2023-01-27T11:11:49-06:00 2022-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2021-04-01 391181480 LA CLINICA DE LOS CAMPESINOS INC LACL 9207875514 400 S TOWNLINE ROAD WAUTOMA WI 54982 LAURA WALDVOGEL PRESIDENT & CEO 9207875514 2023-01-25 1 LAURA WALDVOGEL 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2023-01-25 3 AAL1 IAL1 2021 2023-03-07 01:45:13Z FAMILY HEALTH LA CLINICA LAURA WALDVOGEL 400 S TOWNLINE ROAD WAUTOMA WI 54982 18983180 0 X WWW.FAMHEALTH.ORG X 1973 WI OUR MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF ALL PEOPLE IN COMMUNITIES WE SERVE. 11 11 252 14 0 0 9764525 8186618 10406647 10795355 1326 1207 0 0 20172498 18983180 0 8000 0 0 10625313 14074753 0 0 0 7002617 5221121 17627930 19303874 2544568 -320694 11315532 10404383 2527388 1947481 8788144 8456902 OUR MISSION IS TO IMPROVE THE HEALTH AND WELL-BEING OF ALL PEOPLE IN COMMUNITIES WE SERVE. 0 0 16620785 8000 10795355 COMMUNITY AND MIGRANT HEALTH CLINIC CENTER THAT PROVIDES PRIMARY MEDICAL, BEHAVIORAL HEALTH, AND DENTAL HEALTH SERVICES TO COMMUNITY RESIDENTS AND MIGRANT PATIENTS. THE WISCONSIN COMMUNITY HEALTH CENTER GRANT ENABLES LA CLINICA TO PROVIDE COMMUNITY AND MIGRANT PATIENTS ACCESS TO MEDICAL AND DENTAL SERVICES. IN ADDITION, BEHAVIORAL HEALTH SERVICES ARE PROVIDED WHICH INCLUDE MEDICATION ASSISTED TREATMENT FOR SUBSTANCE AND ALCOHOL ABUSE. 290713 0 0 THE WOMEN, INFANT, AND CHILDREN'S GRANT ALLOWS LA CLINICA TO PROVIDE SUPPLEMENTAL NUTRITION AND EDUCATION TO CLIENTS IN THE PROGRAM SERVICES AREA 16911498 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 34 0 252 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X TOM KAMINSKI 9207875514 400 S TOWNLINE ROAD WAUTOMA WI 54982 LAURA WALDVOGEL PRESIDENT & CEO 40.00 X 183874 0 49263 JAVIER RINCON PHYSICIAN 28.00 X 211614 0 19143 TRACY HOPKINS DENTIST 40.00 X 179253 0 28340 JOAN FOX DENTIST 40.00 X 168664 0 20305 THOMAS KAMINSKI CFO 40.00 X 160332 0 41925 NATHAN DAILY CDO/DENTIST 32.00 X 159526 0 36767 SAVITA BIMARTHI DENTIST 40.00 X 157346 0 38923 PAUL THEYEL CHAIR 1.00 X X 0 0 0 AIDA M BISE VICE CHAIR (THRU MARCH) 1.00 X X 0 0 0 AMANDA DEDERICH SECRETARY 1.00 X X 0 0 0 MARY SUCHANEK TREASURER (THRU MAY) 1.00 X X 0 0 0 PETER GIERACH DIRECTOR 1.00 X 0 0 0 BRENDA HENKE DIRECTOR 1.00 X 0 0 0 ROSEANNE HENNING DIRECTOR 1.00 X 0 0 0 JAMI HUSTON DIRECTOR (THRU JAN) 1.00 X 0 0 0 FRED JOHANNES DIRECTOR 1.00 X 0 0 0 PATSY MBUGHUNI DIRECTOR 1.00 X 0 0 0 JUANITA 'TERRY' OLIVAS DIRECTOR 1.00 X 0 0 0 SHEILA SHAW DIRECTOR 1.00 X 0 0 0 DAMARIS THOME DIRECTOR 1.00 X 0 0 0 ALMA DELIA TORRES DIRECTOR 1.00 X 0 0 0 1220609 0 234666 17 0 1 0 OCHIN INC 1881 SW NATIO PKWAY PORTLAND OR 97201 SOFTWARE AND CONSULTING 332347 330 PARTNERS LLC PO BOX 1597 GREER SC 29652 FQHC CONSULTING 137809 DURACLEAN SPECIALIST 2801 POST ROAD PLOVER WI 54467 CLEANING 124353 APPLIED TECH SOLUTIONS PO BOX 650823 DALLAS TX 75265 IT NETWORK SUPPORT 124298 GATEHOUSE PSYCHIATRIC SOLUTIONS 901 BROADWAY ST BARABOO WI 53913 CONTRACTED BH PROVIDER 106408 5 8179197 7421 8186618 PATIENT SERVICE REVENUE 621110 10557422 10557422 340B PROGRAM REVENUE 900099 170268 170268 MISCELLANEOUS 900099 67665 67665 10795355 1207 