Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 91,577 | 37,857 | 118,645 | 21,481 | 37,283 | 306,843 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 160,219 | 105,196 | 8,400 | 108,133 | 141,200 | 523,148 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 251,796 | 143,053 | 127,045 | 129,614 | 178,483 | 829,991 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 1,610 | 7,308 | 2,793 | 346 | 12,057 | |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 127,006 | 59,686 | 105,052 | 101,373 | 129,725 | 522,842 |
| c | Add lines 7a and 7b.. | 128,616 | 66,994 | 107,845 | 101,719 | 129,725 | 534,899 |
| 8 | Public support. (Subtract line 7c from line 6.) | 295,092 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 251,796 | 143,053 | 127,045 | 129,614 | 178,483 | 829,991 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 251,796 | 143,053 | 127,045 | 129,614 | 178,483 | 829,991 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990-EZ, PART I, LINE 16 | EXPENSES OFFICE 299 INFORMATION TECHNOLOGY 2,116 TRAVEL 535 CONFERENCES/MEETINGS 1,218 INSURANCE 1,422 PROGRAM SUPPLIES 2,554 MISCELLANEOUS 196 TOTAL 8,340 |
| FORM 990-EZ, PART II, LINE 24 | ACCOUNTS RECEIVABLE 2,842 29,633 TOTAL 2,842 29,633 |
| FORM 990-EZ, PART II, LINE 26 | DEFERRED REVENUE 96,096 17,415 |
| FORM 990-EZ, PART III | THE MISSION OF THE MINNESOTA COMMUNITY HEALTH WORKER ALLIANCE ("ALLIANCE") IS TO "BUILD COMMUNITY AND SYSTEM'S CAPACITY FOR BETTER HEALTH THROUGH THE INTEGRATION OF COMMUNITY HEALTH WORKER STRATEGIES. OUR VISION IS EQUITABLE AND OPTIMAL OUTCOMES FOR ALL COMMUNITIES. COMMUNITY HEALTH WORKERS (CHWS) BRIDGE CLINICAL SETTINGS AND DIVERSE COMMUNITIES TO IMPROVE ACCESS, REDUCE COSTS, IMPROVE HEALTH OUTCOMES, AND DIVERSIFY THE WORKPLACE. THE ALLIANCE IS A STATE-WIDE NOT FOR PROFIT ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF CHWS, HEALTH PROFESSIONALS, EDUCATORS, PUBLIC AND NONPROFIT LEADERS. THERE ARE THREE PRIMARY AREAS OF PROGRAMMATIC FOCUS: EDUCATION & TRAINING, FIELD BUILDING, AND PUBLIC POLICY. |
| FORM 990-EZ, PART III, LINE 28 | 2022 PROGRAM HIGHLIGHTS INCLUDE: BLUE CROSS BLUE SHIELD OF MINNESOTA SPONSORSHIP GRANT IN 2022 THE ALLIANCE CONTINUED TO BUILD UPON A MINNESOTA COMMUNITY HEALTH WORKER REGISTRY WITH THE PURPOSES TO COLLECT DATA ON CHWS CERTIFICATION YEAR, CITY OF RESIDENCE, EMPLOYER, DEMOGRAPHIC PROFILE (INCLUDING LANGUAGES SPOKEN) AND ADDITIONAL TRAINING AND CREDENTIALS. SINCE ITS FORMATION, THE ALLIANCE HAS CONTINUED TO PROMOTE, RECRUIT, AND MAINTAIN THE PLATFORM AS A RESOURCE FOR CHWS ACROSS THE STATE AND TO LEARN MORE ABOUT THE STATE OF THE CHW FIELD IN MINNESOTA. IN THE 2021-2022 