2012-08-15T09:55:19-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-01-01 237113799 SOUTHSIDE COMMUNITY HEALTH SERVICES INC SOUT 6128223282 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 WILLIAM TENDLE 6128223282 2012-08-06 1 KOREY L BOELTER P00775161 6123764500 2011 2016-02-24 21:20:13Z WILLIAM TENDLE 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 5652830 0 X WWW.SOUTHSIDECHS.ORG X 1971 MN TO PROVIDE HIGH QUALITY HEALTH CARE IN THE COMMUNITIES SERVED. 10 10 112 10 0 0 2351170 2154313 4208792 3494129 4032 1911 1557 2477 6565551 5652830 0 0 0 0 4817729 3854394 0 0 0 2274193 1997720 7091922 5852114 -526371 -199284 3435459 3003326 1021497 788648 2413962 2214678 X SOUTHSIDE COMMUNITY HEALTH SERVICES EXISTS TO SERVE THE COMMUNITY BY OFFERING FRIENDLY SUPERIOR QUALITY AND FISCALLY RESPONSIBLE HEALTH SERVICES IN AN ENVIRONMENT THAT FOSTERS LEARNING AND RESPECT. IT DOES THIS THROUGH COLLABORATION AND COMMUNICATION WHICH PATIENTS ACCEPT AS AN OPPORTUNITY TO IMPROVE THEIR HEALTH. 0 0 2252463 1830383 MEDICALFAMILY PRACTICE INCLUDING SPECIAL PROGRAMS FOR AT RISK POPULATIONS, FAMILY PLANNING, PRENATAL AND PEDIATRICS.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. SCHS HAS ONE MEDICAL CLINIC IN MINNEAPOLIS, ONE MEDICAL CLINIC IN STILLWATER AND ONE DENTAL CLINIC IN MINNEAPOLIS. WHILE THE MAJORITY OF PATIENTS COME FROM THE SOUTHSIDE OF MINNEAPOLIS, SCHS DRAWS PATIENTS FROM THROUGHOUT THE TWIN CITIES METROPOLITAN AREA (PATIENTS CAME FROM OVER 110 ZIP CODES). SCHS HAS HAD AN "ESSENTIAL COMMUNITY SAFETY NET PROVIDER" DESIGNATION FROM THE STATE OF MINNESOTA SINCE 1997. SCHS DOES NOT DISCRIMINATE AGAINST ANY PATIENT BASED ON RACE, COLOR, NATIONAL ORIGIN, DISABILITY, RELIGION, SEXUAL ORIENTATION, AGE, OR ABILITY TO PAY.IN 2011, OUR CLINICS SERVED MOSTLY LOW INCOME AND UNDER-SERVED WOMEN, CHILDREN AND FAMILIES. THESE 10,309 PATIENTS GENERATED 27,033 CLINIC VISITS. IN ADDITION TO THE CLINIC VISITS, OUR OUTREACH ACTIVITIES NOW KNOWN AS Q HEALTH CONNECTIONS, REACHED ANOTHER 10,000 RESIDENTS THROUGH LOCAL HEALTH FAIRS, A VARIETY OF PROGRAMS, AND OTHER COMMUNITY EVENTS. Q HEALTH CONNECTIONS PROVIDES MUCH NEEDED HEALTH EDUCATION AND HEALTH AWARENESS TO MINORITY POPULATIONS SUFFERING DRAMATICALLY HIGHER HEALTH OUTCOME DISPARITIES.IN 2011, THE UNINSURED REPRESENTED 37.6% OF TOTAL PATIENTS. IF YOU REMOVE THE UNKNOWN OR UNREPORTED NUMBER OF PATIENTS FROM THE POVERTY LEVEL CALCULATION, THE REMAINDER WAS EVEN A HIGHER PERCENT OF POVERTY, NAMELY 74.7%. 21.2% OF PATIENTS WERE ON MEDICAID AND 2.2% WERE ON OTHER PUBLIC INSURANCE COVERAGE. 10.6% OF PATIENTS WERE PRIVATELY INSURED. THE UNINSURED WERE PLACED ON A SLIDING FEE SCHEDULE. 52.9% OF PATIENTS WERE BELOW 100% OF FEDERAL POVERTY LEVEL AND ANOTHER 8.6% OF PATIENTS WERE BETWEEN 100% AND 200% OF FEDERAL POVERTY LEVEL. AS A RESULT, 61.5% OF PATIENTS WERE CONSIDERED ECONOMICALLY DISADVANTAGED. WHEN YOU COMBINE POVERTY LEVEL, THOSE ON MEDICAID AND OTHER PUBLICALLY SUBSIDIZED INSURANCE COVERAGE AND DISCOUNTED CARE THROUGH THE SLIDING FEE SCHEDULE, THIS RESULTED IN A SIGNIFICANT SHORTFALL IN OPERATING REVENUES, NECESSITATING SOME LAYOFFS FOR A SECOND YEAR IN A ROW.IN 2011, SCHS PATIENT CASELOAD REPRESENTED 26.5% CHILDREN AND TEENS AND 74.5% WERE ADULTS. 