLAKE DARSOW CFO 6516027537 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 PETE SURDO CHAIR 1.00 0.00 X X 0 0 0 HLEE LEE-KRON VICE CHAIR 1.00 0.00 X X 0 0 0 ZACHARY HYLTON TREASURER 1.00 0.00 X X 0 0 0 ANDREATTE HAMES SECRETARY 1.00 0.00 X X 0 0 0 SUMMER ABDALLA DIRECTOR 1.00 0.00 X 0 0 0 ROMAN CRESS DIRECTOR 1.00 0.00 X 0 0 0 MARSHA CRESSY DIRECTOR 1.00 0.00 X 0 0 0 AMELIA HARDY DIRECTOR 1.00 0.00 X 0 0 0 CORDELL HARDY DIRECTOR 1.00 0.00 X 0 0 0 JEANETTE JONES DIRECTOR 1.00 0.00 X 0 0 0 DAWN KSEPKA DIRECTOR (THRU JUNE 2018) 1.00 0.10 X 0 0 0 SUSAN MARSCHALK DIRECTOR (THRU DEC 2017) 1.00 0.00 X 0 0 0 KRISA RYAN DIRECTOR 1.00 0.00 X 0 0 0 BILL THOMPSON DIRECTOR 1.00 0.00 X 0 0 0 CAROL WILLIAMS DIRECTOR 1.00 0.00 X 0 0 0 JANET ZASTROW DIRECTOR 1.00 0.00 X 0 0 0 REUBEN MOORE CHIEF EXECUTIVE OFFICER 40.00 0.10 X 51859 0 4622 BLAKE DARSOW CHIEF FINANCIAL OFFICER 40.00 0.10 X 138583 0 22819 DR MARY NESVIG CHIEF CLINICAL OFFICER 40.00 0.00 X 220922 0 12440 CHRIS SINGER CHIEF OPERATING OFFICER 40.00 0.00 X 120567 0 22570 JAESON FOURNIER FORMER CEO 40.00 X 129806 0 12029 DR MUAJ LO PHYSICIAN 40.00 0.00 X 197308 0 24421 DR STEFAN POMRENKE PHYSICIAN 40.00 0.00 X 184302 0 23969 DR ROBERT MCDONALD DENTIST 40.00 0.00 X 153903 0 252 DR KATHIE CULHANE-PERA PHYSICIAN 32.00 0.00 X 152373 0 20549 DR BRAD MCDONNELL DENTIST 34.00 0.00 X 148063 0 10618 1497686 0 154289 25 1 1 0 REGENTS OF THE UNIVERSITY OF MN NW 5960 PO BOX 1450 MINNEAPOLIS MN 55485 CONTRACTED PROVIDERS 425417 NETGAIN TECHNOLOGIES INC 720 W SAINT GERMAIN ST STE 200 ST CLOUD MN 56301 IT HOSTING SERVICE 370549 QUEST DIAGNOSTICS 12989 COLLECTIONS CENTER DRIVE CHICAGO IL 606930129 LABORATORY SERVICES 257664 GE HEALTHCARE IITS 15724 COLLECTIONS CENTER DR CHICAGO IL 606930129 IT LICENSING 186541 NAC MECHANICAL & ELECTRICAL 1001 LABORE INDUSTRIAL CT SUITE B VADNAIS HEIGHTS MN 55110 EQUIPMENT REPAIR 138381 7 10476773 486989 10963762 NET PATIENT SERVICE REVENUE 624100 21434822 21434822 PRECEPT REVENUE 624100 160729 160729 21595551 162496 162496 OTHER 900099 373460 373460 VALUE BASED PAYMENTS 900099 110987 110987 484447 33206256 21595551 0 646943 201721 201721 779556 779556 18165695 15526870 2638825 411753 351267 60486 3104444 2596376 508068 1367569 1124824 242745 157441 157441 13675 13675 64694 64694 1818510 1502855 315655 8523 8523 331234 181613 149621 1314634 787668 526966 1360878 1119320 241558 67181 41458 25723 155928 123196 32732 3277 3277 544259 520856 23403 60007 60007 MEDICAL SUPPLIES & DRUG 4119613 4119613 BAD DEBT 867438 867438 MN CARE TAX 397452 397452 EMPLOYEE TRAINING AND R 157916 66172 91744 175126 69306 105820 35648524 29598005 6050519 0 2756088 976643 6667962 5666297 1074196 1259585 2242272 2396259 4037691 4037691 