2018-04-11T13:49:06-05:00 2017-05-31 390758449 Wipfli LLP 10000 Innovation Drive Suite 250 Milwaukee WI 532264837 990 2016-06-01 264321839 Lakeshore Community Health Care Inc LAKE 9207836633 1721 Saemann Avenue Sheboygan WI 53081 Kristin Blanchard Stearns CEO 9207836633 2018-04-06 1 DAVE GLOBIG P01356041 4144319300 2018-03-30 207.250.78.130 2018-04-06 11:04:50 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D482E504488B33FE332F9841DC0BE60818D7B9FD 2016 2021-01-29 14:40:06Z Kristin Blanchard Stearns 1721 Saemann Avenue Sheboygan WI 53081 12079928 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. 13 13 102 15 0 0 2279856 5304787 5582320 6770671 2128 -9609 1383 2560 7865687 12068409 0 257359 0 0 5094643 6291320 85333 120194 123454 2168074 2592458 7348050 9261331 517637 2807078 4177046 10376013 1718305 5110194 2458741 5265819 Lakeshore Community Health Care provides access to comprehensive, integrated health care, regardless of ability to pay, eliminating health disparities among the underserved. 0 0 6612592 257359 6770671 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 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. 6612592 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 18 0 102 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X Martin Schaller 3604836223 1721 Saemann Avenue Sheboygan WI 53081 Lucy Angulo de Araujo Board Member 2.00 0.00 X 0 0 0 Dana Clark Board Member (Starting 9/7/16) 2.00 0.00 X 0 0 0 Mysti Gruenke Board Member (Starting 1/4/17) 2.00 0.00 X 0 0 0 Scott Hayes Board Member (Starting 3/1/17) 2.00 0.00 X 0 0 0 Dale Hippensteel Past President (Thru 8/4/16) 2.00 0.00 X 0 0 0 Stephanie Huebschen Board Member (Thru 10/5/16) 2.00 0.00 X 0 0 0 Lori Jochimson Board Member 2.00 0.00 X 0 0 0 Rachel Laborde Board Member (Starting 1/4/17) 2.00 0.00 X 0 0 0 Debbie Libby Board Member 2.00 0.00 X 0 0 0 Karlyn Raddatz Board Member 2.00 0.00 X 0 0 0 Joseph Rupnik Board Member (Starting 12/7/16) 2.00 0.00 X 0 0 0 Barbara Dodge President 2.00 0.00 X X 0 0 0 Tammy Harris Vice President 2.00 0.00 X X 0 0 0 Uriah Warner Secretary 2.00 0.00 X X 0 0 0 Martin Schaller Treasurer 2.00 1.00 X X 0 0 0 Kristin Blanchard Stearns CEO 40.00 1.00 X 104398 0 19177 David Hughes CFO/COO (thru 5/22/17) 40.00 0.00 X 135884 0 18780 Bradley Smith Dental Director 40.00 0.00 X 186165 0 13131 Thomas Kissner Dentist 40.00 0.00 X 168544 0 24646 Casey Wilson Dentist 40.00 0.00 X 128121 0 22464 Tara Stream Dentist 40.00 0.00 X 129931 0 18197 Robert Wenberg Physician 40.00 0.00 X 265639 0 40362 1118682 0 156757 10 0 1 0 Abacus Architects Inc 1135-A Michigan Avenue Sheboygan WI 53081 Architectural Services 177543 Plexus Health Solutions Inc PO Box 0655 Kenosha WI 53141 Contract Billing 166280 Non-Profit Fundraising Partners 1711 Van Hise Avenue Madison WI 53726 Professional Fundraising Services 120194 Greenway Health PO Box 2036658 Dallas TX 75320 Electronic Health Records 108746 4 3750 2706603 2594434 917 5304787 Patient Revenue 621400 6640694 6640694 Meaningful use revenue 624100 127500 127500 Electronic health record incentiv 624100 2477 2477 6770671 1910 1910 11519 -11519 -11519 -11519 2560 2560 2560 12068409 6770671 0 -7049 257359 257359 293821 293821 4845959 3580261 1265698 212810 141978 70832 584147 389720 194427 354583 236564 118019 19992 10910 9082 19853 10834 9019 120194 120194 564957 345431 219526 26067 25450 617 147686 122395 25291 313931 247482 66449 39686 28155 11531 37721 26761 10960 66795 35692 31103 239999 189199 50800 26819 14331 12488 Medical Supplies 452792 442069 10723 Equipment 282009 242305 39704 Electronic Health Recor 181505 150423 31082 Other Staff Support 141425 100332 41093 31221 14941 13020 3260 9261331 6612592 2525285 123454 166859 426640 1099435 1172968 725062 1471377 38488 1371808 0 4955250 16107 210997 1037990 538759 2131095 499231 0 267742 4177046 10376013 624511 856268 1044621 4229706 49173 24220 1718305 5110194 X 1438584 2793565 1020157 2472254 2458741 5265819 4177046 10376013 2807078 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 23621 15354 8267 934637 523405 411232 79732 79732 499231 Capital Lease Obligation 24220 24220 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 orgnaization recorded no assets or liabilities related to uncertain tax positions. X X X X 1 Non-Profit Fundraising Partners 1711 Van Hise Avenue Madison WI 53726 Capital campaign fundraising, government and non-government 0 2502381 120194 2382187 2502381 120194 2382187 WI 1 LCHC QALICB Inc 1721 Saemann Avenue Sheboygan WI 53081 815453995 501(c)(3) 257359 General Support 1 0 Part I, Line 2: Records are maintained for all board approvals for funds designated to LCHC QALICB Inc. X X 0 0 0 0 0 0 0 0 0 David Hughes CFO/COO (thru 5/22/17) 133904 0 0 0 1980 0 6923 0 11857 0 154664 0 0 0 Bradley Smith Dental Director 184875 0 0 0 1290 0 9255 0 3876 0 199296 0 0 0 Thomas Kissner Dentist 167254 0 0 0 1290 0 8578 0 16068 0 193190 0 0 0 Casey Wilson Dentist 127881 0 0 0 240 0 6644 0 15820 0 150585 0 0 0 Robert Wenberg Physician 263659 0 0 0 1980 0 13750 0 26612 0 306001 0 0 0 Form 990, Part VI, Section B, line 11b Board members are given copies 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. 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LCHC QALICB Inc B 257359 FMV