57.9% OF PATIENTS WERE FEMALE, 42.1% WERE MALE. OF THOSE PATIENTS REPORTING RACE (6,325 OUT OF 10,309) 23.6% WERE BLACK/AFRICAN-AMERICAN; 31.0% WERE HISPANIC/LATINO, 3.4% WERE ASIAN/NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER; 0.5% WERE AMERICAN INDIAN 40.8%% WERE NON HISPANIC WHITE AND 1.2% SELF-IDENTIFIED THEMSELVES AS MORE THAN ONE RACE. IN 2011, 23.8% OF SCHS' PATIENTS WERE IMMIGRANTS, MANY WITH LIMITED ENGLISH SPEAKING ABILITIES AND LITERACY LEVELS, 32 PATIENTS WERE CLASSIFIED AS HOMELESS AND 20 PATIENTS WERE MIGRANTS/SEASONAL WORKERS.IN CONCLUSION, SCHS HAS LONG SERVED THE POOR AND HISTORICALLY DISENFRANCHISED POPULATIONS WITHIN THE COMMUNITY. AS A RESULT, A LARGE PROPORTION OF ITS REVENUE IS HIGHLY DISCOUNTED, WITH SIGNIFICANT UNCOLLECTABLE. OUR NEED TO SOLICIT OTHER INCOME FROM COMMUNITY SOURCES INCLUDING FEDERAL, STATE, MUNICIPAL AND FOUNDATIONS REFLECTS THIS REALITY. 2083250 1663746 DENTALGENERAL DENTAL SERVICES FOR PEOPLE OF ALL AGES. EXPANSION WAS COMPLETED IN LATE 2009 TO ADD TWO DENTAL OPERATORIES. 195288 OUTREACHFIRST KNOWN AS SOUTHSIDE COMMUNITY HEALTH SERVICES (SCHS) OUTREACH DEPARTMENT, THIS PROGRAM WAS ORIGINALLY CREATED TO CONNECT SCHS MEDICAL AND DENTAL CLINICS WITH THE UNDERSERVED AND UNINSURED POPULATIONS OF SOUTH MINNEAPOLIS.TODAY, Q HEALTH CONNECTIONS 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 PROVEN THAT THE EARLIER HEALTHY PRACTICES ARE ESTABLISHED, THE BETTER THE QUALITY OF LIFE FOR THE INDIVIDUAL. THESE PRACTICES CAN INCLUDE HEALTHY DIET, CONSISTENT EXERCISE, AND ENVIRONMENTAL AND SOCIAL HEALTH 4531001 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 32 0 112 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 PATRICIA WIDBOOM 6128212014 4243 FOURTH AVENUE SOUTH MINNEAPOLIS MN 55409 X JIM GALLAGHER 1.00 X 0 0 0 VICTOR L M GOMEZ 1.00 X 0 0 0 LANCE HAAKENSTAD 1.00 X 0 0 0 RITA SALONE 1.00 X 0 0 0 YAA NTI 1.00 X 0 0 0 TIM RIDLEY 1.00 X 0 0 0 NATALIE TEJADA 1.00 X 0 0 0 SHEREESE MCINTOSH 1.00 X 0 0 0 GREG BARLOW 1.00 X 0 0 0 MICHELLE EVANS 1.00 X 0 0 0 WILLIAM TENDLE 40.00 X 126121 0 9123 PATRICIA WIDBOOM 40.00 X 101385 0 6337 DR LEON NESVACIL 40.00 X 100700 0 0 MARY CRACKEL 40.00 X 102189 0 1181 THOMAS R RESNICK 40.00 X 116663 0 1040 DR RYAN LINDNER 40.00 X 120092 0 5614 JANELLA FUCHS 40.00 X 122473 0 1051 789623 0 24346 7 0 0 0 0 89781 1784151 280381 2154313 PATIENT FEES 621110 2877573 2877573 FQHC SETTLEMENTS 621110 616556 616556 3494129 1911 1911 MISCELLANEOUS INCOME 900099 2477 2477 2477 5652830 3494129 0 4388 242965 85038 157927 3063717 2441856 621861 17323 11393 5930 248552 147107 101445 281837 215499 66338 17443 17443 23901 23901 493242 420791 72451 52876 41526 11350 190123 95927 94196 70008 34515 35493 244417 223618 20799 20572 11164 9408 5118 3688 1430 6740 6740 331730 286097 45633 35022 24111 10911 MEDICAL SUPPLIES 293354 286681 6673 BAD DEBTS 122130 122130 MINNESOTA PROVIDERS TAX 54703 54703 36341 25157 11184 5852114 4531001 1321113 0 43968 188376 569392 300957 505166 295748 304704 298861 30510 21033 4071004 2175253 1979119 1895751 2600 2600 3435459 3003326 681497 593648 340000 195000 1021497 788648 X 2178962 2131657 235000 83021 