148763 186907 209252 265186 10485668 5120769 5236928 5364899 1250000 1250000 23623152 21403467 2904751 3254926 95918 96546 149387 21167 4000000 4000000 7150056 7372639 X 16038466 13997391 434630 33437 16473096 14030828 23623152 21403467 -2442268 0 X 0 1 X 1 1 1 X 8679676 9633360 10787115 10412033 10963762 50475946 8679676 9633360 10787115 10412033 10963762 50475946 50475946 59801 69011 67940 81047 162496 440295 1005320 484447 1489767 52406008 101951933 0.96320 0.97440 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: VALUE BASED PAYMENTS MEANINGFUL USE OTHER 791640 791640 6381497 2889551 3491946 697412 697412 2564869 2231218 333651 50250 50250 5364899 PARTICIPATION SHARES 1250000 C 1250000 DUE TO RELATED PARTY 4000000 4000000 X PART X, LINE 2: WSCHS HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, WSCHS IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. 1 EVICTION PREVENTION - UTILITY ASSISTANCE, SANITATION, RENTAL ASSISTANCE, OTHER DIRECT PATIENT ASSISTANCE 337 201721 PART I, LINE 2: MONITORING OF GRANTS RECIPIENTS OF UTILITY ASSISTANCE ARE SCREENED BY RAMSEY COUNTY/WSCHS STAFF FOR ELIGIBILITY. DATA REGARDING THE AMOUNT AND PURPOSE OF THE LOAN, WITH CLIENT IDENTIFIERS ARE COMPILED IN RAMSEY COUNTY HMIS SYSTEM AND TRACKED ON SPREADSHEETS AT THE GRANTING LOCATION AND IN ACCOUNTING. IF APPROVED APPLICANT IS ELIGIBLE FOR ASSISTANCE FROM LARGER PROGRAMS BUT NEEDS ADDITIONAL FUNDS TO PAY THE BILL OR IF THEY ARE NOT ELIGIBLE FOR THOSE PROGRAMS, WEST SIDE COMMUNITY HEALTH SERVICES, INC. WILL ASSIST IN RESOLVING THE BILL. ALL PAYMENTS ARE MADE DIRECTLY TO THE LANDLORD, UTILITY COMPANY, OR SANITATION COMPANY. CHECKS ARE PROCESSED BY WSCHS WITH SPECIFIC NAMES AND ACCOUNT NUMBERS. THIS INFORMATION GOES TO THE UTILITIES AND HC STAFF TO VERIFY AND RECORD. X X X X X 0 0 0 0 0 0 0 0 0 BLAKE DARSOW CHIEF FINANCIAL OFFICER 138583 0 0 0 0 0 3549 0 19270 0 161402 0 0 0 DR MARY NESVIG CHIEF CLINICAL OFFICER 220922 0 0 0 0 0 5543 0 6897 0 233362 0 0 0 JAESON FOURNIER FORMER CEO 99729 0 10000 0 20077 0 2515 0 9514 0 141835 0 0 0 DR MUAJ LO PHYSICIAN 197308 0 0 0 0 0 5024 0 19397 0 221729 0 0 0 DR STEFAN POMRENKE PHYSICIAN 184302 0 0 0 0 0 4699 0 19270 0 208271 0 0 0 DR ROBERT MCDONALD DENTIST 153903 0 0 0 0 0 0 0 252 0 154155 0 0 0 DR KATHIE CULHANE-PERA PHYSICIAN 152373 0 0 0 0 0 3936 0 16613 0 172922 0 0 0 DR BRAD MCDONNELL DENTIST 148063 0 0 0 0 0 3721 0 6897 0 158681 0 0 0 PETER SINGER SPOUSE OF COO 25300 CONSULTING SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM USING THE AUDITED FINANCIAL RECORDS OF THE ORGANIZATION. THEN, THE CEO, CRO, FINANCE COMMITEE, AND BOARD OF DIRECTORS REVIEW AND APPROVE THE RETURN PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE