2021-02-24T17:38:08-06:00 2020-05-31 390758449 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2019-06-01 264321839 LAKESHORE COMMUNITY HEALTH CARE INC LAKE 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 KRISTIN BLANCHARD STEARNS CEO 9207836633 2021-02-23 1 CHLOE CHIUMINATTO P01924323 4144319300 2021-02-23 2019 2022-09-23 18:48:47Z KRISTIN BLANCHARD STEARNS 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 13699238 0 X WWW.LAKESHORECHC.ORG X 2009 WI LCHC STRIVES TO CREATE COMMUNITIES WHERE ALL PEOPLE LIVE HEALTHY, ACTIVE, AND PROSPEROUS LIVES. LCHC ASPIRES TO BE A PREFERRED PROVIDER AND AN EMPLOYER OF CHOICE. 11 11 146 16 0 0 2132094 2695777 8771921 10892612 65106 87865 6048 6304 10975169 13682558 440609 0 0 0 7192998 8141024 81309 70139 70139 3839590 3818600 11554506 12029763 -579337 1652795 8999501 11827632 980363 2155699 8019138 9671933 LAKESHORE COMMUNITY HEALTH CARE PROVIDES ACCESS TO COMPREHENSIVE, INTEGRATED HEALTH CARE, REGARDLESS OF ABILITY TO PAY, ELIMINATING HEALTH DISPARITIES AMONG THE UNDERSERVED. 0 0 8773368 0 10892612 LAKESHORE COMMUNITY HEALTH CARE, INC. PROVIDES HEALTH CARE SERVICES TO PEOPLE WHO STRUGGLE TO FIND A DOCTOR, DENTIST OR A COUNSELOR FOR CARE. THE ORGANIZATION ALSO PROVIDES PHARMACY AND CHIROPRACTIC SERVICES. THE ORGANIZATION WORKS WITH OUR COMMUNITY PARTNERS TO REFER PATIENTS FOR ANY SERVICES THE ORGANIZATION IS UNABLE TO PROVIDE. THE ORGANIZATION WORKS VERY HARD TO MAKE SURE PATIENTS GET WHAT THEY NEED, AND PROVIDE UP TO 90% DISCOUNTS FOR ANYONE WHO CANNOT AFFORD TO PAY FOR THESE SERVICES. 8773368 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 22 0 146 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X MARTIN SCHALLER 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 MICHELLE ELDER BOARD MEMBER 2.00 X 0 0 0 DEANNA FLOWERS BOARD MEMBER (THRU NOVEMBER) 2.00 X 0 0 0 BECK GROUMAN BOARD MEMBER 2.00 X 0 0 0 CARLY HAKALA BOARD MEMBER 2.00 X 0 0 0 SCOTT HAYES BOARD MEMBER 2.00 X 0 0 0 GERALYN LEANNAH BOARD MEMBER 2.00 X 0 0 0 KELYN NETZ BOARD MEMBER 2.00 X 0 0 0 PENNY SENKBEIL BOARD MEMBER 2.00 X 0 0 0 URIAH WARNER BOARD MEMBER (THRU JUNE) 2.00 X 0 0 0 TAMMY HARRIS PRESIDENT (THRU DECEMBER) 2.00 X X 0 0 0 RACHEL LABORDE PRESIDENT (BEG. DECEMBER) 2.00 X X 0 0 0 BARBARA DODGE VICE PRESIDENT (THRU DECEMBER) 2.00 X X 0 0 0 BRENDA SMITH VICE PRESIDENT (BEG. DECEMBER) 2.00 X X 0 0 0 DIANE LIEBENTHAL SECRETARY 2.00 X X 0 0 0 JOSEPH RUPNIK TREASURER 2.00 X X 0 0 0 KRISTIN BLANCHARD STEARNS CEO 40.00 1.00 X 129677 0 27491 MARTIN SCHALLER CFO/COO 40.00 1.00 X 120754 0 31484 ROBERT WENBERG MD MEDICAL DIRECTOR 40.00 X 265776 0 38346 CASEY WILSON DDS DENTAL DIRECTOR 40.00 X 160376 0 16949 MAI JUA XIONG DDS DENTIST 40.00 X 156853 0 6623 IVONA CRISTI DDS DENTIST 40.00 X 146453 0 14337 CHRISTINA BENNETT DDS DENTIST 40.00 X 136884 0 16344 1116773 0 151574 13 0 1 0 PLEXUS HEALTH SOLUTIONS INC PO BOX 0655 KENOSHA WI 53141 CONTRACT BILLING SERVICES 353875 BARTON ASSOCIATES PO BOX 417844 BOSTON MA 02241 PHYSICIAN STAFFING SERVICES 350629 SABERCOR LLC 2935 S FISH HATCHERY ROAD UNIT 283 FITCHBURG WI 53711 HOUSEKEEPING/JANITORIAL SERVICES 112968 3 17500 12310 15000 2401875 249092 2695777 PATIENT SERVICE REVENUE 621400 10344309 10344309 PHARMACY REVENUE 621400 498556 498556 49747 49747 10892612 86448 86448 1500 83 1417 1417 1417 10730 12310 16597 -5867 -5867 12171 12171 12171 13682558 10892612 0 94169 X 308758 308758 6261211 4765269 1495942 232932 178521 54411 879921 607230 272691 458202 333941 124261 2529 256 2273 47925 14218 33707 70139 70139 1104334 667074 437260 21421 13000 8421 66933 38231 28702 189269 117050 72219 702307 558201 144106 32024 16289 15735 52345 37681 14664 7387 6064 1323 186666 154751 31915 33454 20890 12564 MEDICAL SUPPLIES 754142 754142 EQUIPMENT 342687 261813 80874 OTHER STAFF SUPPORT 157343 114893 42450 ELECTRONIC HEALTH RECOR 100458 100458 17376 13396 3980 12029763 8773368 3186256 70139 712529 469529 1197826 4733403 383894 61206 858444 496466 4955250 4955250 7875 48996 131398 107197 2017479 1072906 741251 944573 11034 11012 8999501 11827632 858580 788886 93018 49358 28765 1317455 980363 2155699 X 7162846 9007809 856292 664124 8019138 9671933 8999501 11827632 1652795 0 X 0 1 X 1 1 1 X SCHEDULE A: THE ORGANIZATION IS NOT LICENSED AS A HOSPITAL IN THE STATE OF WISCONSIN. THE ORGANIZATION HAS RECEIVED ITS IRS DETERMINATION LETTER SHOWING THAT THE ORGANIZATION'S PUBLIC CHARITY STATUS IS SECTION 170(B)(1)(A)(III). