WEST SIDE COMMUNITY HEALTH SERVICES INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- WEST SIDE COMMUNITY HEALTH SERVICES INC (EIN 23-7156236)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-07-16
- IRS object ID
- 201811989349301251
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-07-16T10:59:03-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237156236 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST SIDE COMMUNITY HEALTH SERVICES | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WEST | BusinessNameControlTxt |
| Phone | 6516027500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 153 CESAR CHAVEZ STREET | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 551072226 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | REUBEN MOORE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6516027500 | PhoneNum |
| Signature | 2018-07-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RYAN ENGEBRETSON | PreparerPersonNm |
| PTIN | P01585625 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | REUBEN MOORE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 153 CESAR CHAVEZ STREET | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 551072226 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $34,344,732 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WESTSIDECHS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | WSCHS PROVIDES MULTILINGUAL, MULTICULTURAL AND COMPREHENSIVE HEALTH CARE IN URBAN NEIGHBORHOODS, SCHOOLS, PUBLIC HOUSING AND HOMELESS SHELTERS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 376 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $10,787,115 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,412,033 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,497,046 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,846,332 | CYProgramServiceRevenueAmt |
| PY Investment Income | $67,940 | PYInvestmentIncomeAmt |
| CY Investment Income | $81,047 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $1,005,320 | CYOtherRevenueAmt |
| PY Total Revenue | $29,352,101 | PYTotalRevenueAmt |
| CY Total Revenue | $34,344,732 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $99,967 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $220,463 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,708,211 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,676,150 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,742,524 | PYOtherExpensesAmt |
| CY Other Expenses | $11,133,870 | CYOtherExpensesAmt |
| PY Total Expenses | $29,550,702 | PYTotalExpensesAmt |
| CY Total Expenses | $32,030,483 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$198,601 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,314,249 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,312,664 | TotalAssetsBOYAmt |
| Total Assets EOY | $23,623,152 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,153,817 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,150,056 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $14,158,847 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,473,096 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WEST SIDE COMMUNITY HEALTH SERVICES' MISSION IS STRENGTHENING THE WELL-BEING OF OUR COMMUNITY THROUGH HEALTH CARE FOR ALL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $18,894,367 | ExpenseAmt |
| Grant | $220,463 | GrantAmt |
| Revenue | $14,638,321 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,514,109 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,649,275 | RevenueAmt |
| Desc | 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,026,905 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $5,558,736 | RevenueAmt |
| Desc | 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 ASSURE 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 | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $27,435,381 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 48 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 376 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLAKE DARSOW CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6516027537 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 153 CESAR CHAVEZ STREET | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 551072226 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| PETE SURDO | ||||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| HLEE LEE-KRON | ||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAWN KSEPKA | ||||||||
| TREASURER | 1.00 | 0.10 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARSHA CRESSY | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ANDREA CARO | ||||||||
| DIRECTOR THRU DEC 2016 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MAHOGANY ELLIS-CRUTCHFIELD | ||||||||
| DIRECTOR THRU APR 2017 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ANDREATTE HAMES | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| ZACHARY HYLTON | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JEANETTE JONES | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SUSAN MARSCHALK | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| SHENG THAO | ||||||||
| DIRECTOR THRU DEC 2016 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BILL THOMPSON | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROL WILLIAMS | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BRYAN WARREN | ||||||||
| DIRECTOR THRU OCT 2016 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| KIMERY WORKMAN | ||||||||
| DIRECTOR THRU SEP 2017 | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JAESON FOURNIER | ||||||||
| CEO THRU JUN 2017 | 40.00 | 0.10 | Yes (X) | $227,805 | $0 | $20,211 | ||
| BLAKE DARSOW | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 0.10 | Yes (X) | $41,874 | $0 | $5,755 | ||
| DR MARY NESVIG | ||||||||
| CHIEF CLINICAL OFFICER & INTERIM-CEO | 40.00 | 0.10 | Yes (X) | $169,652 | $0 | $9,850 | ||
| CHRIS SINGER | ||||||||
| CHIEF OPERATING OFFICER | 40.00 | 0.00 | Yes (X) | $121,773 | $0 | $17,561 | ||
| DR MUAJ LO | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $182,964 | $0 | $19,090 | Yes (X) | ||
| DR JASON COMO | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $154,469 | $0 | $15,959 | Yes (X) | ||
| DR KATHIE CULHANE-PERA | ||||||||