2413962 2214678 3435459 3003326 -199284 0 X 0 1 1 X 1 1 X 1761073 1610936 2474324 2351170 2154313 10351816 5771606 4986795 5679676 4208792 3494129 24140998 7532679 6597731 8154000 6559962 5648442 34492814 0 0 0 34492814 39393 38628 23206 4032 1911 107170 39393 38628 23206 4032 1911 107170 86938 57214 13241 1557 2477 161427 7659010 6693573 8190447 6565551 5652830 34761411 0.99230 0.99240 0.00310 0.00310 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 130543 130543 1406121 502272 903849 475288 414376 60912 2059052 1258605 800447 1895751 LINE OF CREDIT 195000 195000 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S CONSOLIDATED FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED.THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2008 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. X X X 0 0 0 1 0 0 0 0 0 PART I, LINE 5 THE DEVELOPMENT DIRECTOR RECEIVES AN INCENTIVE BASED ON REVENUES. HE RECEIVES A 5% INCENTIVE ON ALL NON-GOVERNMENTAL GRANT REVENUES FOR PROGRAM SERVICES SUPPORT. HE RECEIVES A FLAT $5,000 FOR EACH GOVERNMENTAL GRANT. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPRISED OF THE FOUR OFFICERS AND THE EXECUTIVE DIRECTOR (NON-VOTING). AT THE DISCRETION OF THE BOARD CHAIR, THE CLINICAL AND RISK MANAGEMENT CHAIRS WILL BE ON THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL ADVISE AND AID THE EXECUTIVE DIRECTOR OF THE CORPORATION IN ALL MATTERS CONCERNING THE BUSINESS AFFAIRS OF THE CORPORATION AND GENERALLY PERFORM DUTIES AND EXERCISE POWERS AS MAY BE DIRECTED OR DELEGATED BY THE BOARD OF DIRECTORS FROM TIME TO TIME. THE EXECUTIVE COMMITTEE IS ALSO CHARGED WITH THE ANNUAL EVALUATION OF THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11 THE CEO PROVIDED A COPY OF THE FORM 990 TO ALL BOARD MEMBERS FOR REVIEW. ALL QUESTIONS WERE ANSWERED AT A BOARD MEETING BEFORE THE 990 WAS APPROVED BY THE BOARD. THE FORM 990 WAS THEN 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 INTERST 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 MEMBERS OBLIGATIONS. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE USED EXECUTIVE SALARY SURVEYS FOR COMPARABILITY PURPOSES TO UPDATE THE EXECUTIVE DIRECTOR/CEO'S COMPENSATION. THE DECISION OF THE EXECUTIVE COMMITTEE WAS ALSO REVIEWED AND APPROVED BY THE FULL BOARD OF DIRECTORS. THE PROCESS WAS CONTEMPORANEOUSLY SUBSTANTIATED. THE EXECUTIVE DIRECTOR REVIEWED AND APPROVED THE COMPENSATION FOR THE OTHER OFFICERS, USING A MARKET SURVEY CONDUCTED BY AN OUTSIDE H.R. CONSULTANT FOR COMPARABILITY PURPOSES. THE PROCESS INCLUDED COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION, BUT DID NOT INCLUDE REVIEW AND APPROVAL BY INDEPENDENT PERSONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. OVERLAP OF BOARD MEMBERS FORM 990, PART VII, SECTION A ALL MEMBERS OF THE SOUTHSIDE COMMUNITY HEALTH SERVICES, INC. BOARD ARE ALSO MEMBERS OF THE Q FOUNDATION, INC. BOARD. ON AVERAGE, EACH BOARD MEMBER SPENDS APPROXIMATELY ONE HOUR PER WEEK SERVING EACH ORGANIZATION. Q FOUNDATION INC 4243 4TH AVENUE SOUTH MINNEAPOLIS MN 55409 260138861 COMMUNITY HEALTH & WELLNESS MN 501(C)(3) LINE 11A, I SOUTHSIDE COMMUNITY HEALTH SERVICES 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0