2018-07-16T10:59:03-05:00 2017-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2016-10-01 237156236 WEST SIDE COMMUNITY HEALTH SERVICES INC WEST 6516027500 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 REUBEN MOORE CEO 6516027500 2018-07-12 1 RYAN ENGEBRETSON P01585625 6123764500 2016 2022-09-23 18:48:47Z REUBEN MOORE 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 34344732 0 X WWW.WESTSIDECHS.ORG X 1972 MN WSCHS PROVIDES MULTILINGUAL, MULTICULTURAL AND COMPREHENSIVE HEALTH CARE IN URBAN NEIGHBORHOODS, SCHOOLS, PUBLIC HOUSING AND HOMELESS SHELTERS. 10 10 376 25 0 0 10787115 10412033 18497046 22846332 67940 81047 0 1005320 29352101 34344732 99967 220463 0 0 18708211 20676150 0 0 0 10742524 11133870 29550702 32030483 -198601 2314249 24312664 23623152 10153817 7150056 14158847 16473096 X WEST SIDE COMMUNITY HEALTH SERVICES' MISSION IS STRENGTHENING THE WELL-BEING OF OUR COMMUNITY THROUGH HEALTH CARE FOR ALL. 0 0 18894367 220463 14638321 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. 4514109 0 2649275 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. 4026905 0 5558736 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 ASSURE 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 27435381 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 48 0 376 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 0 0 MN X BLAKE DARSOW CFO 6516027537 153 CESAR CHAVEZ STREET ST PAUL MN 551072226 PETE SURDO CHAIR 1.00 0.00 X X 0 0 0 HLEE LEE-KRON VICE CHAIR 1.00 0.00 X X 0 0 0 DAWN KSEPKA TREASURER 1.00 0.10 X X 0 0 0 MARSHA CRESSY SECRETARY 1.00 0.00 X X 0 0 0 ANDREA CARO DIRECTOR THRU DEC 2016 1.00 0.00 X 0 0 0 MAHOGANY ELLIS-CRUTCHFIELD DIRECTOR THRU APR 2017 1.00 0.00 X 0 0 0 ANDREATTE HAMES DIRECTOR 1.00 0.00 X 0 0 0 ZACHARY HYLTON DIRECTOR 1.00 0.00 X 0 0 0 JEANETTE JONES DIRECTOR 1.00 0.00 X 0 0 0 SUSAN MARSCHALK DIRECTOR 1.00 0.00 X 0 0 0 SHENG THAO DIRECTOR THRU DEC 2016 1.00 0.00 X 0 0 0 BILL THOMPSON DIRECTOR 1.00 0.00 X 0 0 0 CAROL WILLIAMS DIRECTOR 1.00 0.00 X 0 0 0 BRYAN WARREN DIRECTOR THRU OCT 2016 1.00 0.00 X 0 0 0 KIMERY WORKMAN DIRECTOR THRU SEP 2017 1.00 0.00 X 0 0 0 JAESON FOURNIER CEO THRU JUN 2017 40.00 0.10 X 227805 0 20211 BLAKE DARSOW CHIEF FINANCIAL OFFICER 40.00 0.10 X 41874 0 5755 DR MARY NESVIG CHIEF CLINICAL OFFICER & INTERIM-CEO 40.00 0.10 X 169652 0 9850 CHRIS SINGER CHIEF OPERATING OFFICER 40.00 0.00 X 121773 0 17561 DR MUAJ LO PHYSICIAN 40.00 0.00 X 182964 0 19090 DR JASON COMO PHYSICIAN 40.00 0.00 X 154469 0 15959 DR KATHIE CULHANE-PERA PHYSICIAN 32.00 0.00 X 148617 0 16003 DR STEFAN POMRENKE PHYSICIAN 40.00 0.00 X 157202 0 18448 DR ROBERT MCDONALD DENTIST 40.00 0.00 X 148780 0 0 1353136 0 122877 25 0 1 0 UNIVERSITY OF MINNESOTA 100 CHURCH ST SE MINNEAPOLIS MN 55455 CONTRACTED PROVIDERS 399370 QUEST DIAGNOSTICS 12989 COLLECTIONS CENTER DR CHICAGO IL 606930129 LABORATORY SERVICES 348855 NETGAIN TECHNOLOGIES INC 720 W SAINT GERMAIN ST STE 200 ST CLOUD MN 56301 IT HOSTING SERVICE 340885 GE HEALTHCARE IITS 15724 COLLECTIONS CENTER DR CHICAGO IL 606930129 IT LICENSING 225098 SENTAGE CORPORATION PO BOX 206813 DALLAS TX 75320 LABORATORY SERVICES 131945 7 332000 9540187 539846 36377 10412033 NET PATIENT SERVICE REVENUE 624100 22679984 22679984 PRECEPT REVENUE 624100 166348 166348 22846332 81047 81047 VALUE BASED PAYMENTS 900099 630738 630738 MEANINGFUL USE 900099 267750 267750 OTHER 900099 106832 106832 1005320 34344732 22846332 0 1086367 220463 220463 707812 707812 15496673 13655256 1841417 278053 234311 43742 3013186 2539163 474023 1180426 994726 185700 73792 73792 18871 18871 109525 109525 1848441 1643660 204781 3054 140 2914 204131 195872 8259 1135872 684860 451012 1354771 1121812 232959 54385 39329 15056 118993 100557 18436 