2020-11-14T10:30:52-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-01-01 270052697 UNITED FAMILY PRACTICE HEALTH CENTER UNIT 6512411027 1026 WEST 7TH STREET ST PAUL MN 55102 THOMAS ZACHARY CFO 6512411027 2020-11-13 1 RYAN ENGEBRETSON P01582625 6123764500 66.188.188.148 2020-11-13 12:39:12 CS P E168BB59A4AC1B98DF6FDFCBC72C1446FCA85D8B 8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4C 2019 2021-01-29 14:40:06Z UNITED FAMILY MEDICINE DAYMOND DEAN 1026 WEST 7TH STREET ST PAUL MN 55102 24661194 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 9 141 25 0 0 3658724 3131447 12110078 12405839 5382 71757 1991405 1950744 17765589 17559787 0 0 0 0 6901976 7641908 0 21030 319208 9864950 9451055 16766926 17113993 998663 445794 21908335 22684328 808789 991885 21099546 21692443 X UNITED FAMILY MEDICINE PROVIDES GENERAL PRACTICE PRIMARY CARE, DENTAL, AND MENTAL HEALTH SERVICES TO MEDICALLY UNINSURED AND UNDER INSURED PATIENTS AND IS A FAMILY PRACTICE RESIDENCY LOCATION. 0 0 14151982 0 14356583 AS A FEDERALLY QUALIFIED HEALTH CENTER, UNITED FAMILY MEDICINE SERVICED OVER 15,000 PAITENTS AT TWO LOCATIONS WITH CLOSE TO 5,000 OF THE PATIENTS UNDER 100% FOR FEDERAL POVERTY GUIDELINES AND 70% OF OUR PATIENTS ARE UNINSURED, ON MEDICAID OR CHIP, OR ON MEDICARE. WE PROVIDE A SLIDING FEE DISCOUNT TO ALL OF OUR PATIENTS WHO QUALIFY WITH DISCOUNTS PROVIDED TO PATIENTS AT OR BELOW 200% FPL. AS AN ESSENTIAL COMMUNITY PROVIDER, SERVICES PROVIDED INCLUDE FAMILY MEDICINE, DENTISTRY AND INTEGRATED BEHAVIORAL HEALTH. UNITED FAMILY MEDICINE IS ALSO A LOCATION FOR A FAMILY PRACTICE RESIDENCY PROGRAM TRAINING PROVIDERS FOR TOMORROW. MANY OF WHICH GO ON TO PRACTICE IN OTHER COMMUNITY CLINIC SETTINGS. UFM HAS SERVED AS THE FAMILY PRACTICE RESIDENCY TRAINING SITE FOR THE UNITED FAMILY MEDICINE RESIDENCY PROGRAM FOR OVER 30 YEARS. UFM IS COMMITTED TO THE DEVELOPMENT OF NEW PROVIDERS TO SERVE THE TARGET POPULATION. EACH YEAR TRAINING IS PROVIDED FOR 21 FAMILY PRACTICE RESIDENTS. MANY RESIDENTS WHO HAVE PARTICIPATED IN THE RESIDENCY PROGRAM GO ON TO ESTABLISH PRACTICES IN UNDERSERVED AND RURAL AREAS OF MINNESOTA AND THROUGHOUT THE NATION. UFM OFFERS ONSITE DENTAL SERVICES TO MEET THE NEEDS OF OUR COMMUNITY AND AN AREA WERE CRITIAL ACCESS DENTISTRY IS OF VERY SHORT SUPPLY. POPULATIONS SERVED BY UFM OFTEN SEEK DENTISTRY IN EMERGENCY DEPARTMENTS DUE TO LACK OF ACCESS. THIS IS AN AREA OF FOCUS AND EXPANSION FOR UNITED FAMILY MEDICINE. UFM OFFERS COMPREHENSIVE BEHAVIORAL HEALTH SERVICES, INCLUDING MENTAL HEALTH AND SUBSTANCE ABUSE USE SERVICES TO PATIENTS. BEHAVIORAL HEALTH SERVICES ARE INTEGRATED WITH FAMILY PRACTICE SERVICES, WHICH PROVIDE PATIENTS DIRECT ACCESS TO BEHAVIORAL HEALTH SERVICES AT THE TIME OF A PRIMARY CARE VISIT. UFM BEHVIORAL HEALTH PROGRAMS EXPANDED TO INCLUDE MEDICATION ASSISTED TREATMENT (MAT) WITH A GOAL OF CERTIFICATION FOR PRESCRIBING SUBOXONE. 