2017-04-17T10:42:32-05:00 2016-05-31 390758449 Wipfli LLP 10000 Innovation Drive Suite 250 Milwaukee WI 532264837 990 2015-06-01 264321839 Lakeshore Community Health Care Inc LAKE 9207836633 1721 Saemann Avenue Sheboygan WI 53081 Kristin Blanchard Stearns CEO 9207836633 2017-04-17 1 DAVE GLOBIG P01356041 4144319300 2017-03-30 2015 2021-01-29 14:40:06Z Kristin Blanchard Stearns 1721 Saemann Avenue Sheboygan WI 53081 7865687 0 X www.lakeshorecommunityhc.org X 2009 WI To offer comprehensive, primary health services to medically underserved individuals through the operation of a community-based clinic. 10 10 92 10 0 0 2319267 2279856 4267670 5582320 965 2128 6773 1383 6594675 7865687 0 0 0 0 3891200 5094643 0 85333 102098 1752294 2168074 5643494 7348050 951181 517637 2357978 4177046 416874 1718305 1941104 2458741 To improve the health and well-being of Sheboygan County and surrounding communities, by providing quality, patient-centered, family-based health care, health promotion and support services free from linguistic, cultural and economic barriers. 0 0 5174201 0 5582320 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. 5174201 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 21 0 92 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X David Hughes 3604836223 1721 Saemann Avenue Sheboygan WI 53081 Lucy Angulo de Araujo Board Member 2.00 X 0 0 0 Dymtro Glazunov Board Member (thru Nov) 2.00 X 0 0 0 Dale Hippensteel Past President 2.00 X 0 0 0 Stephanie Huebschen Board Member 2.00 X 0 0 0 Karlyn Raddatz Board Member 2.00 X 0 0 0 Lori Jochimson Board Member 2.00 X 0 0 0 Debbie Libby Board Member 2.00 X 0 0 0 Barbara Dodge President 2.00 X X 0 0 0 Tammy Harris Vice President/Secretary 2.00 X X 0 0 0 Uriah Warner Secretary 2.00 X X 0 0 0 Martin Schaller Treasurer 2.00 X X 0 0 0 Kristin Blanchard Stearns CEO 40.00 X 86885 0 11263 David Hughes CFO/COO 40.00 X 129931 0 20270 Bradley Smith Dental Director 40.00 X 184026 0 13206 Thomas Kissner Dentist 40.00 X 166826 0 34383 Casey Wilson Dentist 40.00 X 123191 0 16918 Tara Stream Dentist 40.00 X 123150 0 16717 814009 0 112757 7 0 1 0 Plexus Health Solutions Inc PO Box 0655 Kenosha WI 53141 Contract Billing 131058 Greenway Health 100 Greenway Blvd Carrollton GA 30117 Electronic Health Record 120561 2 22009 1890032 367815 217077 2279856 Patient Revenue 621400 5516599 5516599 Meaningful use revenue 624100 63750 63750 Electronic health reco 624100 1971 1971 5582320 2128 2128 1383 1383 1383 7865687 5582320 0 3511 256431 256431 3832554 2793009 1039545 174922 126147 48775 541682 382556 159126 289054 195998 93056 4162 4162 18774 18774 85333 85333 482365 309384 172981 37118 20722 16396 130922 85706 45216 292181 227286 64895 36055 21993 14062 32433 19784 12649 197709 153796 43913 17228 17155 73 Medical Supplies 345429 345429 Equipment 294836 229351 65485 Electronic Health Recor 145218 145218 Other Staff Support 40746 24855 15891 92898 75812 321 16765 7348050 5174201 2071751 102098 184646 166859 266350 1099435 1000000 725062 294745 38488 13206 16107 2509143 378048 595224 2131095 3807 0 2357978 4177046 352865 624511 0 1044621 64009 49173 416874 1718305 X 941104 1438584 1000000 1020157 1941104 2458741 2357978 4177046 517637 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 85500 85500 441883 8707 433176 23621 10630 12991 942179 358711 583468 1015960 1015960 2131095 Capital Lease Obligation 49173 49173 X 7865687 0 7865687 0 7865687 7348050 0 7348050 0 7348050 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 10 Merlham Drive Madison WI 53705 Capital campaign fundraising, government and non-government 0 15000 85333 15000 15000 85333 15000 WI X X 0 0 0 0 0 0 0 0 0 David Hughes CFO/COO 127951 0 0 0 1980 0 6531 0 13739 0 150201 0 0 0 Bradley Smith Dental Director 183336 0 0 0 690 0 9178 0 4028 0 197232 0 0 0 Thomas Kissner Dentist 165536 0 0 0 1290 0 8500 0 25883 0 201209 0 0 0 X Software 1 206920 Cost of donated prop X Plumbing Fixtures 32 10157 Cost of donated prop 0 0 0 0 Part I, Column (b): The organization reports the actual number of contributions received. Form 990, Part VI, Section B, line 11 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.