2022-11-15T13:39:37-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-01-01 270052697 UNITED FAMILY PRACTICE HEALTH CENTER UNIT 6517581408 1026 WEST 7TH STREET ST PAUL MN 55102 ERIC BLUM CFO 6517581408 2022-11-14 1 ERIC BLUM 999009999 RYAN ENGEBRETSON P01582625 6123764500 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z UNITED FAMILY MEDICINE DAYMOND DEAN 1026 WEST 7TH STREET ST PAUL MN 55102 14367703 0 X WWW.UNITEDFAMILYMEDICINE.ORG X 2003 MN TO PROVIDE CLINICAL HEALTH, BEHAVIORAL HEALTH, DENTAL, AND SUPPORTING SERVICES AS A FQHC TO MEDICALLY UNDERSERVED AND UNDERINSURED PATIENTS. 10 10 181 60 0 0 3285138 5408293 10368906 7598729 52761 65173 2768188 1160839 16474993 14233034 0 0 0 0 8179532 10606083 76486 10636 69225 8091824 4400088 16347842 15016807 127151 -783773 23538534 22572994 1608540 1378433 21929994 21194561 UNITED FAMILY MEDICINE PROVIDES GENERAL PRACTICE PRIMARY CARE, DENTAL, AND MENTAL HEALTH SERVICES TO MEDICALLY UNINSURED AND UNDER INSURED PATIENTS. 0 0 11856777 8759568 UFM SERVED MORE THAN 10,000 PATIENTS IN 2021 BY OFFERING PRIMARY MEDICAL, DENTAL AND BEHAVIORAL HEALTH SERVICES. SEPARATELY, WE PROVIDED MORE THAN 10,000 VACCINATIONS AND COMPLETED THOUSANDS OF COVID-19 TESTS. IN FACT, UFM WAS IN THE TOP 10% OF COMMUNITY CLINICS NATIONWIDE THAT PROVIDED COVID-19 VACCINATIONS TO TRADITIONALLY UNDERSERVED COMMUNITIES ACCORDING TO THE HEALTH RESOURCES AND SERVICES ADMINISTRATION. 11856777 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 31 0 181 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X ANN NYAKUNDI CEO 6517581408 1026 WEST 7TH STREET ST PAUL MN 55102 JINNY PALEN BOARD CHAIR 2.00 0.00 X X 0 0 0 WILLIAM SCHULTZ DIRECTOR 1.00 0.00 X 0 0 0 STEPHEN GUMNIT DIRECTOR 1.00 0.00 X 0 0 0 MARIA MACWILLIAMS DIRECTOR 1.00 0.00 X 0 0 0 HEATHER JAMES DIRECTOR 1.00 0.00 X 0 0 0 RAHCEL DAYTON DIRECTOR 1.00 0.00 X 0 0 0 BETSY DAVID DIRECTOR 1.00 0.00 X 0 0 0 DAVID BAKER SECRETARY 1.00 0.00 X X 0 0 0 KAREN GRIES TREASURER 1.00 0.00 X 0 0 0 ZACK RYAN VICE CHAIR 1.00 0.00 X X 0 0 0 ANN NYAKUNDI CEO 40.00 0.00 X 160935 0 31321 TOM ZACHARY CFO (LEFT SEPTEMBER 2021) 40.00 0.00 X 115874 0 14186 DAVID THORSON CMO (AS OF AUGUST 2021) 40.00 0.00 X 10827 0 24000 DAVID BUCHER CMO (LEFT JULY 2021) 8.00 0.00 X 131463 0 27382 SARAH TORRES COO (LEFT NOVEMBER 2021 40.00 0.00 X 120379 0 16743 DAYMOND DEAN DIRECTOR 1.00 0.00 X 0 0 0 PHOUNG-GIANG T PHAM DDS 40.00 0.00 X 142808 0 28476 XOUA THAO MD 40.00 0.00 X 202636 0 12953 NATHAN GUIMONT MD 40.00 0.00 X 159315 0 30336 SCOTT TONGEN MD 40.00 0.00 X 205303 0 46103 DAWN BROTHERS PA 40.00 0.00 X 134083 0 1355 1383623 0 232855 9 0 1 0 JOHN WHITINGTON 507 THOMAS DRIVE EAGLE LAKE MN 56024 IT SERVICES 173792 EMD CLEANING SERVICES PO BOX 600250 ST PAUL MN 55106 CLEANING SERVICES 107384 2 4483123 925170 5408293 PATIENT FEE REVENUE 621110 7598729 7598729 7598729 46654 46654 153188 134669 18519 18519 18519 340B 