LAKESHORE COMMUNITY HEALTH CARE INC: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- LAKESHORE COMMUNITY HEALTH CARE INC (EIN 26-4321839)
- Tax period
- 2023-06-01 to 2024-05-31
- Filed
- 2025-03-13
- IRS object ID
- 202500729349301655
- Schema version
- 2023v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-03-13T16:47:07-05:00 | ReturnTs |
| Tax Period End | 2024-05-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 170 N RADNOR-CHESTER RD SUITE 200 | AddressLine1Txt |
| City | RADNOR | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19087 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-06-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 264321839 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKESHORE COMMUNITY HEALTH CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LAKE | BusinessNameControlTxt |
| Phone | 9207836633 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1721 SAEMANN AVENUE | AddressLine1Txt |
| City | SHEBOYGAN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53081 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KRISTIN BLANCHARD STEARNS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9207836633 | PhoneNum |
| Signature | 2025-03-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SOLOMON MARDAKHAEV | PreparerPersonNm |
| PTIN | P01806552 | PTIN |
| Phone | 6105653930 | PhoneNum |
| Preparation | 2025-03-13 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KRISTIN BLANCHARD STEARNS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1721 SAEMANN AVENUE | AddressLine1Txt |
| City | SHEBOYGAN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53081 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,312,485 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LAKESHORECHC.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2009 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 179 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,208,382 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,339,826 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,424,643 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,809,479 | CYProgramServiceRevenueAmt |
| PY Investment Income | $101,665 | PYInvestmentIncomeAmt |
| CY Investment Income | -$235,361 | CYInvestmentIncomeAmt |
| PY Other Revenue | $29,742 | PYOtherRevenueAmt |
| CY Other Revenue | $14,520 | CYOtherRevenueAmt |
| PY Total Revenue | $16,764,432 | PYTotalRevenueAmt |
| CY Total Revenue | $17,928,464 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,781,035 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,639,137 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,012,623 | PYOtherExpensesAmt |
| CY Other Expenses | $6,113,977 | CYOtherExpensesAmt |
| PY Total Expenses | $16,793,658 | PYTotalExpensesAmt |
| CY Total Expenses | $18,753,114 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$29,226 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$824,650 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,947,200 | TotalAssetsBOYAmt |
| Total Assets EOY | $15,725,508 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,603,030 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,775,918 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,344,170 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,949,590 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | LAKESHORE COMMUNITY HEALTH CARE PROVIDES ACCESS TO COMPREHENSIVE, INTEGRATED HEALTH CARE, REGARDLESS OF ABILITY TO PAY, ELIMINATING HEALTH DISPARITIES AMONG THE UNDERSERVED. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,091,881 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $14,809,479 | RevenueAmt |
| Desc | 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 PROVIDES UP TO 90% DISCOUNTS FOR ANYONE WHO CANNOT AFFORD TO PAY FOR THESE SERVICES.LAKESHORE PROVIDED SERVICES TO 12,971 UNDUPLICATED PATIENTS IN OUR 2024 FISCAL YEAR. THESE PATIENTS WERE SEEN FOR 27,965 DENTAL VISITS 3,616 OF THOSE THROUGH OUR SCHOOL-BASED DENTAL PROGRAM), 8,232 MEDICAL VISITS, 12,220 BEHAVIORAL HEALTH VISITS (8,080 OF THOSE THROUGH OUR SCHOOL-BASED PATH PROGRAM), AND 4,474 CHIROPRACTIC VISITS. LAKESHORE ALSO PROVIDED 38,602 PRESCRIPTIONS TO OUR PATIENTS THROUGH OUR 340B PHARMACY PROGRAM. | Desc |
| Total Program Service Expenses | $14,091,881 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 179 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALEB JENSEMA CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9207836633 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1721 SAEMANN AVENUE | AddressLine1Txt |
| City | SHEBOYGAN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53081 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LEIGHANNE MATTER-JENSEN | ||||||||
| PRESIDENT | 2.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DENISE WITTSTOCK | ||||||||
| VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM PFEFFERKORN | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| KELYN NETZ | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SHERRIE BOETTCHER | ||||||||