ACADEMIC YEAR, THE UPDATED CURRICULUM CONTINUED BEING PILOTED. INCLUDED IN THE UPDATES WERE: "UPDATING EXISTING COMPETENCIES AND RESOURCES " ADDING RECOMMENDED KNOWLEDGE AND SKILLS'-BASED COMPONENTS BASED ON THE NATIONAL CHW CORE CONSENSUS PROJECT "INTEGRATING INFORMATION ON ASTHMA, TRAUMA INFORMED CARE AND MENTAL HEALTH; (4) STRENGTHENING THE MOTIVATIONAL INTERVIEWING FOCUS "INCORPORATING UPDATED INSTRUCTIONAL APPROACHES AND RESOURCES "ADDRESSING PROFESSIONALISM AND "SOFT" SKILLS. BLUE CROSS BLUE SHIELD OF MINNESOTA CULTURAL HUMILITY TRAINING "CHWS AS CATALYSTS FOR COMMUNITY CHANGE FOR HEALTH EQUITY" NEW MATERIALS CREATED BY CHW STUDENT INTERNS WERE INTEGRATED INTO THE CHW CERTIFICATE CURRICULUM. HEALTH EQUITY SPEAKERS WERE PROVIDED FOR CHW EVENTS SUCH AS THE CHW LEADERSHIP PROGRAM AND THE CHW CIRCLE. DEPARTMENT OF HEALTH BOLD GRANT ALLIANCE AND MN DEPT. OF HEALTH STAFF WORKED COLLABORATIVELY TO DRAFT AN ONLINE CHW PROGRAM FOR DEMENTIA AWARENESS AND PREVENTION. A FIRST REVIEW OF THE DRAFT PROGRAM WAS COMPLETED. WHEN COMPLETED AND PILOTED, THIS PROGRAM WILL BE AVAILABLE FREE OF CHARGE ON THE MINNESOTA DEPT. OF HEALTH WEB SITE. DEPARTMENT OF HUMAN SERVICES MOTHERS IN RECOVERY PROGRAM WITH FUNDING FROM THE MINNESOTA DEPARTMENT OF HEALTH THE ALLIANCE CREATED THE CHW MOTHER'S RECOVERY PROGRAM TRAINING PROGRAMMING. IN 2022 THE PROGRAM OFFERED A SERIES OF ONLINE WORKSHOPS ABOUT MOTHERS IN RECOVERY FEATURING EXPERTS FROM ACROSS MINNESOTA. THE PROGRAMMING WAS HELD ONLINE AND TRAINED OVER 100 CHWS IN VARIOUS TOPICS. GUEST SPEAKERS AND FACILITATORS FROM A WIDE VARIETY OF SUBJECT MATTERS SUCH AS SUBSTANCE ABUSE AND HOLISTIC HEALING. HEALTH PARTNERS HOTSPOTTING THE ALLIANCE FACILITATED OUTREACH TO AND DEPLOYMENT OF CHWS TO ADVISE THIS CHW RESEARCH PROJECT. MINNESOTA STATE COLLEGES VOICES OF HEALTH EQUITY PROJECT ALLIANCE STAFF WORKED WITH CHWS, FACULTY AND STUDENTS AT TWO COMMUNITY COLLEGES TO PRODUCE CHW PROGRAM PROMOTIONAL VIDEOS AND SHORT VIDEO CLIPS THAT WERE INTEGRATED WITHIN THE CURRICULUM IN ALL SCHOOLS PROVIDING THE CHW CERTIFICATE. THIS PROJECT ALSO PROVIDED OUTREACH AND TECHNICAL ASSISTANCE TO EMPLOYERS ADDING CHWS AND PROVIDED SOME SUPPORT FOR THE CHW EDUCATION COMMITTEE. MISSISSIPPI DEPARTMENT OF HEALTH TRAINING AND TECHNICAL ASSISTANCE TECHNICAL ASSISTANCE WAS PROVIDED TO THE MISSISSIPPI DEPARTMENT OF HEALTH AS THEY CREATED AN OFFICE OF COMMUNITY HEALTH WORKERS. TECHNICAL ASSISTANCE INCLUDED PROGRAM DEVELOPMENT AND IMPLEMENTATION DETAILS, USE OF AND ASSISTANCE IMPLEMENTING THE MINNESOTA CHW CERTIFICATE CURRICULUM, AND TRAINING FOR CHWS, NEW SUPERVISORS AND ORGANIZATIONS STARTING CHW PROGRAMS. NATIONAL ASSOCIATION