LAKE AREA FREE CLINIC INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization: LAKE AREA FREE CLINIC INC (EIN 39-2006388)
Tax period: 2021-01-01 to 2021-12-31
Filed: 2022-07-18
IRS object ID: 202201999349300220
Schema version: 2021v4.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule G
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-07-18T10:16:02-05:00	ReturnTs
Tax Period End	2021-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	410746749	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CLIFTONLARSONALLEN LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	10401 W INNOVATION DR STE 300	AddressLine1Txt
City	WAUWATOSA	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53226	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2021-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	392006388	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	LAKE AREA FREE CLINIC INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	LAKE	BusinessNameControlTxt
Phone	2625694990	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	856 ARMOUR ROAD	AddressLine1Txt
City	OCONOMOWOC	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53066	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	PEG KOENIGS	PersonNm
Person Title	TREASURER	PersonTitleTxt
Phone	2625694990	PhoneNum
Signature	2022-06-28	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	PEG	PersonFirstNm
Person Last	KOENIGS	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	PAUL SENGER	PreparerPersonNm
PTIN	P00005154	PTIN
Phone	4144761880	PhoneNum
Preparation	2022-06-27	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2021	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	MARY REICH	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	856 ARMOUR ROAD	AddressLine1Txt
City	OCONOMOWOC	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53066	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$1,740,064	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.LAKEAREAFREECLINIC.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	2001	FormationYr
Legal Domicile State	WI	LegalDomicileStateCd
Activity Or Mission	PROVIDES HIGH-QUALITY MEDICAL AND DENTAL CARE TO LOW-INCOME RESIDENTS OF WAUKESHA COUNTY.	ActivityOrMissionDesc
Voting Members Governing Body	20	VotingMembersGoverningBodyCnt
Voting Members Independent	19	VotingMembersIndependentCnt
Total Employee	30	TotalEmployeeCnt
Total Volunteers	260	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,143,543	PYContributionsGrantsAmt
CY Contributions Grants	$1,214,766	CYContributionsGrantsAmt
PY Program Service Revenue	$303,463	PYProgramServiceRevenueAmt
CY Program Service Revenue	$520,576	CYProgramServiceRevenueAmt
PY Investment Income	$1,314	PYInvestmentIncomeAmt
CY Investment Income	$2,160	CYInvestmentIncomeAmt
PY Other Revenue	$177,811	PYOtherRevenueAmt
CY Other Revenue	-$11,554	CYOtherRevenueAmt
PY Total Revenue	$1,626,131	PYTotalRevenueAmt
CY Total Revenue	$1,725,948	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$1,061,871	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$1,200,008	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$91,502	CYTotalFundraisingExpenseAmt
PY Other Expenses	$421,551	PYOtherExpensesAmt
CY Other Expenses	$473,086	CYOtherExpensesAmt
PY Total Expenses	$1,483,422	PYTotalExpensesAmt
CY Total Expenses	$1,673,094	CYTotalExpensesAmt
PY Revenues Less Expenses	$142,709	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$52,854	CYRevenuesLessExpensesAmt
Total Assets BOY	$1,578,126	TotalAssetsBOYAmt
Total Assets EOY	$1,669,300	TotalAssetsEOYAmt
Total Liabilities BOY	$46,762	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$85,082	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$1,531,364	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$1,584,218	NetAssetsOrFundBalancesEOYAmt
Mission	THE LAKE AREA FREE CLINIC IS THE MEDICAL AND DENTAL HOME TO LOW-INCOME RESIDENTS OF WAUKESHA COUNTY. THE MISSION IS TO PROVIDE HIGH-QUALITY COMPREHENSIVE HEALTH CARE TO THOSE IN NEED.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$1,476,707	ExpenseAmt
Revenue	$520,576	RevenueAmt