1207 18983180 10795355 0 1207 8000 8000 435393 435393 10501081 9807703 693378 363889 340608 23281 1972052 1822528 149524 802338 715070 87268 40022 40022 38300 38300 1438508 1226527 211981 107506 107316 190 451802 226383 225419 11527 11527 558094 482444 75650 189137 168437 20700 92542 61957 30585 29596 26714 2882 614981 469226 145755 102268 12010 90258 MEDICAL SUPPLIES 1119363 1045557 73806 BAD DEBT EXPENSE 235599 235599 REPAIRS & MAINTENANCE 92211 88274 3937 DUES, PUBLICATIONS, & M 68699 29114 39585 30966 26504 4462 19303874 16911498 2392376 0 3811783 2621394 277337 277483 278382 361950 899930 1316008 112638 23069 10959648 5453520 5600462 5506128 335000 298351 11315532 10404383 1595628 1185652 113154 0 818606 761829 2527388 1947481 X 8299064 8024424 489080 432478 8788144 8456902 11315532 10404383 -320694 -10548 X X 0 1 X 1 1 1 X PART I, LINE 3 LA CLINICA DE LOS CAMPESINOS IS A NOT-FOR-PROFIT CORPORATION THAT PROVIDES HEALTHCARE SERVICES THROUGH MEDICAL, BEHAVIORAL AND DENTAL CLINICS. IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29600 29600 5532329 1816475 3715854 7344 7344 0 3796956 2861078 935878 1593419 768623 824796 5506128 X 18630593 -342039 -342039 18972632 10548 10548 18983180 18961835 0 18961835 342039 342039 19303874 PART X, LINE 2: TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE CLINIC DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE CLINIC HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. PART XI, LINE 2D - OTHER ADJUSTMENTS: 340B EXPENSES -106,440. BAD DEBT EXPENSE -235,599. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN COMMUNITY FUND 10,548. PART XII, LINE 4B - OTHER ADJUSTMENTS: 340B EXPENSES 106,440. BAD DEBT EXPENSE 235,599. 1 SCHOLARSHIP 1 8000 0 CASH PART I, LINE 2: THE SCHOLARSHIPS AWARDED ARE MANAGED BY AN OUTSIDE FOUNDATION. THE FOUNDATION MAINTAINS THE RECORDS AND ENSURES THE RECIPIENTS MEET THE ELIGIBILITY REQUIREMENTS. X X 0 0 0 0 0 0 0 0 0 LAURA WALDVOGEL PRESIDENT & CEO 174681 0 3612 0 5581 0 9887 0 39376 0 233137 0 0 0 JAVIER RINCON PHYSICIAN 208814 0 2800 0 0 0 0 0 19143 0 230757 0 0 0 TRACY HOPKINS DENTIST 174245 0 3424 0 1584 0 9065 0 19275 0 207593 0 0 0 JOAN FOX DENTIST 160954 0 3352 0 4358 0 790 0 19515 0 188969 0 0 0 THOMAS KAMINSKI CFO 147612 0 3520 0 9200 0 8400 0 33525 0 202257 0 0 0 NATHAN DAILY CDO/DENTIST 149614 0 2732 0 7180 0 8165 0 28602 0 196293 0 0 0 SAVITA BIMARTHI DENTIST 154048 0 3082 0 216 0 8148 0 30775 0 196269 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED BY THE CFO AND CEO AND APPROVED BY THE BOARD OF DIRECTORS BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL DIRECTORS AND OFFICERS DISCLOSE ALL INFORMATION REGARDING THEIR INTERESTS AND THOSE OF THEIR FAMILY MEMBERS THAT COULD GIVE RISE TO CONFLICTS THE MEMBERS OF GOVERNING BODY MAKE DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW ACTUAL CONFLICTS. ANY PERSON WITH A CONFLICT IS PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE DIRECTORS ANNUALLY DETERMINE THE CEO'S COMPENSATION USING DATA ON COMPENSATION PAID BY COMPARABLE ORGANIZATIONS IN SIMILAR COMMUNITIES FOR SIMILAR SERVICES FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.