2022-11-15T11:01:53-06:00 2021-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-01-01 237113799 SOUTHSIDE COMMUNITY HEALTH SERVICES INC SOUT 6128212025 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 ANN CAZABAN EXECUTIVE DIRECTOR 6128212025 2022-10-28 1 ANN CAZABAN 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-10-19 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z ANN CAZABAN 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 11571047 0 X WWW.SOUTHSIDECHS.ORG X 1971 MN TO PROVIDE HIGH QUALITY HEALTH CARE IN THE COMMUNITIES SERVED. 11 11 127 5 0 0 5625759 5963359 3965507 5591309 0 1754 18769 14625 9610035 11571047 0 0 0 0 5545410 6986736 0 0 0 3130589 3492583 8675999 10479319 934036 1091728 2905207 4106552 970740 1080357 1934467 3026195 IMPROVING THE HEALTH OF OUR PATIENTS AND COMMUNITIES BY DELIVERING EXCEPTIONAL CARE, REMOVING BARRIERS, AND PROMOTING HEALTHY LIFESTYLES. 0 0 4774688 0 2403191 MEDICAL:SOUTHSIDE COMMUNITY HEALTH SERVICES, INC (SCHS) IS A 501(C)(3) NONPROFIT ORGANIZATION AND IS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) LOCATED IN SOUTH MINNEAPOLIS. SOUTHSIDE MEDICAL CURRENTLY PROVIDES FAMILY PRACTICE MEDICINE INCLUDING SPECIAL PROGRAMS FOR AT RISK POPULATIONS, FAMILY PLANNING, PRENATAL AND PEDIATRICS. SCHS HAS ONE MEDICAL CLINIC LOCATED IN MINNEAPOLIS AND A DENTAL AND VISION CLINIC LOCATED IN MINNEAPOLIS. WHILE THE MAJORITY OF PATIENTS COME FROM THE SOUTHSIDE OF MINNEAPOLIS, SCHS CONTINUES TO HAVE AN "ESSENTIAL COMMUNITY SAFETY NET PROVIDER" DESIGNATION FROM THE STATE OF MINNESOTA. 3626231 0 3188118 DENTAL:SOUTHSIDE DENTAL CLINIC CURRENTLY PROVIDES GENERAL DENTAL SERVICES FOR PEOPLE OF ALL AGES. SOUTHSIDE CURRENTLY OPERATES FOURTEEN DENTAL OPERATORIES.IN 2021, SOUTHSIDE PROVIDED 30,175 VISITS BETWEEN MEDICAL, BEHAVIORAL, HEALTH, DENTAL, AND VISION. 0 0 0 OUTREACH:SOUTHSIDE'S OUTREACH PROGRAM PROVIDES THE COMMUNITY WITH INNOVATIVE PROGRAMS, ACTIVITIES AND EDUCATIONAL OPPORTUNITIES DESIGNED TO IMPROVE HEALTH LITERACY AND ASSIST PEOPLE IN GETTING INVOLVED IN THEIR PERSONAL HEALTH CARE. IT HAS BEEN PROVIDED THAT THE EARLIER HEALTHY PRACTICES ARE ESTABLISHED, THE BETTER THE QUALITY OF LIFE FOR THE INDIVIDUAL. THESE PRACTICES CAN INCLUDE HEALTH DIET, CONSISTENT EXERCISE, AND MONITORING LIFESTYLE CHOICES. 8400919 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 19 0 127 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X MARK BUECHELE 6128212025 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 BRIAN OSBERG CHAIR 1.00 X X 0 0 0 PATRICK LYTLE VICE CHAIR 1.00 X X 0 0 0 SHAUN ZEIG TREASURER 1.00 X X 0 0 0 JIM GALLAGHER SECRETARY 1.00 X X 0 0 0 KALEECA BIBLE DIRECTOR 1.00 X 0 0 0 MICHELLE EVANS DIRECTOR 1.00 X 0 0 0 ANGEL EVEN DIRECTOR 1.00 X 0 0 0 KRISTY GRAUME DIRECTOR 1.00 X 0 0 0 D'WAYNE MORRIS DIRECTOR 1.00 X 0 0 0 MARIKA REECE DIRECTOR 1.00 X 0 0 0 YECTLI HUERTA DIRECTOR 1.00 X 0 0 0 ANN CAZABAN EXECUTIVE DIRECTOR 40.00 X 177164 0 4005 MARK BUECHELE CHIEF FINANCIAL OFFICER 11.00 X 67426 0 0 BRIAN QUINLAN DENTAL DIRECTOR 40.00 X 172232 0 6724 JAMES ADAMCZAK DENTIST 40.00 X 147406 0 1669 DANIEL GINGERICH-BOBERG