Desc	LAKE AREA FREE CLINIC IS THE MEDICAL HOME TO ADULTS AND PROVIDES ACUTE AND CHRONIC CARE SERVICES AND SPECIALITIES INCLUDE: CARDIOLOGY, DERMATOLOGY, INTERNAL MEDICINE, GYNECOLOGY, HEPATOLOGY, HEMATOLOGY, RHEUMATOLOGY, NEPHROLOGY, NEUROLOGY, PHYSICAL THERAPY, MENTAL HEALTH, ORTHOPEDICS, WELLNESS, AND COMPREHENSIVE DIABETES CLINIC. LAFC DENTAL IS THE 7-CHAIR DENTAL HOME FOR THOSE IN NEED OF ACCESS TO BASIC DENTAL, EDUCATIONAL AND REFERRAL SERVICES. LAFC DENTAL SERVES MEDICAID AND UNINSURED ADULTS.	Desc
Total Program Service Expenses	$1,476,707	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	7	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	30	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	20	GoverningBodyVotingMembersCnt
Independent Voting Member	19	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	0	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	WI	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	PEG KOENIGS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	2625694990	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	856 ARMOUR RD	AddressLine1Txt
City	OCONOMOWOC	CityNm
State Abbreviation	WI	StateAbbreviationCd
ZIP	53066	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd
PABLO FERNANDEZ DDS
EMPLOYEE	40.00	Yes (X)	$215,579	$0	$0
MARY REICH
EXECUTIVE DIRECTOR	40.00		$101,979	$0	$0	Yes (X)
DR JAY PLUDEMAN
MEDICAL DIRECTOR	5.00		$0	$0	$0		Yes (X)
DR ROBERT SCHWADE
DENTAL DIRECTOR	5.00		$0	$0	$0		Yes (X)
MARY RODE
DIRECTOR	5.00		$0	$0	$0		Yes (X)
MICHAEL RODE
DIRECTOR	5.00		$0	$0	$0		Yes (X)
DR ROB PANTHER
DIRECTOR	1.00		$0	$0	$0		Yes (X)
DR ERIC RUIZ
DIRECTOR	1.00		$0	$0	$0		Yes (X)
BETH BOYER-RYAN
DIRECTOR	1.00		$0	$0	$0		Yes (X)
JOE SORUM
DIRECTOR	1.00		$0	$0	$0		Yes (X)
JOYANN MCCHESNEY
DIRECTOR	1.00		$0	$0	$0		Yes (X)
JULIE JACKSON
DIRECTOR	1.00		$0	$0	$0		Yes (X)
LINDA MORONEY
DIRECTOR	1.00		$0	$0	$0		Yes (X)
MITZI CASS
DIRECTOR	1.00		$0	$0	$0		Yes (X)
RAMON AGUIRRE
DIRECTOR	1.00		$0	$0	$0		Yes (X)
SARAH BUTZ
DIRECTOR	1.00		$0	$0	$0		Yes (X)
TERRY LADWIG
DIRECTOR	1.00		$0	$0	$0		Yes (X)
VICKI DALLMANN-PAPKE
DIRECTOR	1.00		$0	$0	$0		Yes (X)
LISA DREW
PRESIDENT	5.00		$0	$0	$0	Yes (X)	Yes (X)
MARY JO O'MALLEY
VICE PRESIDENT	5.00		$0	$0	$0	Yes (X)	Yes (X)
NANCY BRADT
SECRETARY	5.00		$0	$0	$0	Yes (X)	Yes (X)
PEG KOENIGS
TREASURER	5.00		$0	$0	$0	Yes (X)	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$317,558	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$0	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	2	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K	0	CntrctRcvdGreaterThan100KCnt
Fundraising	$184,729	FundraisingAmt
Government Grants	$291,386	GovernmentGrantsAmt
All Other Contributions	$738,651	AllOtherContributionsAmt
Noncash Contributions	$3,066	NoncashContributionsAmt
Total Contributions	$1,214,766	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	DENTAL SERVICES	Desc
Business	621300	BusinessCd
Total Revenue Column	$520,576	TotalRevenueColumnAmt
Related Or Exempt Func Income	$520,576	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$520,576	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,160	TotalRevenueColumnAmt
Exclusion	$2,160	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$0	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$184,729	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$14,116	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$14,116	TotalRevenueColumnAmt
Exclusion	-$14,116	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	OTHER INCOME	Desc
Business	621110	BusinessCd
Total Revenue Column	$2,562	TotalRevenueColumnAmt
Exclusion	$2,562	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$2,562	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,725,948	TotalRevenueColumnAmt
Related Or Exempt Func Income	$520,576	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	-$9,394	ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$1,102,177	TotalAmt
Program Services	$965,615	ProgramServicesAmt
Management And General	$69,460	ManagementAndGeneralAmt
Fundraising	$67,102	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$12,916	TotalAmt
Program Services	$6,458	ProgramServicesAmt
Management And General	$6,458	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$84,915	TotalAmt
Program Services	$75,474	ProgramServicesAmt
Management And General	$4,802	ManagementAndGeneralAmt
Fundraising	$4,639	FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$102,512	TotalAmt
Program Services	$101,284	ProgramServicesAmt
Management And General	$1,228	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$17,225	TotalAmt