| PHYSICIAN | 32.00 | 0.00 | $148,617 | $0 | $16,003 | Yes (X) | ||
| DR STEFAN POMRENKE | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $157,202 | $0 | $18,448 | Yes (X) | ||
| DR ROBERT MCDONALD | ||||||||
| DENTIST | 40.00 | 0.00 | $148,780 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,353,136 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $122,877 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 25 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| UNIVERSITY OF MINNESOTA | |||||
| 100 CHURCH ST SE | MINNEAPOLIS | MN | 55455 | CONTRACTED PROVIDERS | $399,370 |
| QUEST DIAGNOSTICS | |||||
| 12989 COLLECTIONS CENTER DR | CHICAGO | IL | 606930129 | LABORATORY SERVICES | $348,855 |
| NETGAIN TECHNOLOGIES INC | |||||
| 720 W SAINT GERMAIN ST STE 200 | ST CLOUD | MN | 56301 | IT HOSTING SERVICE | $340,885 |
| GE HEALTHCARE IITS | |||||
| 15724 COLLECTIONS CENTER DR | CHICAGO | IL | 606930129 | IT LICENSING | $225,098 |
| SENTAGE CORPORATION | |||||
| PO BOX 206813 | DALLAS | TX | 75320 | LABORATORY SERVICES | $131,945 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $332,000 | RelatedOrganizationsAmt |
| Government Grants | $9,540,187 | GovernmentGrantsAmt |
| All Other Contributions | $539,846 | AllOtherContributionsAmt |
| Noncash Contributions | $36,377 | NoncashContributionsAmt |
| Total Contributions | $10,412,033 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 624100 | $22,679,984 | $22,679,984 |
| PRECEPT REVENUE | 624100 | $166,348 | $166,348 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,846,332 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $81,047 | TotalRevenueColumnAmt |
| Exclusion | $81,047 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| VALUE BASED PAYMENTS | 900099 | $630,738 | $630,738 |
| MEANINGFUL USE | 900099 | $267,750 | $267,750 |
| OTHER | 900099 | $106,832 | $106,832 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,005,320 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,344,732 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,846,332 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,086,367 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,463 | TotalAmt |
| Program Services | $220,463 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $707,812 | TotalAmt |
| Management And General | $707,812 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,496,673 | TotalAmt |
| Program Services | $13,655,256 | ProgramServicesAmt |
| Management And General | $1,841,417 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $278,053 | TotalAmt |
| Program Services | $234,311 | ProgramServicesAmt |
| Management And General | $43,742 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,013,186 | TotalAmt |
| Program Services | $2,539,163 | ProgramServicesAmt |
| Management And General | $474,023 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,180,426 | TotalAmt |
| Program Services | $994,726 | ProgramServicesAmt |
| Management And General | $185,700 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $73,792 | TotalAmt |
| Management And General | $73,792 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,871 | TotalAmt |
| Management And General | $18,871 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,525 | TotalAmt |
| Management And General | $109,525 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,848,441 | TotalAmt |
| Program Services | $1,643,660 | ProgramServicesAmt |
| Management And General | $204,781 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,054 | TotalAmt |
| Program Services | $140 | ProgramServicesAmt |
| Management And General | $2,914 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,131 | TotalAmt |
| Program Services | $195,872 | ProgramServicesAmt |
| Management And General | $8,259 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,135,872 | TotalAmt |
| Program Services | $684,860 | ProgramServicesAmt |
| Management And General | $451,012 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,354,771 | TotalAmt |
| Program Services | $1,121,812 | ProgramServicesAmt |
| Management And General | $232,959 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,385 | TotalAmt |
| Program Services | $39,329 | ProgramServicesAmt |
| Management And General | $15,056 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,993 | TotalAmt |
| Program Services | $100,557 | ProgramServicesAmt |
| Management And General | $18,436 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $117,826 | TotalAmt |
| Management And General | $117,826 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $504,698 | TotalAmt |
| Program Services | $489,077 | ProgramServicesAmt |
| Management And General | $15,621 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,025 | TotalAmt |
| Program Services | $21,010 | ProgramServicesAmt |
| Management And General | $17,015 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUG | $3,758,150 | $3,758,150 | |
| BAD DEBT | $1,201,247 | $1,201,247 | |
| MN CARE TAX | $438,670 | $438,670 | |
| LICENSES, DUES & SUBSCR | $90,255 | $37,966 | $52,289 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,164 | TotalAmt |
| Program Services | $59,112 | ProgramServicesAmt |
| Management And General | $4,052 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,030,483 | TotalAmt |
| Program Services | $27,435,381 | ProgramServicesAmt |
| Management And General | $4,595,102 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,870,218 | BOYAmt |
| EOY | $2,756,088 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,254,391 | BOYAmt |
| EOY | $6,667,962 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,432,467 | BOYAmt |
| EOY | $1,074,196 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,461,954 | BOYAmt |
| EOY | $2,242,272 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,037,691 | BOYAmt |
| EOY | $4,037,691 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,112 | BOYAmt |
| EOY | $148,763 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $178,508 | BOYAmt |
| EOY | $209,252 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,853,438 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,616,510 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,441,323 | BOYAmt |
