KENOSHA COMMUNITY HEALTH CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- KENOSHA COMMUNITY HEALTH CENTER INC (EIN 39-1789874)
- Tax period
- 2021-03-01 to 2022-02-28
- Filed
- 2022-12-16
- IRS object ID
- 202233509349300308
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-12-16T08:31:07-06:00 | ReturnTs |
| Tax Period End | 2022-02-28 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 363168081 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIKICH LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 17335 GOLF PARKWAY | AddressLine1Txt |
| City | BROOKFIELD | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53045 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-03-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391789874 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENOSHA COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KENO | BusinessNameControlTxt |
| Phone | 2627643608 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4006 WASHINGTON RD | AddressLine1Txt |
| City | KENOSHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53144 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY MOSS | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 2627713560 | PhoneNum |
| Signature | 2022-12-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | GARY | PersonFirstNm |
| Person Last | MOSS | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JILL M BOYLE CPA | PreparerPersonNm |
| PTIN | P01246734 | PTIN |
| Phone | 2627549400 | PhoneNum |
| Preparation | 2022-12-09 | 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) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | MARY OUIMET | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4006 WASHINGTON RD | AddressLine1Txt |
| City | KENOSHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53144 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,756,385 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.KENOSHACHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1994 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE ACCESS TO HEALTH CARE SERVICES AND REDUCE HEALTH DISPARITIES FOR THE UNDERSERVED PEOPLE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 170 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $6,920,754 | PYContributionsGrantsAmt |
| CY Contributions Grants | $7,301,308 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,673,053 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,424,301 | CYProgramServiceRevenueAmt |
| PY Investment Income | $77 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,474 | CYInvestmentIncomeAmt |
| PY Other Revenue | $8,457 | PYOtherRevenueAmt |
| CY Other Revenue | $29,302 | CYOtherRevenueAmt |
| PY Total Revenue | $11,602,341 | PYTotalRevenueAmt |
| CY Total Revenue | $15,756,385 | 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 | $7,475,120 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,523,159 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,391,201 | PYOtherExpensesAmt |
| CY Other Expenses | $4,355,193 | CYOtherExpensesAmt |
| PY Total Expenses | $10,866,321 | PYTotalExpensesAmt |
| CY Total Expenses | $12,878,352 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $736,020 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,878,033 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,428,339 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,618,597 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,063,820 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,376,045 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,364,519 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,242,552 | NetAssetsOrFundBalancesEOYAmt |
| Mission | KENOSHA COMMUNITY HEALTH CENTER, INC.'S PURPOSE IS TO PROVIDE PRIMARY CARE AND REFERRAL HEALTH SERVICES TO DISADVANTAGED AND UNDERSERVED POPULATIONS AND PROMOTE AND ENSURE THAT BASIC PRIMARY HEALTH SERVICES ARE ACCESSIBLE TO UNINSURED AND UNDERINSURED RESIDENTS OF KENOSHA, WI. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,750,263 | ExpenseAmt |
| Revenue | $4,528,590 | RevenueAmt |
| Desc | DENTAL CAREINCREASE ACCESS TO COMPREHENSIVE DENTAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $4,644,570 | ExpenseAmt |
| Revenue | $3,551,530 | RevenueAmt |
| Desc | MEDICAL CAREINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $325,294 | ExpenseAmt |
| Revenue | $344,181 | RevenueAmt |
| Desc | BEHAVIORAL HEALTH SERVICESINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE FOR BEHAVIORAL HEALTH CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $9,720,127 | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | 0 | 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 | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | 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 | 24 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 170 | 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 |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | 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 | Yes (1) | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY MOSS | PersonNm |
| Phone | 2627713560 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4006 WASHINGTON RD | AddressLine1Txt |
| City | KENOSHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53144 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| TAMARRA COLEMAN | |||||||
| BOARD MEMBER & BOARD PRES | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ANITA JOHNSON | |||||||
| BOARD MEMBER & BOARD VP | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOSEPH CLARK | |||||||
| BOARD MEMBER & TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANA BERRY | |||||||
| BOARD MEMBER & SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAUL SPOTTSWOOD | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LAVETTA ARRINGTON | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SUE GERBER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHANNON BOURQUE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEFFERY ZELLER | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TERRY ROSE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN ROCHA II | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHLEEN WOESTE | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| VENKATA THOTA | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIN GINN | |||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARY OUIMET | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | Yes (X) | $208,230 | $0 | $157 | ||