Fundraising	$17,225	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$14,805	TotalAmt
Program Services	$11,104	ProgramServicesAmt
Management And General	$3,701	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$97,018	TotalAmt
Program Services	$87,316	ProgramServicesAmt
Management And General	$9,702	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$631	TotalAmt
Program Services	$631	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$67,235	TotalAmt
Program Services	$67,235	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$15,441	TotalAmt
Program Services	$11,581	ProgramServicesAmt
Management And General	$3,860	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt
MEDICAL SUPPLIES	$110,944	$110,944
TRANSPORTATION	$10,650	$10,650
REPAIRS & MAINTENANCE	$10,076	$10,076
MISCELLANEOUS	$9,577	$9,577

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$16,972	TotalAmt
Program Services	$8,762	ProgramServicesAmt
Management And General	$5,674	ManagementAndGeneralAmt
Fundraising	$2,536	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,673,094	TotalAmt
Program Services	$1,476,707	ProgramServicesAmt
Management And General	$104,885	ManagementAndGeneralAmt
Fundraising	$91,502	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$990,464	BOYAmt
EOY	$1,074,580	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$105,706	BOYAmt
EOY	$161,760	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$4,297	BOYAmt
EOY	$11,621	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$24,777	BOYAmt
EOY	$19,641	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$15,249	BOYAmt
EOY	$6,685	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$692,637	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$297,624	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$437,633	BOYAmt
EOY	$395,013	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,578,126	BOYAmt
EOY	$1,669,300	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$46,762	BOYAmt
EOY	$85,082	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$46,762	BOYAmt
EOY	$85,082	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,468,389	BOYAmt
EOY	$1,436,398	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$62,975	BOYAmt
EOY	$147,820	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,531,364	BOYAmt
EOY	$1,584,218	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$1,578,126	BOYAmt
EOY	$1,669,300	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$52,854	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Public Organization170	Yes (X)	PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$459,959	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$945,210	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$890,732	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,230,498	CurrentTaxYearMinus1YearAmt
Current Tax Year	$1,214,766	CurrentTaxYearAmt
Total	$4,741,165	TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$459,959	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$945,210	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$890,732	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,230,498	CurrentTaxYearMinus1YearAmt
Current Tax Year	$1,214,766	CurrentTaxYearAmt
Total	$4,741,165	TotalAmt

Field	Value	IRS element (for citing)
Substantial Contributors Tot	$89,398	SubstantialContributorsTotAmt
Public Support Total170	$4,651,767	PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$5,670	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$3,053	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$1,898	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,314	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,160	CurrentTaxYearAmt
Total	$14,095	TotalAmt

Other Income170 OtherIncome170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	$4,958	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,293	CurrentTaxYearMinus1YearAmt
Current Tax Year	$2,562	CurrentTaxYearAmt
Total	$9,813	TotalAmt

Field	Value	IRS element (for citing)
Total Support	$4,765,073	TotalSupportAmt
Gross Receipts Rltd Activities	$520,576	GrossReceiptsRltdActivitiesAmt
Public Support CY170	0.97620	PublicSupportCY170Pct
Public Support PY170	0.98120	PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170	Yes (X)	ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$480,161	OtherCostOrOtherBasisAmt
Depreciation	$297,624	DepreciationAmt