446110 975293 975293 FUHN IHP GAIN SHARING 624100 185546 185546 1160839 14233034 8759568 0 65173 653110 330794 290084 32232 7873976 5955140 1917437 1399 237910 175381 61591 938 1308105 964299 338647 5159 532982 392900 137980 2102 63201 63201 87504 87504 10636 10636 42842 42842 -156574 217733 -375283 976 174502 115306 53910 5286 135412 62155 73257 416827 347184 67383 2260 466163 362107 100584 3472 40047 3136 36900 11 8382 2197 6149 36 423724 317851 102269 3604 148716 115320 33396 EQUIPMENT AND SUPPLIES 1290450 1243785 45582 1083 BAD DEBT 956228 956228 INTERPRETER SERVICES 183485 183450 35 MINNESOTA CARE TAX 95881 95881 23298 15930 7337 31 15016807 11856777 3090805 69225 11840632 10248682 546419 0 30371 24571 1021185 562900 39019 34231 15679755 6991084 8154567 8688671 1233797 1367395 672544 1646544 23538534 22572994 1327275 942847 281265 435586 1608540 1378433 X 20855271 20153947 1074723 1040614 21929994 21194561 23538534 22572994 X -783773 82450 -34112 X 0 1 X 1 1 1 X 3197871 3658724 3131447 3225793 5152444 18366279 11542812 12110078 12405839 10368906 7598729 54026364 2077357 1991405 1950744 2768188 1160839 9948533 16818040 17760207 17488030 16362887 13912012 82341176 16322 8391 3658 2903 959 32233 1663195 1647243 1599286 1655669 835706 7401099 1679517 1655634 1602944 1658572 836665 7433332 74907844 22630 5382 84849 44917 46654 204432 22630 5382 84849 44917 46654 204432 16840670 17765589 17572879 16407804 13958666 82545608 0.90750 0.90690 0.00250 0.00200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1040613 1040613 1015378 25235 1040613 928272 87106 1015378 148374 779898 928272 5062 143166 146 148374 0 0 2464157 2464157 9187752 3930315 5257437 182232 182232 0 2755922 2572777 183145 1089692 305760 783932 8688671 OTHER RECEIVABLES 1646544 1646544 X 13325145 82450 -956228 -873778 14198923 34111 34111 14233034 14060580 0 14060580 956228 956228 15016808 PART V, LINE 4: THE ENDOWMENT CONSIST OF ONE FUND USED TO SUPPORT THE HEALTH CENTER. THE FUNDS ARE TO BE USED FOR FUTURE CAPITAL IMPROVEMENTS OR PROJECTS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE FOR OTHER PURPOSES. PART X, LINE 2: THE HEALTH CENTER QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, THE HEALTH CENTER IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE IRC. THE HEALTH CENTER IS CLASSIFIED AS A PUBLICLY SUPPORTED CHARITABLE ORGANIZATION UNDER SECTION 509(A)(2) OF THE IRC AND CONTRIBUTIONS TO THE HEALTH CENTER QUALIFY AS A CHARITABLE TAX DEDUCTION BY THE CONTRIBUTOR. THE HEALTH CENTER HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HEALTH CENTER FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -956,228. PART XI, LINE 4B - OTHER ADJUSTMENTS: NET ASSETS REALEASED FROM RESTRICTIONS 34,111. