2022-08-04T13:29:24-05:00 2021-09-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-10-01 237156236 WEST SIDE COMMUNITY HEALTH SERVICES INC WEST 6516027500 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 CHRISTIE JANSEN VP OF FINANCE 6516027500 2022-08-04 1 CHRISTIE JANSEN 999009999 RYAN ENGEBRETSON P01585625 6123764500 2022-08-04 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MINNESOTA COMMUNITY CARE CHRISTIE JANSEN 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 43452444 0 X WWW.MNCARE.ORG X 1972 MN MCC PROVIDES MULTILINGUAL, MULTICULTURAL AND COMPREHENSIVE HEALTH CARE IN URBAN NEIGHBORHOODS, SCHOOLS, PUBLIC HOUSING AND HOMELESS SHELTERS. 12 12 552 20 0 0 20030474 18138416 23914395 24804493 20428 12580 1045347 496955 45010644 43452444 126124 309753 0 0 27634569 28490887 4871 0 0 13156975 18513216 40922539 47313856 4088105 -3861412 28025534 23869557 9076608 9726797 18948926 14142760 X MINNESOTA COMMUNITY CARE'S MISSION IS STRENGTHENING THE WELL-BEING OF OUR COMMUNITY THROUGH HEALTH CARE FOR ALL. 0 0 26083788 309753 14458784 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. 4376292 0 4075116 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. 5384227 0 6270593 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 35844307 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 118 0 552 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X CHRISTIE JANSEN 6516027500 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 ZACHARY HYLTON CHAIR 1.00 X X 0 0 0 ANDREATTE HAMES SECRETARY 1.00 X X 0 0 0 CORDELL HARDY TREASURER 1.00 X X 0 0 0 ROMAN CRESS DIRECTOR 1.00 X 0 0 0 MARSHA CRESSY DIRECTOR 1.00 X 0 0 0 RUDY DUFOR DIRECTOR 1.00 X 0 0 0 AMELIA HARDY DIRECTOR 1.00 X 0 0 0 HLEE LEE KRON DIRECTOR 1.00 X 0 0 0 CALLIE CHAMBERLAIN DIRECTOR 1.00 X 0 0 0 ALEJANDRA LUSE-RIVERA DIRECTOR 1.00 X 0 0 0 DANIEL RODRIGUEZ DIRECTOR 1.00 X 0 0 0 SUMMER ABDALLA DIRECTOR 1.00 X 0 0 0 REUBEN MOORE CHIEF EXECUTIVE OFFICER 40.00 X 278600 0 60323 CHRISTIE JANSEN VICE PRESIDENT OF FINANCE 40.00 X 4655 0 0 RUBEN VAZQUEZ VICE PRESIDENT OF EQUITY, PEOPLE, AND CULTURE 40.00 X 26096 0 5793 MIGUEL POZO SENIOR VICE PRESIDENT POPULATION HEALTH/PHYSICIAN 40.00 X 0 0 0 DR LAUREN GRABER SENIOR VICE PRESIDENT POPULATION HEALTH/PHYSICIAN 40.00 X 201159 0 42577 CHRISTINE SINGER VICE PRESIDENT CLINICAL OPERATIONS AND NURSING 40.00 X 148900 0 31574 PAIGE BOWEN VICE PRESIDENT OF ADVANCEMENT 40.00 X 120453 0 24767 BLAKE DARSOW VICE PRESIDENT OF FINANCE (THROUGH DEC 2020) 40.00 X 173060 0 37514 DR MUAJ LO PHYSICIAN 40.00 X 202238 0 43390 DR PETER MEYERS PHYSICIAN 40.00 X 184021 0 39467 DR STEFAN POMRENKE PHYSICIAN 40.00 X 211058 0 45954 DR BRAD MCDONNELL DENTIST 40.00 X 220605 0 48837 DR ALISON WARFORD PHYSICIAN 40.00 X 184851 0 40780 1955696 0 420976 12 0 1 0 COZEN O'CONNOR 123 N WACKER DR SUITE 1800 CHICAGO IL 60606 LEGAL 477084 NETGAIN TECHNOLOGY INC 720 W SAINT GERMAIN ST SUITE 200 ST CLOUD MN 56301 IT HOSTING 447164 SALO LLC 20 SOUTH 13TH ST SUITE 200 MINNEAPOLIS MN 55403 CONTRACTED PROVIDERS 421324 REGENTS OF THE UNIVERSITY OF MN NW 5960 PO BOX 1450 MINNEAPOLIS MN 55485 CONTRACTED PROVIDERS 330048 NORTHWESTERN HEALTH SCIENCES UNIVERSITY 2501 WEST 84TH STREET BLOOMINGTON MN 55431 CONTRACTED PROVIDERS 239737 12 16498639 1639777 18138416 NET PATIENT SERVICE RE 624100 24718631 24718631 PRECEPT REVENUE 624100 85862 85862 24804493 12580 12580 VALUE BASED PAYMENTS 900099 413547 413547 OTHER 900099 83408 83408 496955 43452444 25301448 0 12580 309753 309753 848657 848657 22535183 17732812 4802371 483042 483042 3131669 3299277 -167608 1492336 1492336 1000780 1000780 530686 530686 336433 336433 1932757 1340893 591864 29279 29279 406613 290844 115769 2018641 1233532 785109 1288988 1128035 160953 13076 13076 268316 268316 257618 257618 1263813 1233083 30730 85393 85393 MEDICAL SUPPLIES & DRUG 4287029 4287029 BAD DEBT 1323790 1323790 MN CARE TAX 268681 268681 CONFERENCES, CONVENTION 57857 11302 46555 3143466 2846266 297200 47313856 35844307 11469549 0 5907937 3793117 3136004 889146 1699932 1599018 1593011 2830818 