2021-12-16T07:47:41-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 270052697 UNITED FAMILY PRACTICE HEALTH CENTER UNIT 6517581408 1026 WEST 7TH STREET ST PAUL MN 55102 ANN NYAKUNDI CEO 6517581408 2021-12-08 1 ANN NYAKUNDI 999009999 RYAN ENGEBRETSON P01582625 6123764500 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z UNITED FAMILY MEDICINE DAYMOND DEAN 1026 WEST 7TH STREET ST PAUL MN 55102 16743997 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. 9 9 171 25 0 0 3131447 3285138 12405839 10368906 71757 52761 1950744 2768188 17559787 16474993 0 0 0 0 7641908 8179532 21030 76486 254219 9451055 8091824 17113993 16347842 445794 127151 22684328 23538534 991885 1608540 21692443 21929994 UNITED FAMILY MEDICINE PROVIDES GENERAL PRACTICE PRIMARY CARE, DENTAL, AND MENTAL HEALTH SERVICES TO MEDICALLY UNINSURED AND UNDER INSURED PATIENTS. 0 0 13013643 0 13137094 AS A FEDERALLY QUALIFIED HEALTH CENTER, UNITED FAMILY MEDICINE SERVICED OVER 10,000 PATIENTS CLOSE TO 30% OF PATIENT UNDER 100% OF FEDERAL POVERTY GUIDELINES AND APPROXIMATELY 80% OF OUR PATIENTS ARE UNINSURED, ON MEDICAID OR CHIP, OR ON MEDICARE. WE PROVIDE SLIDING FEE DISCOUNT TO ALL OF OUR PATIENT WHO QUALIFY WITH DISCOUNTS PROVIDED TO PATIENTS AT OR BELOW 200% FPL. AS AN ESSENTAIL COMMUNITY PROVIDER SERVICES PROVIDED INCLUDE FAMILY MEDICINE, DENTISTRY AND INTEGRATED BEHAVIORAL HEALTH. 13013643 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 1 171 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 VICE CHAIR 4.00 X X 0 0 0 KATE KNAPP SECRETARY 2.00 X X 0 0 0 ZACK RYAN TREASURER 2.00 X X 0 0 0 DAVID BAKER DIRECTOR 2.00 X 0 0 0 ASHER SCHULTZ DIRECTOR 2.00 X 0 0 0 BETSY DAVID DIRECTOR 2.00 X 0 0 0 HEATHER JAMES DIRECTOR 2.00 X 0 0 0 RAHCEL DAYTON DIRECTOR 2.00 X 0 0 0 DAYMOND DEAN CHAIR 4.00 X 0 0 0 ANN NYAKUNDI CEO 40.00 X 162119 0 689 BECKY HOWARD COO 40.00 X 61697 0 8806 TOM ZACHARY CFO 40.00 X 0 0 0 SARAH TORRES COO 40.00 X 101596 0 26132 DAVID BUCHER CMO 40.00 X 79437 0 19309 STEVE FICKS CFO 40.00 X 38684 0 4249 DAVID THORSON CMO 8.00 X 55200 0 0 SEAN MEYER CTO 40.00 X 145042 0 584 MARGARET KILPATRIK HR 40.00 X 106285 0 24327 PHOUNG-GIANG T PHAM DDS 40.00 X 153198 0 10639 TEGAN PRESLEY PA-C 40.00 X 117652 0 52382 ELIZABETH SPOONER-FALDE CNS 40.00 X 104992 0 43205 DAYA SRINIVASAN DDS 40.00 X 123746 0 7549 1249648 0 197871 8 0 1 0 ZACHARY CONSULTING LLC 9248 187TH AVE NW NOWTHEN MN 55330 INTERIM CFO 192046 1 2625501 659637 3285138 PATIENT FEE REVENUE 621110 10368906 10368906 10368906 44917 44917 276848 269004 7844 7844 7844 340B 900099 1775314 1775314 FUHN IHP GAIN SHARING 900099 434716 434716 REIMBURSEMENT OF STAFF SUPPORT 900099 420000 420000 138158 138158 2768188 16474993 13137094 0 52761 X 703544 352177 330793 20574 5565738 4363188 1123356 79194 169677 127621 39356 2700 1219806 917462 282932 19412 520767 391689 120791 8287 124430 124430 79700 79700 76486 76486 42864 