14151982 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 19 0 1 141 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X THOMAS ZACHARY CFO 6512411027 1026 WEST 7TH STREET ST PAUL MN 55102 X MELISSA PARKER CEO (THROUGH OCT 2019) 40.00 X 191578 0 31863 STEVE FICKS CFO 40.00 X 146672 0 32925 DR PHAM PHUING-GIANG DENTIST 40.00 X 139471 0 8839 DR TEGAN S PRESLEY PHYSICIAN ASSISTANT 40.00 X 116132 0 32855 DR DAYA SRINIVASAN DENTIST 40.00 X 109603 0 6058 BECKY HOWARD COO 40.00 X 94384 0 29287 ANN NYAKUNDI INTERIM CEO 40.00 X X 32413 0 0 KIM HYERS CHAIR (THROUGH OCT 2019) 4.00 X 0 0 0 DAYMOND DEAN CHAIR 4.00 X 0 0 0 CHRISTOPHER MARKOV VICE CHAIR (THROUGH NOV 2019) 2.00 X 0 0 0 JINNY PALEN VICE CHAIR 4.00 X 0 0 0 KATE KNAPP SECRETARY 2.00 X 0 0 0 ZACK RYAN TREASURER 2.00 X 0 0 0 GEORGE BABOILA DIRECTOR (THROUGH OCT 2019) 4.00 X 0 0 0 DAVID BAKER DIRECTOR 2.00 X 0 0 0 BETSY DAVID DIRECTOR 2.00 X 0 0 0 RACHEL DAYTON DIRECTOR 2.00 X 0 0 0 ROBERTO FONTS DIRECTOR (THROUGH MAY 2019) 2.00 X 0 0 0 HEATHER JAMES DIRECTOR 2.00 X 0 0 0 STEVEN LAMBROS DIRECTOR (THROUGH MAY 2019) 2.00 X 0 0 0 ASHER SCHULTZ DIRECTOR 2.00 X 0 0 0 830253 0 141827 2 0 1 0 SEAN'S TECH SUPPORT 1491 RICE CREEK DRIVE FRIDLEY MN 55432 IT SUPPORT 149189 1 1769642 1361805 3131447 PATIENT FEE REVENUE 621110 12405839 12405839 12405839 84849 84849 7088315 7101407 -13092 -13092 -13092 304B 900099 1385754 1385754 REIMBURSEMENT OF PHYSICAL PLANT 900099 296184 296184 REIMBURSEMENT OF STAFF SUPPORT 900099 260922 260922 7884 7884 1950744 17559787 14356583 0 71757 X 559121 123670 391906 43545 5388125 4373619 976560 37946 155188 117353 35709 2126 1243134 940054 286046 17034 296340 224091 68188 4061 167063 167063 109812 109812 21030 21030 43352 43352 3507579 3361603 39774 106202 93793 49602 4332 39859 103721 51261 48439 4021 385360 294572 88884 1904 597290 444909 147196 5185 26379 14940 11293 146 93064 30102 41924 21038 428235 315489 108910 3836 71435 70771 664 EQUIPMENT AND SUPPLIES 1839181 1790984 47151 1046 BAD DEBT 1441912 1441912 INTERPRETER SERVICE 277208 277208 MINNESOTA CARE TAX 222155 222155 43516 7687 25600 10229 17113993 14151982 2642803 319208 8271855 9187485 1978814 1983329 133342 94263 1194304 1374305 476646 33051 14706527 6177906 8869225 8528621 760471 1025607 223678 457667 21908335 22684328 808789 991885 808789 991885 X 20171274 20677065 928272 1015378 21099546 21692443 21908335 22684328 445794 147103 0 X X 0 1 X 1 1 1 X 2358964 2814744 3197871 3658724 3131447 15161750 10842293 11558041 11542812 12110078 12405839 58459063 1499826 1923369 2077357 1991405 1950744 9442701 0 0 0 0 0 0 0 0 0 0 14701083 16296154 16818040 17760207 17488030 83063514 4950 7100 16322 8391 3658 40421 2005143 1129113 1663195 1647243 1247828 7692522 2010093 1136213 1679517 1655634 