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 207393 9217 198176 204768 57935 146833 1555719 1005754 549965 49599 49599 944573 CAPITAL LEASE OBLIGATIONS 21790 REFUNDABLE ADVANCE LIABILITY - PAYCHECK PROTECTION PROGRAM 1279500 DUE TO LCHC QALICB INC. 16165 1317455 X PART X, LINE 2: THE ORGANIZATION RECOGNIZES THE BENEFITS OF A TAX POSITION ONLY AFTER DETERMINING WHETHER IT IS MORE LIKELY THAN NOT THAT THE TAXING AUTHORITY WOULD SUSTAIN THE TAX POSITION UPON EXAMINATION OF THE TECHNICAL MERITS OF THE TAX POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. X X X X X X 1 NON-PROFIT FUNDRAISING PARTNERS 1711 VAN HISE AVENUE MADISON WI 53726 GOVERNMENT AND NON-GOVERNMENT GRANT WRITING AND FUNDRAISING 0 2150710 70139 2080571 2150710 70139 2080571 WI CAVEMAN RUN 23040 12310 10730 5613 441 774 9769 23040 12310 10730 5613 441 774 9769 16597 -5867 X X 0 0 0 0 0 0 0 0 0 KRISTIN BLANCHARD STEARNS CEO 129377 0 0 0 300 0 5503 0 21988 0 157168 0 0 0 MARTIN SCHALLER CFO/COO 119464 0 0 0 1290 0 5174 0 26310 0 152238 0 0 0 ROBERT WENBERG MD MEDICAL DIRECTOR 263796 0 0 0 1980 0 11046 0 27300 0 304122 0 0 0 CASEY WILSON DDS DENTAL DIRECTOR 160136 0 0 0 240 0 6711 0 10238 0 177325 0 0 0 MAI JUA XIONG DDS DENTIST 156583 0 0 0 270 0 5013 0 1610 0 163476 0 0 0 IVONA CRISTI DDS DENTIST 135935 0 10000 0 518 0 5558 0 8779 0 160790 0 0 0 CHRISTINA BENNETT DDS DENTIST 136704 0 0 0 180 0 5665 0 10679 0 153228 0 0 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION MADE THE FOLLOWING CHANGES TO ITS BYLAWS DURING THE FISCAL YEAR: - NO INDIVIDUAL, ENTITY, OR COMMITTEE RESERVES OR HAS APPROVAL/VETO POWER OVER THE BOARD WITH REGARD TO THE REQUIRED AUTHORITIES AND FUNCTIONS. - NO COLLABORATION OR AGREEMENT WITH OTHER ENTITIES SHALL RESTRICT OR INFRINGE UPON THE BOARD'S REQUIRED AUTHORITIES AND FUNCTIONS. FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS ARE GIVEN COPIES OF THE FORM 990 TO REVIEW BEFORE FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EVERY MEMBER OF THE ORGANIZATION SIGNS A CONFLICT OF INTEREST STATEMENT ANNUALLY. ADMINISTRATION MONITORS THIS WITH THE USE OF A CHECKLIST. EACH INDIVIDUAL SHALL DISCLOSE TO THE ORGANIZATION, ANY PERSONAL INTEREST THAT HE OR SHE MAY HAVE IN ANY MATTER PENDING BEFORE THE ORGANIZATION AND SHALL REFRAIN FROM PARTICIPATION IN ANY DECISION ON SUCH MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION LOOKS AT NATIONAL AND LOCAL COMPARISON DATA FROM NACHC AND MGMA TO SET SALARY RANGES FOR EACH POSITION. ACTUAL SALARIES ARE DETERMINED BASED ON QUALIFICATIONS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G TRANSLATION SERVICES: PROGRAM SERVICE EXPENSES 71,375. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,375. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 19,000. MANAGEMENT AND GENERAL EXPENSES 41,038. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 60,038. BILLING SERVICES: PROGRAM SERVICE EXPENSES 45. MANAGEMENT AND GENERAL EXPENSES 396,222. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 396,267. DENTAL LAB SERVICES: PROGRAM SERVICE EXPENSES 140,589. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,589. CLINICAL SERVICES: PROGRAM SERVICE EXPENSES 436,065. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 436,065. LCHC QALICB INC 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 815453995 TO SUPPORT LAKESHORE COMMUNITY HEALTH CARE, INC. WI 501(C)(3) LINE 12A, I LAKESHORE COMMUNITY HEALTH CARE INC 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0