| EOY | $5,236,928 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $485,000 | BOYAmt |
| EOY | $1,250,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,312,664 | BOYAmt |
| EOY | $23,623,152 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,846,301 | BOYAmt |
| EOY | $2,904,751 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,618 | BOYAmt |
| EOY | $95,918 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,210,898 | BOYAmt |
| EOY | $149,387 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,000,000 | BOYAmt |
| EOY | $4,000,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,153,817 | BOYAmt |
| EOY | $7,150,056 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,538,969 | BOYAmt |
| EOY | $16,038,466 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $619,878 | BOYAmt |
| EOY | $434,630 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,158,847 | BOYAmt |
| EOY | $16,473,096 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,312,664 | BOYAmt |
| EOY | $23,623,152 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,314,249 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,697,274 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,679,676 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,633,360 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,787,115 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,412,033 | CurrentTaxYearAmt |
| Total | $51,209,458 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $11,697,274 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,679,676 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $9,633,360 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $10,787,115 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,412,033 | CurrentTaxYearAmt |
| Total | $51,209,458 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $51,209,458 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $62,533 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $59,801 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $69,011 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $67,940 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $81,047 | CurrentTaxYearAmt |
| Total | $340,332 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | $1,005,320 | CurrentTaxYearAmt |
| Total | $1,005,320 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $52,555,110 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $96,041,260 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.97440 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99450 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | VALUE BASED PAYMENTS MEANINGFUL USE OTHER | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $632,640 | OtherCostOrOtherBasisAmt |
| Book Value | $632,640 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,127,910 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,651,492 | DepreciationAmt |
| Book Value | $3,476,418 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $595,731 | OtherCostOrOtherBasisAmt |
| Book Value | $595,731 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,497,157 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,965,018 | DepreciationAmt |
| Book Value | $532,139 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,236,928 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PARTICIPATION SHARES | Desc |
| Book Value | $1,250,000 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $1,250,000 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTY | Desc |
| Amt | $4,000,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,000,000 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | EVICTION PREVENTION - UTILITY ASSISTANCE, SANITATION, RENTAL ASSISTANCE, OTHER DIRECT PATIENT ASSISTANCE | GrantTypeTxt |
| Recipient | 476 | RecipientCnt |
| Cash Grant | $220,463 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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 COUTY HMIS SYSTEM AND TRACKED ON SPREADSHEETS AT THE GRANTING LOCATION AND IN ACCOUNTING. IF APPROVED APPLICANT IS ELGIBLE 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAESON FOURNIER | ||||||||||||||
| CEO THRU JUN 2017 | $227,625 | $0 | $0 | $0 | $180 | $0 | $5,691 | $0 | $14,520 | $0 | $248,016 | $0 | $0 | $0 |
| DR MARY NESVIG | ||||||||||||||
| CHIEF CLINICAL OFFICER & INTERIM-CEO | $168,860 | $0 | $0 | $0 | $792 | $0 | $4,222 | $0 | $5,628 | $0 | $179,502 | $0 | $0 | $0 |
| DR MUAJ LO | ||||||||||||||
| PHYSICIAN | $182,784 | $0 | $0 | $0 | $180 | $0 | $4,570 | $0 | $14,520 | $0 | $202,054 | $0 | $0 | $0 |
| DR JASON COMO | ||||||||||||||
| PHYSICIAN | $154,369 | $0 | $0 | $0 | $100 | $0 | $3,859 | $0 | $12,100 | $0 | $170,428 | $0 | $0 | $0 |
| DR KATHIE CULHANE-PERA | ||||||||||||||
| PHYSICIAN | $148,112 | $0 | $0 | $0 | $505 | $0 | $3,703 | $0 | $12,300 | $0 | $164,620 | $0 | $0 | $0 |
| DR STEFAN POMRENKE | ||||||||||||||
| PHYSICIAN | $157,133 | $0 | $0 | $0 | $69 | $0 | $3,928 | $0 | $14,520 | $0 | $175,650 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 30 | ContributionCnt |
| Noncash Contributions Rpt F990 | $36,377 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTANT USING THE AUDITED FINANCIAL RECORDS OF THE ORGANIZATION. THE CEO, CRO, FINANCE COMMITEE, AND BOARD OF DIRECTORS THEN 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 TRANSACTIO WITH A COMPANY WHIHC 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 EXECUTIVE COMMITTEE OF THE BOARD REVIEWS THE CEO COMPENSATION. THEY USED A NUMBER OF COMPENSATION SURVEYS, INCLUDING THE MORE RECENT 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 EMPLOYEE SALARIES ARE REVIEWED AND APPROVED BY THE CEO ON AN ANNUAL BASIS. A REVIEW LAST OCCURRED IN FISCAL YEAR 2016 AS THE ORGANIZATION'S CEO LEFT ON JUNE 1ST. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EAST SIDE HEALTH CENTER INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 153 CESAR CHAVEZ ST | AddressLine1Txt |
| City | SAINT PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 455562728 | EIN |
| Primary Activities | REAL ESTATE HOLDING | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WEST SIDE COMMUNITY HEALTH SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| EAST SIDE HEALTH CENTER INC | ||
| K | $400,008 | FMV |
| EAST SIDE HEALTH CENTER INC | ||
| C | $332,000 | FMV |