1251486 7732943 75330571 98616 12897 22630 5382 84849 224374 98616 12897 22630 5382 84849 224374 0 0 0 0 0 14799699 16309051 16840670 17765589 17572879 83287888 0.90450 0.91000 0.00270 0.00400 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 928272 87106 0 0 0 0 1015378 148374 779898 0 0 0 0 928272 5062 143166 146 0 0 0 148374 5030 0 32 0 0 0 5062 5000 0 30 0 0 0 5030 0.00000 1.00000 0.00000 0 0 2464157 2464157 9187752 4546771 4640981 182232 182232 0 2600935 1185382 1415553 271451 263521 7930 8528621 X 16177872 147103 -1441912 -1294809 17472681 87106 87106 17559787 15672081 0 15672081 1441912 1441912 17113993 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 -1,441,912. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 87,106. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,441,912. X X 1 SARA BISCHOFF 4407 29TH AVE SOUTH MINNEAPOLIS MN 55406 GRANT WRITER 0 218750 21030 197720 218750 21030 197720 MN X X 0 0 0 0 0 0 0 0 0 MELISSA PARKER CEO (THROUGH OCT 2019) 141271 0 7954 0 42353 0 0 0 31863 0 223441 0 0 0 STEVE FICKS CFO 135649 0 11023 0 0 0 0 0 32925 0 179597 0 0 0 PART I, LINE 3 THE CEO BONUS IS AUTHORIZED BY THE BOARD OF DIRECTORS. IN 2019, 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 A, LINE 4 CHANGES MADE TO THE BYLAWS DURING 2019 REVISE UFM'S COMMITTEES AND THE NUMBER OF DIRECTORS THAT ARE REQUIRED FOR STANDING COMMITTEES. IN SUMMARY, THE EXECUTIVE AND FINANCE COMMITTEES WERE COMBINED TO ONE EXECUTIVE/FINANCE COMMITTEE WHICH IS TO BE COMPRISED OF OFFICERS AND OTHER SUCH VOTING MEMBERS AS APPOINTED BY THE BOARD, AS WELL AS THE CEO AND CFO AS NON-VOTING MEMBERS. ADDITIONALLY, THE GOVERNANCE COMMITTEE WAS REVISED TO CLARIFY IT MUST BE COMPRISED OF TWO DIRECTORS AND THE CFO. 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 WHO ESTABLISH GOALS AND OBJECTIVES FOR THE BOARD OF DIRECTORS, AND IDENTIFY ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY OCCUR DURING 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. THE CONFLICT OF INTEREST POLICY APPLIES TO BOARD MEMBERS AND KEY MANAGEMENT INDIVIDUALS. 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 SOURCES 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. THE MOST RECENT REVIEW WAS IN 2019. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES 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. THE MOST RECENT REVIEW WAS IN 2019. 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 VII, LINE 1A ANN NYAKUNDI LEFT THE POSITION OF DIRECTOR IN SEPTEMBER 2019 AND TRANSITIONED TO THE POSITION OF CEO. DUE TO HER TRANSITION TO CEO SHE WAS NO LONGER A VOTING MEMBER OF THE BOARD. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 3,361,603. MANAGEMENT AND GENERAL EXPENSES 39,774. FUNDRAISING EXPENSES 106,202. TOTAL EXPENSES 3,507,579. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.