2022-12-16T08:31:07-06:00 2022-02-28 363168081 SIKICH LLP 17335 GOLF PARKWAY BROOKFIELD WI 53045 990 2021-03-01 391789874 KENOSHA COMMUNITY HEALTH CENTER INC KENO 2627643608 4006 WASHINGTON RD KENOSHA WI 53144 GARY MOSS CHIEF FINANCIAL OFFICER 2627713560 2022-12-09 1 GARY MOSS 999009999 JILL M BOYLE CPA P01246734 2627549400 2022-12-09 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X MARY OUIMET 4006 WASHINGTON RD KENOSHA WI 53144 15756385 0 X WWW.KENOSHACHC.ORG X 1994 WI TO PROVIDE ACCESS TO HEALTH CARE SERVICES AND REDUCE HEALTH DISPARITIES FOR THE UNDERSERVED PEOPLE. 14 13 170 15 0 0 6920754 7301308 4673053 8424301 77 1474 8457 29302 11602341 15756385 0 0 0 0 7475120 8523159 0 0 0 3391201 4355193 10866321 12878352 736020 2878033 10428339 14618597 5063820 6376045 5364519 8242552 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. 0 0 4750263 4528590 DENTAL CAREINCREASE ACCESS TO COMPREHENSIVE DENTAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 4644570 3551530 MEDICAL CAREINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 325294 344181 BEHAVIORAL HEALTH SERVICESINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE FOR BEHAVIORAL HEALTH CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 9720127 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 24 0 170 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X GARY MOSS 2627713560 4006 WASHINGTON RD KENOSHA WI 53144 TAMARRA COLEMAN BOARD MEMBER & BOARD PRES 1.00 X X 0 0 0 ANITA JOHNSON BOARD MEMBER & BOARD VP 1.00 X X 0 0 0 JOSEPH CLARK BOARD MEMBER & TREASURER 1.00 X X 0 0 0 DANA BERRY BOARD MEMBER & SECRETARY 1.00 X X 0 0 0 PAUL SPOTTSWOOD BOARD MEMBER 1.00 X 0 0 0 LAVETTA ARRINGTON BOARD MEMBER 1.00 X 0 0 0 SUE GERBER BOARD MEMBER 1.00 X 0 0 0 SHANNON BOURQUE BOARD MEMBER 1.00 X 0 0 0 JEFFERY ZELLER BOARD MEMBER 1.00 X 0 0 0 TERRY ROSE BOARD MEMBER 1.00 X 0 0 0 JOHN ROCHA II BOARD MEMBER 1.00 X 0 0 0 KATHLEEN WOESTE BOARD MEMBER 1.00 X 0 0 0 VENKATA THOTA BOARD MEMBER 1.00 X 0 0 0 ERIN GINN BOARD MEMBER 1.00 X 0 0 0 MARY OUIMET CHIEF EXECUTIVE OFFICER 40.00 X 208230 0 157 JOHN VASELANEY CHIEF DENTAL OFFICER (AS OF 7/30) 40.00 X 69604 0 12752 GARY MOSS CHIEF FINANCIAL OFFICER 40.00 X 147710 0 28567 NICOLE MUBANGA CHIEF MEDICAL OFFICER 40.00 X 248758 0 5013 MIHAELA POPA DENTIST 40.00 X 167840 0 28642 DAVID CONNELL DENTIST 40.00 X 175947 0 9473 HEIDI ECKELBERG NURSE PRACTITIONER 40.00 X 139484 0 28066 MARK CELEBRE DIRECTOR OF PHARMACY 40.00 X 141340 0 16210 SACHIN VERMA DENTIST 40.00 X 145451 0 525 1444364 0 129405 18 0 1 0 GREENWAY HEALTH PO BOX 203658 DALLAS TX 753203658 ELECTRONIC HEALTH RECORDS 499015 PANACEA SOLUTIONS LLC 1402 CLARK ST MANITOWOC WI 54220 REVENUE CYCLE AND IT SERVICES 363566 PLEXUS HEALTH SOLUTIONS INC PO BOX 0655 KENOSHA WI 531410655 BILLING AND COLLECTION SERVICES 232524 CLEAN & GREEN SOLUTIONS 5008 GREEN BAY ROAD KENOSHA WI 53144 JANITORIAL SERVICES 147870 PLATINUM SYSTEMS INC 4600 GREEN BAY ROAD KENOSHA WI 53144 IT SERVICES 121471 5 7299706 1602 7301308 PATIENT SERVICE FEE 621110 7477256 7477256 PHARMACY REVENUE 900099 947045 947045 8424301 1474 1474 MISCELLANEOUS REVENUE 900099 29302 29302 29302 15756385 8424301 0 30776 760678 371590 389088 6430016 5011429 1418587 820881 612700 208181 511584 373104 138480 181822 4517 177305 707968 629391 78577 124033 10054 113979 89907 61370 28537 1237698 1133443 104255 304313 205583 98730 4222 3325 897 4428 2133 2295 92224 142 92082 428139 319916 108223 75916 56522 19394 MEDICAL & LAB EXPENSE 743842 725648 18194 EQUIPMENT 207946 127970 79976 STAFF DEVELOPMENT 56319 6920 49399 DUES & SUBSCRIPTIONS 44034 23672 20362 52382 40698 11684 12878352 9720127 3158225 0 600 600 4755946 4681980 69938 234084 710847 1125638 115765 230348 14873849 6527902 4775243 8345947 10428339 14618597 1425889 1064663 1540084 579783 2097847 4731599 0 5063820 6376045 X 5364519 8242552 5364519 8242552 10428339 14618597 2878033 0 X 0 1 X 1 1 1 X 3129166 2713480 3885806 6920754 7301308 23950514 3129166 2713480 3885806 6920754 7301308 23950514 23950514 119 339 423 77 1474 2432 16690 46384 8457 29302 100833 24053779 35505896 0.99570 0.99630 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2018 AMOUNT: $ 16,690. 2019 AMOUNT: $ 46,384. 2020 AMOUNT: $ 8,457. 2021 AMOUNT: $ 29,302. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 876215 876215 6091781 2909883 3181898 842220 154407 687813 3448607 3012505 436102 3615026 451107 3163919 8345947 X PART X, LINE 2: 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. X X X X 0 0 0 0 0 0 0 0 0 NICOLE MUBANGA CHIEF MEDICAL OFFICER 248758 0 0 0 0 0 0 0 5013 0 253771 0 0 0 MARY OUIMET CHIEF EXECUTIVE OFFICER 208230 0 0 0 0 0 0 0 157 0 208387 0 0 0 MIHAELA POPA DENTIST 167840 0 0 0 0 0 0 0 28642 0 196482 0 0 0 DAVID CONNELL DENTIST 175947 0 0 0 0 0 0 0 9473 0 185420 0 0 0 GARY MOSS CHIEF FINANCIAL OFFICER 147710 0 0 0 0 0 0 0 28567 0 176277 0 0 0 HEIDI ECKELBERG NURSE PRACTITIONER 139484 0 0 0 0 0 0 0 28066 0 167550 0 0 0 MARK CELEBRE DIRECTOR OF PHARMACY 141340 0 0 0 0 0 0 0 16210 0 157550 0 0 0 SHANNON BOURQUE 35% CONTROLLED ENTITY OF BOARD MEMBER 232524 REVENUE CYCLE MANAGEMENT SERVICES 0 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. KCHC REAL ESTATE LLC 4536 22ND AVENUE KENOSHA WI 53140 391789874 REAL ESTATE HOLDINGS WI 278258 4854366 KENOSHA COMMUNITY HEALTH CENTER INC