| BOARD MEMBER (THRU JUNE 2023) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| HEATHER FEEST | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| RUTH HENKLE | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| SHENITA SALAAM | ||||||||
| BOARD MEMBER (THRU MAY 2024) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BRENDA SMITH | ||||||||
| BOARD MEMBER (THRU MAY 2024) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JIM STRACHOTA | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| AMALIA VARGAS | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT ZIEGELBAUER | ||||||||
| BOARD MEMBER (THRU MAY 2024) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KRISTIN BLANCHARD STEARNS | ||||||||
| CEO | 40.00 | 1.00 | Yes (X) | $184,146 | $0 | $46,555 | ||
| MICHELE SCHMITT | ||||||||
| COO | 40.00 | Yes (X) | $128,790 | $0 | $17,204 | |||
| CALEB JENSEMA | ||||||||
| CFO | 40.00 | Yes (X) | $108,875 | $0 | $8,881 | |||
| PAJ NTAUB VANG MD | ||||||||
| FAMILY PHYSICIAN | 40.00 | $202,272 | $0 | $20,548 | Yes (X) | |||
| CASEY WILSON DDS | ||||||||
| DENTAL DIRECTOR | 40.00 | $190,442 | $0 | $19,241 | Yes (X) | |||
| OLAIFA TURNER DDS | ||||||||
| DENTIST | 40.00 | $169,140 | $0 | $15,492 | Yes (X) | |||
| SUBHASHISH DAS DDS | ||||||||
| DENTIST | 40.00 | $167,015 | $0 | $17,669 | Yes (X) | |||
| CHRISTINA TORKILSEN DDS | ||||||||
| DENTIST | 40.00 | $158,750 | $0 | $8,451 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,309,430 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $154,041 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PLEXUS HEALTH SOLUTIONS INC | |||||
| PO BOX 0655 | KENOSHA | WI | 53141 | CONTRACT BILLING SERVICES | $479,383 |
| OCHIN | |||||
| PO BOX 8426 | PORTLAND | OR | 97228 | ELECTRIC HEALTH RECORD PROVIDER | $426,208 |
| STRATUS INDEMAND | |||||
| PO BOX 675248 | DETROIT | MI | 48267 | TRANSLATION SERVICES | $274,430 |
| NDX LORDS DENTAL STUDIO | |||||
| PO BOX 19048 | GREEN BAY | WI | 54307 | CONTRACT DENTAL LAB | $234,522 |
| BARTON ASSOCIATES | |||||
| PO BOX 417844 | BOSTON | MA | 02241 | LOCUM DENTIST | $227,329 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $15,000 | FederatedCampaignsAmt |
| Fundraising | $26,046 | FundraisingAmt |
| Related Organizations | $50,535 | RelatedOrganizationsAmt |
| Government Grants | $2,264,345 | GovernmentGrantsAmt |
| All Other Contributions | $983,900 | AllOtherContributionsAmt |
| Noncash Contributions | $390,935 | NoncashContributionsAmt |
| Total Contributions | $3,339,826 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $13,655,154 | $13,655,154 |
| PHARMACY REVENUE | 621400 | $1,136,465 | $1,136,465 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,860 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,860 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,809,479 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $131,624 | TotalRevenueColumnAmt |
| Exclusion | $131,624 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,823 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $20,823 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,823 | TotalRevenueColumnAmt |
| Exclusion | $20,823 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $366,985 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$366,985 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$366,985 | TotalRevenueColumnAmt |
| Exclusion | -$366,985 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $26,046 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $17,036 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$17,036 | TotalRevenueColumnAmt |
| Exclusion | -$17,036 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,733 | TotalRevenueColumnAmt |
| Exclusion | $10,733 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $10,733 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,928,464 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,809,479 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$220,841 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,273 | TotalAmt |
| Management And General | $495,273 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,585,670 | TotalAmt |
| Program Services | $7,145,906 | ProgramServicesAmt |
| Management And General | $2,439,764 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $324,037 | TotalAmt |
| Program Services | $238,623 | ProgramServicesAmt |
| Management And General | $85,414 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,514,441 | TotalAmt |
| Program Services | $1,054,816 | ProgramServicesAmt |
| Management And General | $459,625 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $719,716 | TotalAmt |
| Program Services | $516,560 | ProgramServicesAmt |
| Management And General | $203,156 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,634 | TotalAmt |
| Program Services | $1,579 | ProgramServicesAmt |