EXPECTED TO EXERCISE INDEPENDENT JUDGMENT IN OVERSEEING THE BUSINESS AFFAIRS OF THE ORGANIZATION. BOARD MEMBERS ARE PROHIBITED FROM ENGAGING IN ANY SITUATION THAT IS OR APPEARS TO BE A CONFLICT OF INTEREST. THIS INCLUDES PROHIBITING BOARD MEMBERS AND MEMBERS OF THEIR IMMEDIATE FAMILY FROM BEING EMPLOYEES OR CONTRACTORS OF WEST SIDE COMMUNITY HEALTH SERVICES, INC. ON AN ANNUAL BASIS, ALL BOARD OF DIRECTORS AND COMMITTEE MEMBERS MUST SIGN A WRITTEN DECLARATION OF THE FOLLOWING: 1. FIT OF ORGANIZATONAL MISSION WITH PERSONAL GOALS. 2. INDIVIDUAL OR IMMEDIATE FAMILY PARTICIPATION IN OTHER BUSINESS RELATIONSHIPS OR THE ENGAGEMENT OF OTHER OUTSIDE ACTIVITIES THAT MAY IMPAIR INDEPENDENCE OF JUDGMENT CONCERNING THE OPERATIONS OF WEST SIDE COMMUNITY HEALTH SERVICES, INC. 3. INDIVIDUAL OR IMMEDIATE FAMILY PERSONAL FINANCIAL INTERESTS THAT MAY IMPAIR INDEPENDENCE OF JUDGMENT OR INFLUENCE DECISIONS OR ACTIONS CONCERNING WEST SIDE COMMUNITY HEALTH SERVICES, INC. 4. INDIVIDUAL OR IMMEDIATE FAMILY INVOLVEMENT, OR OTHER BOARD OR OFFICER INVOLVEMENT, IN ANY BUSINESS TRANSACTIONS INVOLVING MATERIAL INTEREST, DIRECT OR INDIRECT, PENDING OR COMPLETED, TO WHICH WEST SIDE COMMUNITY HEALTH SERVICES, INC. WAS OR IS TO BE A PARTY. 5. INDIVIDUAL OR IMMEDIATE FAMILY INVOLVEMENT OR OTHER BOARD OR OFFICER INVOLVEMENT, IN ANY BUSINESS TRANSACTION WITH A COMPANY WHICH SUBSTANTIALLY COMPETES WITH WEST SIDE COMMUNITY HEALTH SERVICES, INC. 6. SIGNED STATEMENTS WILL BE KEPT ON FILE ANY DECLARATION NOTING A POTENTIAL CONFLICT OF INTEREST WILL BE FURTHER REVIEWED BY THE EXECUTIVE COMMITTEE. IF A CONFLICT OF INTEREST IS DEEMED TO EXIST, THE CONFLICTED BOARD MEMBER WOULD ABSTAIN FROM VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS REVIEWS THE CEO'S PERFORMANCE AND COMPENSATION. THEY USED A NUMBER OF COMPENSATION STUDIES, PREPARED BY THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS (NACHC) AT THE TIME OF REVIEW AND MARKET BASED SURVEYS. THE EXECUTIVE COMMITTEE RECOMMENDED THE COMPENSATION STRUCTURE TO THE FULL BOARD FOR APPROVAL. ALL OTHER OFFICERS AND KEY SALARIES ARE REVIEW AND APPROVED BY THE CEO ON AN ANNUAL BASIS. A REVIEW OCCURRED SHORTLY AFTER THE CONCLUSION OF FISCAL YEAR 2018. FORM 990, PART VI, SECTION C, LINE 19 THE AUDIT REPORT AND FORM 990 ARE IN THE PROCESS OF BEING POSTED ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST, AND WILL BE MAILED TO THE REQUESTOR WHEN ANY INQUIRY IS RECEIVED BY THE ORGANIZATION. EAST SIDE HEALTH CENTER INC 153 CESAR CHAVEZ ST SAINT PAUL MN 55107 455562728 REAL ESTATE HOLDING MN 501(C)(3) LINE 12C, III-FI WEST SIDE COMMUNITY HEALTH SERVICES INC 1 0 0 0 0 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 EAST SIDE HEALTH CENTER INC K 400008 FMV