117826 117826 504698 489077 15621 38025 21010 17015 MEDICAL SUPPLIES & DRUG 3758150 3758150 BAD DEBT 1201247 1201247 MN CARE TAX 438670 438670 LICENSES, DUES & SUBSCR 90255 37966 52289 63164 59112 4052 32030483 27435381 4595102 0 7870218 2756088 2254391 6667962 1432467 1074196 2461954 2242272 4037691 4037691 151112 148763 178508 209252 9853438 4616510 5441323 5236928 485000 1250000 24312664 23623152 2846301 2904751 96618 95918 3210898 149387 4000000 4000000 10153817 7150056 X 13538969 16038466 619878 434630 14158847 16473096 24312664 23623152 2314249 0 X 0 1 X 1 1 1 X 11697274 8679676 9633360 10787115 10412033 51209458 11697274 8679676 9633360 10787115 10412033 51209458 51209458 62533 59801 69011 67940 81047 340332 1005320 1005320 52555110 96041260 0.97440 0.99450 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 632640 632640 6127910 2651492 3476418 595731 595731 2497157 1965018 532139 5236928 PARTICIPATION SHARES 1250000 C 1250000 DUE TO RELATED PARTY 4000000 4000000 X PART X, LINE 2: WSCHS HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, WSCHS IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. 1 EVICTION PREVENTION - UTILITY ASSISTANCE, SANITATION, RENTAL ASSISTANCE, OTHER DIRECT PATIENT ASSISTANCE 476 220463 PART I, LINE 2: MONITORING OF GRANTS RECIPIENTS OF UTILITY ASSISTANCE ARE SCREENED BY RAMSEY COUNTY/WSCHS STAFF FOR ELIGIBILITY DATA REGARDING THE AMOUNT AND PURPOSE OF THE LOAN, WITH CLIENT IDENTIFIERS ARE COMPILED IN RAMSEY COUTY HMIS SYSTEM AND TRACKED ON SPREADSHEETS AT THE GRANTING LOCATION AND IN ACCOUNTING. IF APPROVED APPLICANT IS ELGIBLE FOR ASSISTANCE FROM LARGER PROGRAMS BUT NEEDS ADDITIONAL FUNDS TO PAY THE BILL OR IF THEY ARE NOT ELIGIBLE FOR THOSE PROGRAMS, WEST SIDE COMMUNITY HEALTH SERVICES, INC. WILL ASSIST IN RESOLVING THE BILL. ALL PAYMENTS ARE MADE DIRECTLY TO THE LANDLORD, UTILITY COMPANY, OR SANITATION COMPANY. CHECKS ARE PROCESSED BY WSCHS 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 JAESON FOURNIER CEO THRU JUN 2017 227625 0 0 0 180 0 5691 0 14520 0 248016 0 0 0 DR MARY NESVIG CHIEF CLINICAL OFFICER & INTERIM-CEO 168860 0 0 0 792 0 4222 0 5628 0 179502 0 0 0 DR MUAJ LO PHYSICIAN 182784 0 0 0 180 0 4570 0 14520 0 202054 0 0 0 DR JASON COMO PHYSICIAN 154369 0 0 0 100 0 3859 0 12100 0 170428 0 0 0 DR KATHIE CULHANE-PERA PHYSICIAN 148112 0 0 0 505 0 3703 0 12300 0 164620 0 0 0 DR STEFAN POMRENKE PHYSICIAN 157133 0 0 0 69 0 3928 0 14520 0 175650 0 0 0 X 30 36377 FMV 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTANT USING THE AUDITED FINANCIAL RECORDS OF THE ORGANIZATION. THE CEO, CRO, FINANCE COMMITEE, AND BOARD OF DIRECTORS THEN REVIEW AND APPROVE 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, INC. 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, INC. 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, INC. 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, INC. 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, INC. 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 EXECUTIVE COMMITTEE OF THE BOARD REVIEWS THE CEO COMPENSATION. THEY USED A NUMBER OF COMPENSATION SURVEYS, INCLUDING THE MORE RECENT 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 EMPLOYEE SALARIES ARE REVIEWED AND APPROVED BY THE CEO ON AN ANNUAL BASIS. A REVIEW LAST OCCURRED IN FISCAL YEAR 2016 AS THE ORGANIZATION'S CEO LEFT ON JUNE 1ST. FORM 990, PART VI, SECTION C, LINE 19 THE AUDIT REPORT AND FORM 990 ARE IN THE PROCESS OF BEING POSTED ON THE ORGANIZATION'S WEBSITE. 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. 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 1 0 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 EAST SIDE HEALTH CENTER INC K 400008 FMV EAST SIDE HEALTH CENTER INC C 332000 FMV