| JOHN VASELANEY | |||||||
| CHIEF DENTAL OFFICER (AS OF 7/30) | 40.00 | Yes (X) | $69,604 | $0 | $12,752 | ||
| GARY MOSS | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | Yes (X) | $147,710 | $0 | $28,567 | ||
| NICOLE MUBANGA | |||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $248,758 | $0 | $5,013 | ||
| MIHAELA POPA | |||||||
| DENTIST | 40.00 | $167,840 | $0 | $28,642 | Yes (X) | ||
| DAVID CONNELL | |||||||
| DENTIST | 40.00 | $175,947 | $0 | $9,473 | Yes (X) | ||
| HEIDI ECKELBERG | |||||||
| NURSE PRACTITIONER | 40.00 | $139,484 | $0 | $28,066 | Yes (X) | ||
| MARK CELEBRE | |||||||
| DIRECTOR OF PHARMACY | 40.00 | $141,340 | $0 | $16,210 | Yes (X) | ||
| SACHIN VERMA | |||||||
| DENTIST | 40.00 | $145,451 | $0 | $525 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,444,364 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $129,405 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 18 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GREENWAY HEALTH | |||||
| PO BOX 203658 | DALLAS | TX | 753203658 | ELECTRONIC HEALTH RECORDS | $499,015 |
| PANACEA SOLUTIONS LLC | |||||
| 1402 CLARK ST | MANITOWOC | WI | 54220 | REVENUE CYCLE AND IT SERVICES | $363,566 |
| PLEXUS HEALTH SOLUTIONS INC | |||||
| PO BOX 0655 | KENOSHA | WI | 531410655 | BILLING AND COLLECTION SERVICES | $232,524 |
| CLEAN & GREEN SOLUTIONS | |||||
| 5008 GREEN BAY ROAD | KENOSHA | WI | 53144 | JANITORIAL SERVICES | $147,870 |
| PLATINUM SYSTEMS INC | |||||
| 4600 GREEN BAY ROAD | KENOSHA | WI | 53144 | IT SERVICES | $121,471 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,299,706 | GovernmentGrantsAmt |
| All Other Contributions | $1,602 | AllOtherContributionsAmt |
| Total Contributions | $7,301,308 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE FEE | 621110 | $7,477,256 | $7,477,256 |
| PHARMACY REVENUE | 900099 | $947,045 | $947,045 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,424,301 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,474 | TotalRevenueColumnAmt |
| Exclusion | $1,474 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $29,302 | TotalRevenueColumnAmt |
| Exclusion | $29,302 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $29,302 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,756,385 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,424,301 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $30,776 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $760,678 | TotalAmt |
| Program Services | $371,590 | ProgramServicesAmt |
| Management And General | $389,088 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,430,016 | TotalAmt |
| Program Services | $5,011,429 | ProgramServicesAmt |
| Management And General | $1,418,587 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $820,881 | TotalAmt |
| Program Services | $612,700 | ProgramServicesAmt |
| Management And General | $208,181 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $511,584 | TotalAmt |
| Program Services | $373,104 | ProgramServicesAmt |
| Management And General | $138,480 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,822 | TotalAmt |
| Program Services | $4,517 | ProgramServicesAmt |
| Management And General | $177,305 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $707,968 | TotalAmt |
| Program Services | $629,391 | ProgramServicesAmt |
| Management And General | $78,577 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,033 | TotalAmt |
| Program Services | $10,054 | ProgramServicesAmt |
| Management And General | $113,979 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,907 | TotalAmt |
| Program Services | $61,370 | ProgramServicesAmt |
| Management And General | $28,537 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,237,698 | TotalAmt |
| Program Services | $1,133,443 | ProgramServicesAmt |
| Management And General | $104,255 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $304,313 | TotalAmt |
| Program Services | $205,583 | ProgramServicesAmt |
| Management And General | $98,730 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,222 | TotalAmt |
| Program Services | $3,325 | ProgramServicesAmt |
| Management And General | $897 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,428 | TotalAmt |
| Program Services | $2,133 | ProgramServicesAmt |
| Management And General | $2,295 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,224 | TotalAmt |
| Program Services | $142 | ProgramServicesAmt |
| Management And General | $92,082 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,139 | TotalAmt |
| Program Services | $319,916 | ProgramServicesAmt |
| Management And General | $108,223 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,916 | TotalAmt |
| Program Services | $56,522 | ProgramServicesAmt |
| Management And General | $19,394 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL & LAB EXPENSE | $743,842 | $725,648 | $18,194 |
| EQUIPMENT | $207,946 | $127,970 | $79,976 |
| STAFF DEVELOPMENT | $56,319 | $6,920 | $49,399 |
| DUES & SUBSCRIPTIONS | $44,034 | $23,672 | $20,362 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,382 | TotalAmt |
| Program Services | $40,698 | ProgramServicesAmt |
| Management And General | $11,684 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,878,352 | TotalAmt |
| Program Services | $9,720,127 | ProgramServicesAmt |
| Management And General | $3,158,225 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600 | BOYAmt |
| EOY | $600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,755,946 | BOYAmt |
| EOY | $4,681,980 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $69,938 | BOYAmt |
| EOY | $234,084 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $710,847 | BOYAmt |
| EOY | $1,125,638 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,765 | BOYAmt |
| EOY | $230,348 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,873,849 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,527,902 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,775,243 | BOYAmt |
| EOY | $8,345,947 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,428,339 | BOYAmt |
| EOY | $14,618,597 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,425,889 | BOYAmt |
| EOY | $1,064,663 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,540,084 | BOYAmt |