Book Value	$182,537	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$212,476	OtherCostOrOtherBasisAmt
Book Value	$212,476	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$395,013	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$1,880,029	TotalRevEtcAuditedFinclStmtAmt
Donated Services And Use Fclts	$140,065	DonatedServicesAndUseFcltsAmt
Other Revenue	$14,016	OtherRevenueAmt
Revenue Not Reported	$154,081	RevenueNotReportedAmt
Revenue Subtotal	$1,725,948	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$1,725,948	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$1,827,175	TotExpnsEtcAuditedFinclStmtAmt
Donated Services Use Fclts	$140,065	DonatedServicesUseFcltsAmt
Other Expenses Included	$14,016	OtherExpensesIncludedAmt
Expenses Not Reported	$154,081	ExpensesNotReportedAmt
Expenses Subtotal	$1,673,094	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$1,673,094	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART X, LINE 2:	THE ORGANIZATION HAS IMPLEMENTED ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES IN ACCORDANCE WITH U.S. GAAP. THIS STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN AND ALSO PROVIDES GUIDANCE ON VARIOUS RELATED MATTERS SUCH AS DERECOGNIZING, INTEREST, PENALTIES AND DISCLOSURES REQUIRED. THE ORGANIZATION RECOGNIZES INTEREST AND PENALTIES, IF ANY, RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EVENT EXPENSES INCLUDED IN PART VIII LN 8B 14,016.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EVENT EXPENSES INCLUDED IN PART VIII LN 8B 14,016.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	GALA	Event1Nm
Gross Receipts Event1	$165,247	GrossReceiptsEvent1Amt
Charitable Contri Event1	$165,247	CharitableContriEvent1Amt
Other Direct Expenses Event1	$14,016	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$165,247	GrossReceiptsTotalAmt
Charitable Contributions Tot	$165,247	CharitableContributionsTotAmt
Oth Direct Expnss Total Events	$14,016	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$14,016	DirectExpenseSummaryEventsAmt
Net Income Summary	-$14,016	NetIncomeSummaryAmt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

Field	Value	IRS element (for citing)
Person	PABLO FERNANDEZ DDS	PersonNm
Title	EMPLOYEE	TitleTxt
Base Compensation Filing Org	$215,579	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$0	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$0	BonusFilingOrganizationAmount
Bonus Related Organizations	$0	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$0	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$0	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$0	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$0	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$0	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$0	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$215,579	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$0	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	ANNA PLUDEMAN VOLUNTEER COORDINATO	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	FAMILY RELATIONSHIP WITH BOARD MEMBER	RelationshipDescriptionTxt
Transaction	$34,793	TransactionAmt
Transaction	COMPENSATION	TransactionDesc
Sharing Of Revenues	0	SharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCH L, PART IV	FormAndLineReferenceDesc
Explanation	DR. JAY PLUDEMAN IS A BOARD MEMBER BY VIRTUE OF HIS VOLUNTEER ROLE AS MEDICAL DIRECTOR.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2	MARY RODE AND MICHAEL RODE HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11B	A DRAFT OF FORM 990 IS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE. A COMPLETE COPY OF FORM 990 FILING IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BOARD BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICTS ARE ADDRESSED AT EVERY BOARD MEETING. EACH BOARD MEMBER IS EXPECTED TO ANNUALLY SIGN THE CONFLICT OF INTEREST FORM DISCLOSING KNOWN CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15	EVERY EMPLOYEE RECEIVES A REVIEW. THE EXECUTIVE DIRECTOR MAKES THE SALARY RECOMMENDATIONS WITH INPUT FROM THE MANAGEMENT TEAM. THE EXECUTIVE DIRECTORS PERFORMANCE AND SALARY IS REVIEWED BY THE PRESIDENT OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 18	FORM 990 AND WISCONSIN FORM 1952 ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	BYLAWS AND ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC UPON REQUEST.