| Management And General | $36,055 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,395 | TotalAmt |
| Program Services | $4,812 | ProgramServicesAmt |
| Management And General | $72,583 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,014,144 | TotalAmt |
| Program Services | $1,812,733 | ProgramServicesAmt |
| Management And General | $201,411 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,492 | TotalAmt |
| Program Services | $13,434 | ProgramServicesAmt |
| Management And General | $21,058 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,663 | TotalAmt |
| Program Services | $54,679 | ProgramServicesAmt |
| Management And General | $14,984 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,007 | TotalAmt |
| Program Services | $84,003 | ProgramServicesAmt |
| Management And General | $51,004 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $472,754 | TotalAmt |
| Program Services | $304,743 | ProgramServicesAmt |
| Management And General | $168,011 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,014 | TotalAmt |
| Program Services | $39,840 | ProgramServicesAmt |
| Management And General | $18,174 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,842 | TotalAmt |
| Program Services | $40,968 | ProgramServicesAmt |
| Management And General | $16,874 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $197,600 | TotalAmt |
| Program Services | $103,232 | ProgramServicesAmt |
| Management And General | $94,368 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $425,852 | TotalAmt |
| Program Services | $337,572 | ProgramServicesAmt |
| Management And General | $88,280 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,319 | TotalAmt |
| Program Services | $29,863 | ProgramServicesAmt |
| Management And General | $20,456 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,414,766 | $1,414,766 | |
| ELECTRONIC HEALTH RECOR | $539,739 | $539,739 | |
| EQUIPMENT | $235,740 | $202,089 | $33,651 |
| LICENSES & DUES | $194,874 | $91,304 | $103,570 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,142 | TotalAmt |
| Program Services | $60,620 | ProgramServicesAmt |
| Management And General | $37,522 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,753,114 | TotalAmt |
| Program Services | $14,091,881 | ProgramServicesAmt |
| Management And General | $4,661,233 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $755,607 | BOYAmt |
| EOY | $773,469 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,854,592 | BOYAmt |
| EOY | $2,563,093 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,795 | BOYAmt |
| EOY | $40,010 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $917,150 | BOYAmt |
| EOY | $845,579 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,955,250 | BOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,924 | BOYAmt |
| EOY | $76,389 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,281 | BOYAmt |
| EOY | $151,696 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,862,499 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,606,066 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,163,582 | BOYAmt |
| EOY | $11,256,433 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,019 | BOYAmt |
| EOY | $18,839 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,947,200 | BOYAmt |
| EOY | $15,725,508 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,225,536 | BOYAmt |
| EOY | $1,493,574 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,028 | BOYAmt |
| EOY | $17,045 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,327,653 | BOYAmt |
| EOY | $3,245,268 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,813 | BOYAmt |
| EOY | $20,031 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,603,030 | BOYAmt |
| EOY | $4,775,918 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,687,793 | BOYAmt |
| EOY | $10,266,884 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $656,377 | BOYAmt |
| EOY | $682,706 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,344,170 | BOYAmt |
| EOY | $10,949,590 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,947,200 | BOYAmt |
| EOY | $15,725,508 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$824,650 | ReconcilationRevenueExpnssAmt |
| Donated Services And Use Fclts | -$10,539 | DonatedServicesAndUseFcltsAmt |
| Other Changes In Net Assets | $440,609 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A: | FormAndLineReferenceDesc |
| Explanation | 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). | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $351,364 | OtherCostOrOtherBasisAmt |
| Book Value | $351,364 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,669,005 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,348,197 | DepreciationAmt |
| Book Value | $9,320,808 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $220,622 | OtherCostOrOtherBasisAmt |
| Depreciation | $150,408 | DepreciationAmt |