| EOY | $579,783 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,097,847 | BOYAmt |
| EOY | $4,731,599 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,063,820 | BOYAmt |
| EOY | $6,376,045 | 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 | $5,364,519 | BOYAmt |
| EOY | $8,242,552 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,364,519 | BOYAmt |
| EOY | $8,242,552 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,428,339 | BOYAmt |
| EOY | $14,618,597 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,878,033 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
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 | $3,129,166 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,713,480 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,885,806 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,920,754 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,301,308 | CurrentTaxYearAmt |
| Total | $23,950,514 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,129,166 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,713,480 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,885,806 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $6,920,754 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $7,301,308 | CurrentTaxYearAmt |
| Total | $23,950,514 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $23,950,514 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $119 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $339 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $423 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $77 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,474 | CurrentTaxYearAmt |
| Total | $2,432 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | $16,690 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $46,384 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,457 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $29,302 | CurrentTaxYearAmt |
| Total | $100,833 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $24,053,779 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $35,505,896 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.99570 | PublicSupportCY170Pct |
| Public Support PY170 | 0.99630 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER REVENUE - 2018 AMOUNT: $ 16,690. 2019 AMOUNT: $ 46,384. 2020 AMOUNT: $ 8,457. 2021 AMOUNT: $ 29,302. | ExplanationTxt |
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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $876,215 | OtherCostOrOtherBasisAmt |
| Book Value | $876,215 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,091,781 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,909,883 | DepreciationAmt |
| Book Value | $3,181,898 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $842,220 | OtherCostOrOtherBasisAmt |
| Depreciation | $154,407 | DepreciationAmt |
| Book Value | $687,813 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,448,607 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,012,505 | DepreciationAmt |
| Book Value | $436,102 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,615,026 | OtherCostOrOtherBasisAmt |
| Depreciation | $451,107 | DepreciationAmt |
| Book Value | $3,163,919 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,345,947 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS OTHER THAN A PRIVATE FOUNDATION AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE LLC IS CONSIDERED A DISREGARDED ENTITY FOR INCOME TAX PURPOSES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NICOLE MUBANGA | ||||||||||||||
| CHIEF MEDICAL OFFICER | $248,758 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $5,013 | $0 | $253,771 | $0 | $0 | $0 |
| MARY OUIMET | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $208,230 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $157 | $0 | $208,387 | $0 | $0 | $0 |
| MIHAELA POPA | ||||||||||||||
| DENTIST | $167,840 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $28,642 | $0 | $196,482 | $0 | $0 | $0 |
| DAVID CONNELL | ||||||||||||||
| DENTIST | $175,947 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,473 | $0 | $185,420 | $0 | $0 | $0 |
| GARY MOSS | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $147,710 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $28,567 | $0 | $176,277 | $0 | $0 | $0 |
| HEIDI ECKELBERG | ||||||||||||||
| NURSE PRACTITIONER | $139,484 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $28,066 | $0 | $167,550 | $0 | $0 | $0 |
| MARK CELEBRE | ||||||||||||||
| DIRECTOR OF PHARMACY | $141,340 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,210 | $0 | $157,550 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHANNON BOURQUE | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | 35% CONTROLLED ENTITY OF BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $232,524 | TransactionAmt |
| Transaction | REVENUE CYCLE MANAGEMENT SERVICES | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AND THE FINANCE COMMITTEE BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ALL NEW BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT. BOARD MEMBERS ARE REQUIRED TO UPDATE THESE STATEMENTS ANNUALLY. SHOULD A CONFLICT ARISE, THE PERSON AFFECTED IS ASKED TO EXCUSE THEMSELVES FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION USES A VARIETY OF REGIONAL AND EXECUTIVE RECRUITING FIRMS FOR KEY EMPLOYEES WHO RECOMMEND COMPENSATION PACKAGES BASED ON MARKET DATA. THE ORGANIZATION ALSO PARTICIPATES IN A VARIETY OF COMPENSATION SURVEYS THROUGH NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, WISCONSIN PRIMARY HEALTH CARE ASSOCIATION, AND GENERALIST HUMAN RESOURCES ORGANIZATIONS AND RECEIVE THOSE REPORTS. THERE ARE ALSO PERIODIC SPOT CHECKS LOCALLY FOR SPECIFIC POSITIONS. COMPENSATION FOR TOP MANAGEMENT IS APPROVED BY THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KCHC REAL ESTATE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4536 22ND AVENUE | AddressLine1Txt |
| City | KENOSHA | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53140 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391789874 | EIN |
| Primary Activities | REAL ESTATE HOLDINGS | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Total Income | $278,258 | TotalIncomeAmt |
| End Of Year Assets | $4,854,366 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENOSHA COMMUNITY HEALTH CENTER INC | BusinessNameLine1Txt |