179979 220572 728974 687194 25647418 11797726 14779697 13849692 28025534 23869557 3856406 4003337 528459 348103 4691743 5375357 9076608 9726797 X 18089881 13953469 859045 189291 18948926 14142760 28025534 23869557 X -3861412 -944754 X X 0 1 X 1 1 1 X 10412033 10963762 14269011 20030474 17193662 72868942 10412033 10963762 14269011 20030474 17193662 72868942 72868942 81047 162496 147530 20428 12580 424081 1005320 484447 1133068 1050718 496952 4170505 77463528 117239968 0.94070 0.94120 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: VALUE BASED PAYMENTS MEANINGFUL USE OTHER RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 791640 791640 18990604 7940401 11050203 790533 790533 5021586 3857325 1164261 53055 53055 13849692 X PART X, LINE 2: MCC HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, MCC IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. 1 EVICTION PREVENTION- UTILITY ASSISTANCE, SANITATION, RENTAL ASSISTANCE, OTHER DIRECT PATIENT ASSISTANCE 416 309753 N/A N/A PART I, LINE 2: MONITORING OF GRANTS RECIPIENTS OF UTILITY ASSISTANCE ARE SCREENED BY RAMSEY COUNTY/MCC 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, MINNESOTA COMMUNITY CARE WILL ASSIST IN RESOLVING THE BILL. ALL PAYMENTS ARE MADE DIRECTLY TO THE LANDLORD, UTILITY COMPANY, OR SANITATION COMPANY. CHECKS ARE PROCESSED BY MCC WITH SPECIFIC NAMES AND ACCOUNT NUMBERS. THIS INFORMATION GOES TO THE UTILITIES AND HC STAFF TO VERIFY AND RECORD. X X X X 0 0 0 0 0 0 0 0 0 REUBEN MOORE CHIEF EXECUTIVE OFFICER 271725 0 0 0 6875 0 13586 0 46737 0 338923 0 0 0 DR BRAD MCDONNELL DENTIST 219985 0 0 0 620 0 10999 0 37837 0 269441 0 0 0 DR STEFAN POMRENKE PHYSICIAN 206999 0 0 0 4059 0 10350 0 35604 0 257012 0 0 0 DR MUAJ LO PHYSICIAN 195449 0 0 0 6789 0 9772 0 33617 0 245627 0 0 0 DR LAUREN GRABER SENIOR VICE PRESIDENT POPULATION HEA 191787 0 0 0 9372 0 9589 0 32987 0 243735 0 0 0 DR ALISON WARFORD PHYSICIAN 183695 0 0 0 1156 0 9185 0 31596 0 225632 0 0 0 DR PETER MEYERS PHYSICIAN 177781 0 0 0 6240 0 8889 0 30578 0 223488 0 0 0 BLAKE DARSOW VICE PRESIDENT OF FINANCE (THROUGH D 168980 0 0 0 4080 0 8449 0 29065 0 210574 0 0 0 CHRISTINE SINGER VICE PRESIDENT CLINICAL OPERATIONS A 142226 0 0 0 6674 0 7111 0 24463 0 180474 0 0 0 PART I, LINE 3 WRITTEN EMPLOYMENT CONTRACT REFERS TO ONE OR MORE RECENT OR CURRENT WRITTEN EMPLOYMENT AGREEMENTS TO WHICH THE TOP MANAGEMENT OFFICIAL AND ANOTHER ORGANIZATION ARE OR WERE PARTIES, WRITTEN EMPLOYMENT AGREEMENTS INVOLVING SIMILARLY SITUATED TOP MANAGEMENT OFFICIALS WITH SIMILARLY SITUATED ORGANIZATIONS, OR WRITTEN EMPLOYMENT OFFERS TO THE TOP MANAGEMENT OFFICIAL FROM OTHER ORGANIZATIONS DEALING AT ARM'S LENGTH. THE BASIS OF CURRENT YEAR CEO COMPENSATION IS BASED ON THE WRITTEN CONTRACT FROM A PRIOR YEAR. FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS CORDELL HARDY AND AMELIA HARDY ARE SPOUSES. FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEES HAVE THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM USING THE AUDITED FINANCIAL RECORDS OF THE ORGANIZATION. THEN, THE CEO, CFO, FINANCE COMMITTEE, AND BOARD OF DIRECTORS REVIEWED AND APPROVED 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 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 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. 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 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 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 PRESIDENT & EXECUTIVE OFFICER PERFORMANCE AND COMPENSATION ON AN ANNUAL BASIS. THEY USE 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 REVIEWED AND APPROVED BY THE PRESIDENT & EXECUTIVE OFFICER ON AN ANNUAL BASIS. A REVIEW OCCURRED IN THE FINAL MONTH OF FY20 WITH COMPENSATION INCREASES TAKING EFFECT ON THE FIRST DAY OF FY21. FORM 990, PART VI, SECTION C, LINE 19 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. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -944,754. FORM 990, PART XII, LINE 2C: THE PROCESS FOR SELECTION AND OVERSIGHT OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0