42864 2591794 2186813 372862 32119 149166 50352 93963 4851 100893 26667 74226 326489 250386 74659 1444 591456 465854 121337 4265 8715 8397 216 102 47096 24393 22431 272 389453 294924 91313 3216 93096 59710 33386 EQUIPMENT AND SUPPLIES 1903104 1865826 36011 1267 BAD DEBT 1306375 1306375 INTERPRETER SERVICE 162284 162284 MINNESOTA CARE TAX 139419 139419 35490 20106 15354 30 16347842 13013643 3079980 254219 9187485 11840632 1983329 546419 94263 30371 1374305 1021185 33051 39019 14721926 6567359 8528621 8154567 1025607 1233797 457667 672544 22684328 23538534 991885 1327275 281265 991885 1608540 X 20677065 20855271 1015378 1074723 21692443 21929994 22684328 23538534 X 127151 110398 2 X X 0 1 X 1 1 1 X 2814744 3197871 3658724 3131447 3225793 16028579 11558041 11542812 12110078 12405839 10368906 57985676 1923369 2077357 1991405 1950744 2768188 10711063 16296154 16818040 17760207 17488030 16362887 84725318 7100 16322 8391 3658 2903 38374 1129113 1663195 1647243 1599286 1655669 7694506 1136213 1679517 1655634 1602944 1658572 7732880 76992438 12897 22630 5382 84849 44917 170675 12897 22630 5382 84849 44917 170675 16309051 16840670 17765589 17572879 16407804 84895993 0.90690 0.90450 0.00200 0.00270 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1015378 25235 1040613 928272 87106 1015378 148374 779898 928272 5062 143166 146 148374 5030 32 5062 0.00000 1.00000 0.00000 0 0 2464157 2464157 9187752 3624056 5563696 182232 182232 0 2616334 2492542 123792 271451 268529 2922 8154567 X 15219671 110398 -1306375 -1195977 16415648 59345 59345 16474993 15041465 0 15041465 1306377 1306377 16347842 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 -1,306,375. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH RESTRICTIONS 59,345. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,306,375. ROUNDING 2. X X 1 SARA BISCHOFF 4407 29TH AVE SOUTH MINNEAPOLIS MN 55406 GRANT WRITER 0 0 15630 -15630 RILEY KARBON 1026 WEST 7TH STREET ST PAUL MN 55102 GRANT WRITER 0 0 60856 -60856 76486 -76486 MN X X 0 0 0 0 0 0 0 0 0 TEGAN PRESLEY PA-C 117652 0 0 0 0 0 6484 0 45898 0 170034 0 0 0 PHOUNG-GIANG T PHAM DDS 153198 0 0 0 0 0 7236 0 3403 0 163837 0 0 0 ANN NYAKUNDI CEO 162119 0 0 0 0 0 0 0 689 0 162808 0 0 0 PART I, LINE 3 THE CEO BONUS IS AUTHORIZED BY THE BOARD OF DIRECTORS. IN 2020, 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 1 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 IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 2,186,813. MANAGEMENT AND GENERAL EXPENSES 372,862. FUNDRAISING EXPENSES 32,119. TOTAL EXPENSES 2,591,794. FORM 990, PART XI, LINE 9: ROUNDING 2. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PAGE 6, PART VI, LINE 8A MOST COMMITTEE MEETINGS WOULD HAVE MINUTES OR NOTES RELATED TO THE COMMITTEE MEETINGS. ANY RESULTING ACTIONS OF A BOARD COMMITTEE WOULD BE INCLUDED IN THE BOARD MINUTES AS PART OF THE COMMITTEE REPORTS TO THE BOARD.