PHYSICIAN 40.00 X 129401 0 10792 MOHIUDDIN QUADRI DENTIST 40.00 X 138740 0 1640 JANELLE KARLSRUD DENTAL DIRECTOR 40.00 X 138939 0 0 971308 0 24830 6 0 1 0 GLORIMAR RIVERA 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 BILLING SERVICES 274059 1 5857695 105664 5963359 DENTAL SERVICES 621400 3188118 3188118 MEDICAL SERVICES 621400 2398418 2398418 4773 4773 5591309 1754 1754 14625 14625 14625 11571047 5591309 0 16379 X 427551 151968 275583 5635382 5089297 546085 87720 79857 7863 313286 200176 113110 522797 277496 245301 17200 17200 1080472 552066 528406 3117 1166 1951 268118 240772 27346 455895 406197 49698 285436 249366 36070 12148 8554 3594 92169 21948 70221 26457 26457 316944 235842 81102 19906 13811 6095 BAD DEBT EXPENSE 438730 438730 PROGRAM SUPPLIES 411008 411008 DUES & SUBSCRIPTIONS 31069 2626 28443 MN PROVIDER TAXES 18165 18165 15749 1874 13875 10479319 8400919 2078400 0 1222871 500243 0 1751754 227338 465193 11267 184073 4258753 3053464 1443731 1205289 2905207 4106552 470473 622201 500267 458156 970740 1080357 X 1934467 3026195 1934467 3026195 2905207 4106552 1091728 0 X 0 1 X 1 1 1 X 3012303 3226004 4327833 5625759 5963359 22155258 3941378 3981110 5096391 3965507 5591309 22575695 6953681 7207114 9424224 9591266 11554668 44730953 0 0 0 44730953 433 1754 2187 433 1754 2187 88365 48611 47489 18769 14625 217859 7042479 7255725 9471713 9610035 11571047 44950999 0.99510 0.99280 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 130543 130543 1289188 955076 334112 315603 315603 0 2468312 1782785 685527 55107 55107 1205289 X 11132317 -438730 -438730 11571047 0 11571047 10040589 0 10040589 438730 438730 10479319 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -438,730. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 438,730. X X X 0 0 0 0 0 0 0 0 0 ANN CAZABAN EXECUTIVE DIRECTOR 168900 0 0 0 8264 0 3912 0 93 0 181169 0 0 0 BRIAN QUINLAN DENTAL DIRECTOR 169539 0 0 0 2693 0 5050 0 1674 0 178956 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF FORM 990 IS PRESENTED TO THE EXECUTIVE COMMITTEE FOR REVIEW AND QUESTIONS. ONCE APPROVED BY THE COMMITTEE, FORM 990 WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE REQUIRED TO BE UPDATED ANNUALLY FOR ALL BOARD MEMBERS AND EMPLOYEES. ANY CONFLICT OF INTEREST MUST BE IMMEDIATELY DISCLOSED TO THE EXECUTIVE DIRECTOR IN WRITING. NO MEMBER OF THE BOARD MAY VOTE ON MATTERS ON ANY AREA WHERE THEY MAY RECEIVE FINANCIAL GAIN, OR WHICH MAY CONFLICT WITH MEMBER OBLIGATIONS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR REVIEWS AND APPROVES THE COMPENSATION OF THE OTHER OFFICERS USING A MARKET SURVEY CONDUCTED BY AN OUTSIDE HR CONSULTANT. THE EXECUTIVE COMMITTEE USED EXECUTIVE SALARY SURVEYS FOR COMPARABILITY PURPOSES TO UPDATE THE EXECUTIVE DIRECTOR'S COMPENSATION. THE DECISION OF THE EXECUTIVE COMMITTEE WAS ALSO REVIEWED AND APPROVED BY THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 176,461. MANAGEMENT AND GENERAL EXPENSES 528,406. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 704,867. LAB FEES: PROGRAM SERVICE EXPENSES 375,605. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 375,605.