OF CHWS (NACHWA) THE ALLIANCE PROVIDED TECHNICAL ASSISTANCE AND INPUT INTO PLANNING FOR A NATIONAL CHW REGISTRY. PILLSBURY UNITED COMMUNITIES TECHNICAL ASSISTANCE TECHNICAL ASSISTANCE WAS PROVIDED TO THE TWIN CITIES CHW HUB LOCATED AT PILLSBURY UNITED. TECHNICAL ASSISTANCE INCLUDED PROGRAM DEVELOPMENT AND IMPLEMENTATION DETAILS, A CHW TRAINING MANUAL, A POLICY MANUAL AND TRAINING FOR CHWS, NEW SUPERVISORS AND ORGANIZATIONS STARTING CHW PROGRAMS. SERVICE DELIVERY IN 2022 THE ALLIANCE HIRED A PART TIME EXECUTIVE DIRECTOR AND A NEW REGISTRY MANAGER. THESE NEW POSITIONS GREATLY INCREASED THE ALLIANCE'S ABILITY TO PROVIDE SERVICES SUCH AS ACCESS TO STAFF, INFORMATION AND WEBINARS, THE CHW REGISTRY WITH CORRESPONDING POSTS AND DISCUSSIONS, SOCIAL MEDIA INFORMATION POSTS AND CHW TOOLS AND RESOURCES. AN EMAIL NEWSLETTER REACHES OVER 800 PEOPLE, OUR REGISTRY OVER 150 PEOPLE, AND MONTH TO MONTH WEBSITE TRAFFIC IS OFTEN OVER 3,000 VIEWS. CHW CIRCLE THE CHW CIRCLE IS A PEER LEARNING CIRCLE THAT MEETS MONTHLY ON ZOOM AND IS ATTENDED BY CHWS FROM ACROSS MINNESOTA. AVERAGE ATTENDANCE AT THE MONTHLY CIRCLE IS ABOUT 20 CHWS AND OVER 100 CHWS RECEIVE INFORMATION AND FOLLOW UP MATERIALS FROM THE EVENT. OVER 200 CHWS WERE SERVED BY THE CIRCLE IN 2022. RECORDINGS OF PRESENTATIONS ARE POSTED ON THE ALLIANCE WEBSITE SO CHWS WHO COULD NOT ATTEND CAN ACCESS THEM. CHW LEADERSHIP PROGRAM THE ALLIANCE PROVIDED ONLINE CONVENINGS OF LEADERSHIP PROGRAM PARTICIPANTS. THIS PROGRAM CONNECTS CHW WITH EXPERTS IN VARIOUS FIELDS SUCH AS POLICY, MEDIA, HEALTH EQUITY, SERVICE DELIVERY, TRAUMA , PHILANTHROPY AND MORE. THE PROGRAM CULMINATED IN AN IN PERSON LEADERSHIP RETREAT WITH A PROGRAM OFFICER FROM THE OTTO BREMER FOUNDATION. ABOUT 70 CHWS PARTICIPATED IN THE PROGRAM WITH 22 ATTENDING THE IN PERSON LEADERSHIP RETREAT. CHW SUPERVISOR ROUNDTABLE THE CHW SUPERVISOR ROUNDTABLE MEETS FOUR TIMES A YEAR ON ZOOM. THIS IS A PEER LEARNING CIRCLE AND PROBLEM-SOLVING GROUP. AVERAGE ATTENDANCE IS 15 CHW SUPERVISORS FROM ACROSS MINNESOTA AND 200 SUPERVISORS RECEIVE THE INFORMATION AS WELL AS FOLLOW UP MATERIALS. PRESENTATIONS ARE RECORDED AND POSTED ON THE ALLIANCE WEBSITE SO SUPERVISORS WHO COULD NOT ATTEND CAN ACCESS THE INFORMATION. CHW EDUCATION COMMITTEE THIS IS A COMMITTEE OF THE FACULTY FROM THE VARIOUS POST SECONDARY INSTITUTIONS OFFERING THE MINNESOTA CHW CERTIFICATE CURRICULUM. THEY MEET MONTHLY DURING THE ACADEMIC YEAR TO REVIEW AND OVERSEE THE STANDARDIZATION OF THE CURRICULUM ACROSS THE STATE OF MINNESOTA. THE COMMITTEE CONSISTS OF MEMBERS REPRESENTING THE SCHOOLS, CHWS AND COMMUNITY REPRESENTATIVES. |
| Software ID: | |
| Software Version: |