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 956,228. ROUNDING X X 0 0 0 0 0 0 0 0 0 SCOTT TONGEN MD 204303 0 1000 0 0 0 9487 0 36616 0 251406 0 0 0 XOUA THAO MD 202636 0 0 0 0 0 0 0 12953 0 215589 0 0 0 ANN NYAKUNDI CEO 150935 0 10000 0 0 0 0 0 31321 0 192256 0 0 0 NATHAN GUIMONT MD 151815 0 7500 0 0 0 7909 0 22427 0 189651 0 0 0 PHOUNG-GIANG T PHAM DDS 142808 0 0 0 0 0 7164 0 21312 0 171284 0 0 0 DAVID BUCHER CMO (LEFT JULY 2021) 131463 0 0 0 0 0 5913 0 21469 0 158845 0 0 0 PART I, LINE 3 THE CEO BONUS IS AUTHORIZED BY THE BOARD OF DIRECTORS. IN 2021, ANY BONUS PROVIDED TO OTHER UFM EMPLOYEES WAS APPROVED BY THE CEO AND THE BONUS WAS BASED UPON EMPLOYMENT CONTRACTS OR EMPLOYEE PERFORMANCE. FORM 990, PART VI, SECTION A, LINE 1A MEMBERS OF THE COMMITTEE SHALL ACT FOR THE CORPORATION IN ALL MATTERS DURING THE INTERIM PERIODS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. ACTIONS TAKEN BY THE EXECUTIVE/FINANCE COMMITTEE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD, AND ALL MATTERS OF MAJOR IMPORTANCE SHALL BE REFERRED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE IRS FORM 990 AND ATTACHED DOCUMENTS ARE PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS TO REVIEW AND TO ADDRESS ANY QUESTIONS. REVISIONS ARE COMPLETED AND THE IRS FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS BY THE FINANCE COMMITTEE FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS CONSISTS OF INDEPENDENT PERSONS ESTABLISHES GOALS AND OBJECTIVES FOR THE BOARD OF DIRECTORS AND ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY OCCUR DURING THEIR MEMBERSHIP ON THE BOARD OF DIRECTORS. EACH YEAR, THE BOARD OF DIRECTORS REVIEWS CONFLICTS OF INTEREST WITH LEGAL COUNSEL. APPROPRIATE EDUCATION AND/OR ACTIONS ARE TAKEN BY THE BOARD AS NEEDED IN ACCORDANCE WITH THE CORPORATION'S CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE REQUIRED TO DISCLOSE AT A BOARD MEETING PREVIOUSLY UNDISCLOSED CONFLICTS AND REFRAIN FROM PARTICIPATION IN DISCUSSION OR VOTING ON THE CONFLICTING SUBJECT. KEY EMPLOYEES OF THE ORGANIZATION ARE REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE ANNUALLY AS PART OF THE ORGANIZATION POLICIES FOR EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS, WHICH CONSIST OF INDEPENDENT PERSONS ESTABLISHES GOALS AND OBJECTIVES FOR THE CEO AND WITH THE ASSISTANCE OF THE HR DIRECTOR OF UFM WILL COMPILE MARKET SALARY SURVEY RESEARCH ANALYSIS AND REVIEW THIS DATA AS PART OF ONGOING CEO COMPENSATION. THIS DATA INCLUDES SOURNCES SUCH AS MNACHC SURVEY AND MN COUNCIL OF NON PROFITS FOR LIKE POSITIONS. THE BOARD, OR COMMITTEE OF THE BOARD WILL DOCUMENT FINDINGS AND ANALYSIS RELATED TO THE MARKET ANALYSIS. COMPENSATION IS REVIEWED FOR EQUITY INTERNALLY WITH HR DIRECTOR PROCESSES AND PROCEDURES. EXTERNAL COMPENSATION REVIEW IS DONE BY HR DIRECTOR USING MNACHC SURVEY, SMALL PRACTICE COMPENSATION SURVEY, AND FAIRVIEW SALARY SURVEY AS COMPENSATION RESOURCES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE CEO OR CFO. FORM 990, PART XI, LINE 9: CHANGE IN RESTRICTED NET ASSETS -34,111. ROUNDING -1.