2020-11-18T16:33:49-06:00 2020-02-29 363168081 SIKICH LLP 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2019-03-01 391789874 KENOSHA COMMUNITY HEALTH CENTER INC KENO 2627643608 625 57TH STREET NO 700 KENOSHA WI 53140 GARY MOSS CHIEF FINANCIAL OFFICER 2627643608 2020-11-16 1 JILL M BOYLE CPA P01246734 2627549400 2020-11-16 173.89.63.177 2020-11-16 09:20:53 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4EEC376E0009DD82B8C158C84BF413102525094C 2019 2021-01-29 14:40:06Z MARY OUIMET 625 57TH STREET NO 700 KENOSHA WI 53140 10990419 0 X WWW.KENOSHACHC.ORG X 1994 WI TO PROVIDE ACCESS TO HEALTH CARE SERVICES AND REDUCE HEALTH DISPARITIES FOR THE UNDERSERVED PEOPLE. 11 10 175 15 0 0 2713480 3885806 7295158 7057806 339 423 16690 46384 10025667 10990419 0 0 0 0 6672909 7251207 0 0 0 3557217 3247105 10230126 10498312 -204459 492107 9359834 7966895 4740541 3338396 4619293 4628499 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 5061595 2942634 DENTAL CAREINCREASE ACCESS TO COMPREHENSIVE DENTAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 3474497 3682376 MEDICAL CAREINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 574227 432796 BEHAVIORAL HEALTH SERVICESINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE FOR BEHAVIORAL HEALTH CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 9110319 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 27 0 175 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X GARY MOSS 2627643619 625 57TH STREET SUITE 700 KENOSHA WI 53140 AMI PRAG THROUGH 10419 CHIEF MEDICAL OFFICER 40.00 X 208973 0 0 ALAN MARSHALL CEO/COO (THROUGH 2/7/20) 40.00 X 169712 0 38152 MIHAELA POPA CHIEF DENTAL OFFICER 40.00 X 156294 0 23426 JOSEPH BARTA DENTIST 40.00 X 141497 0 37625 DAVID CONNELL DENTIST 40.00 X 152187 0 23503 SACHIN VERMA DENTIST 40.00 X 149706 0 21175 PATRYCIA M WIERZBICKI DENTIST 40.00 X 132058 0 17103 MANUEL A RIVERA PHYSICIAN 40.00 X 146371 0 396 JEFFREY GRANT CFO (THROUGH 7/31/2019) 40.00 X 64528 0 26959 GARY MOSS CFO (AS OF 06/24/2019) 40.00 X 68497 0 4860 JOSEPH CLARK BOARD MEMBER & BOARD PRESI 1.00 X X 0 0 0 LAVETTA ARRINGTON BOARD MEMBER & BOARD VP 1.00 X X 0 0 0 YOLANDA ADAMS THROUGH 11119 BOARD MEMBER & TREASURER 1.00 X X 0 0 0 TAMARRA COLEMAN BOARD MEMBER 1.00 X X 0 0 0 PAUL SPOTTSWOOD BOARD MEMBER 1.00 X 0 0 0 JOSEPH MICHAELIS BOARD MEMBER (THROUGH 12/1/19) 1.00 X 0 0 0 SUE GERBER BOARD MEMBER 1.00 X 0 0 0 SHANNON BREHMER 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 LORI ANDREUCCI BOARD MEMBER (THROUGH 10/1/19) 1.00 X 0 0 0 JOHN ROCHA II BOARD MEMBER 1.00 X 0 0 0 KATHERINE MARKS BOARD MEMBER 1.00 X 0 0 0 KATHLEEN WOESTE BOARD MEMBER 1.00 X 0 0 0 1389823 0 193199 8 0 1 0 PLATINUM SYSTEMS INC 4600 GREEN BAY ROAD KENOSHA WI 53144 IT SERVICES 254983 PLEXUS HEALTH SOLUTIONS INC 7001 30TH AVENUE KENOSHA WI 53143 BILLING AND COLLECTION SERVICES 240114 GREENWAY HEALTH 4301 W BOY SCOUT BLVD TAMPA FL 33607 IT SERVICES 230331 RILEY CONSTRUCTION CO INC 5301 99TH AVENUE KENOSHA WI 53144 CONSTRUCTION SERVICES 178547 CLEAN & GREEN SOLUTIONS 5008 GREEN BAY ROAD KENOSHA WI 53144 CLEANING SERVICES 128883 5 3879362 6444 3885806 PATIENT SERVICE FEE 621110 6916867 6916867 PHARMACY REVENUE 900099 140939 140939 7057806 423 423 MISCELLANEOUS REVENUE 900099 46384 46384 46384 10990419 7057806 0 46807 760168 634442 125726 5403884 5212918 190966 644277 577922 66355 442878 396389 46489 146839 21552 125287 373044 288224 84820 55598 2319 53279 39981 28355 11626 858224 677146 181078 405741 253385 152356 6831 2885 3946 3414 359 3055 101671 800 100871 352255 241131 111124 88631 69814 18817 MEDICAL & LAB EXPENSE 442733 442733 EQUIPMENT 244795 184918 59877 STAFF DEVELOPMENT 54883 26342 28541 DUES & SUBSCRIPTIONS 33109 12166 20943 39356 36519 2837 10498312 9110319 1387993 0 600 600 682412 538389 366838 62009 3003466 1027216 115169 155872 10741958 5715746 5191349 5026212 0 1156597 9359834 7966895 1472811 1116640 963043 17923 2304687 2203833 4740541 3338396 X 4619293 4628499 4619293 4628499 9359834 7966895 492107 -482901 0 X 0 1 X 1 1 1 X 2367140 2846771 3129166 2713480 3885806 14942363 2367140 2846771 3129166 2713480 3885806 14942363 14942363 458 154 119 339 423 1493 16690 46384 63074 15006930 40623606 0.99570 0.99860 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2018 AMOUNT: $ 16,690. 2019 AMOUNT: $ 46,384. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 159200 159200 3857274 1127930 2729344 2229506 1306187 923319 588424 400449 187975 3907554 2881180 1026374 5026212 AMOUNTS DUE FROM THIRD PARTY REIMBURSEMENT PROGRAMS 1156597 1156597 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 0 0 0 0 0 0 0 0 0 AMI PRAG THROUGH 10419 CHIEF MEDICAL OFFICER 208973 0 0 0 0 0 0 0 0 0 208973 0 0 0 ALAN MARSHALL CEO/COO (THROUGH 2/7/20) 169712 0 0 0 0 0 25000 0 13152 0 207864 0 0 0 MIHAELA POPA CHIEF DENTAL OFFICER 156294 0 0 0 0 0 23426 0 0 0 179720 0 0 0 JOSEPH BARTA DENTIST 141497 0 0 0 0 0 0 0 37625 0 179122 0 0 0 DAVID CONNELL DENTIST 152187 0 0 0 0 0 17088 0 6415 0 175690 0 0 0 SACHIN VERMA DENTIST 149706 0 0 0 0 0 0 0 21175 0 170881 0 0 0 SHANNON BREHMER 35% CONTROLLED ENTITY OF BOARD MEMBER 240114 BILLING AND COLLECTION 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 233031 2854863 KENOSHA COMMUNITY HEALTH CENTER INC