| Book Value | $70,214 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,621,508 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,107,461 | DepreciationAmt |
| Book Value | $1,514,047 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,256,433 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAPITAL LEASE OBLIGATIONS | Desc |
| Amt | $20,031 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $20,031 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $20,279,718 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $10,396 | DonatedServicesAndUseFcltsAmt |
| Other Revenue | $2,374,172 | OtherRevenueAmt |
| Revenue Not Reported | $2,384,568 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,895,150 | RevenueSubtotalAmt |
| Other Revenues Not Included | $33,314 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $33,314 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $17,928,464 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,912,937 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $20,935 | DonatedServicesUseFcltsAmt |
| Other Expenses Included | $172,202 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $193,137 | ExpensesNotReportedAmt |
| Expenses Subtotal | $18,719,800 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $33,314 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $33,314 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,753,114 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | INTERCOMPANY RENT ELIMINATION -84,000. LCHC QALICB INCOME 2,458,172. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INTERCOMPANY GRANTS 50,350. FUNDRAISING EXPENSES -17,036. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | INTERCOMPANY RENT ELIMINATION -84,000. LCHC QALICB EXPENSES 256,202. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | INTERCOMPANY GRANTS 50,350. FUNDRAISING EXPENSES -17,036. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | CAVEMAN RUN | Event1Nm |
| Gross Receipts Event1 | $26,046 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $26,046 | CharitableContriEvent1Amt |
| Other Direct Expenses Event1 | $17,036 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $26,046 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $26,046 | CharitableContributionsTotAmt |
| Oth Direct Expnss Total Events | $17,036 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $17,036 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$17,036 | NetIncomeSummaryAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KRISTIN BLANCHARD STEARNS | ||||||||||||||
| CEO | $183,696 | $0 | $0 | $0 | $450 | $0 | $7,720 | $0 | $38,835 | $0 | $230,701 | $0 | $0 | $0 |
| PAJ NTAUB VANG MD | ||||||||||||||
| FAMILY PHYSICIAN | $202,002 | $0 | $0 | $0 | $270 | $0 | $8,194 | $0 | $12,354 | $0 | $222,820 | $0 | $0 | $0 |
| CASEY WILSON DDS | ||||||||||||||
| DENTAL DIRECTOR | $190,172 | $0 | $0 | $0 | $270 | $0 | $7,897 | $0 | $11,344 | $0 | $209,683 | $0 | $0 | $0 |
| SUBHASHISH DAS DDS | ||||||||||||||
| DENTIST | $166,775 | $0 | $0 | $0 | $240 | $0 | $6,480 | $0 | $11,189 | $0 | $184,684 | $0 | $0 | $0 |
| OLAIFA TURNER DDS | ||||||||||||||
| DENTIST | $160,985 | $0 | $0 | $0 | $8,155 | $0 | $3,568 | $0 | $11,924 | $0 | $184,632 | $0 | $0 | $0 |
| CHRISTINA TORKILSEN DDS | ||||||||||||||
| DENTIST | $158,510 | $0 | $0 | $0 | $240 | $0 | $6,305 | $0 | $2,146 | $0 | $167,201 | $0 | $0 | $0 |
Schedule M IRS990ScheduleM
Real Estate Commercial RealEstateCommercialGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $390,935 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 16: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS IN PART I, COLUMN (B). | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 | 1. AT LEAST ANNUALLY, THE FOLLOWING INDIVIDUALS MUST REVIEW THIS POLICY AND THE ATTACHED "CONFLICT OF INTEREST DISCLOSURE" FORM. COMPLETED FORMS ARE SUBMITTED TO THE CEO OR COMPLIANCE OFFICER FOR REVIEW: A. MEMBERS OF THE BOARD OF DIRECTORS. B. MEMBERS OF SENIOR MANAGEMENT. C. NON-EMPLOYED COMMITTEE MEMBERS. D. EMPLOYEES WITH PURCHASING AUTHORITY. 2. AT ANY TIME DURING THE YEAR, WHEN AN ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST ARISES, A RESPONSIBLE PERSON MUST CONTACT, AS APPROPRIATE, THE CHAIRPERSON OF THE BOARD OF DIRECTORS OR OTHER COMMITTEE, THE CEO, OR THE COMPLIANCE OFFICER. ALL POTENTIAL CONFLICT OF INTEREST DISCLOSURES MUST BE FORWARDED TO THE CEO OR THE COMPLIANCE OFFICER FOR REVIEW PROCESS MANAGEMENT. 3. THE CEO OR THE COMPLIANCE OFFICER WILL ENSURE THAT THE POTENTIAL CONFLICT OF INTEREST IS REVIEWED TO DETERMINE IF FURTHER ACTION IS REQUIRED. 4. EMPLOYEE DISCLOSURES ARE REVIEWED BY THE CEO. THE CEO'S DISCLOSURES AND THOSE OF MEMBERS OF THE BOARD OF DIRECTORS ARE REVIEWED BY THE BOARD OF DIRECTORS CHAIRPERSON. COMMITTEE MEMBER DISCLOSURES ARE REVIEWED BY THE COMMITTEE CHAIR. 5. PRIOR TO BOARD OR COMMITTEE ACTION ON A CONTRACT OR TRANSACTION INVOLVING A CONFLICT OF INTEREST, A RESPONSIBLE INDIVIDUAL HAVING A CONFLICT OF INTEREST AND WHO IS IN ATTENDANCE AT THE MEETING MUST DISCLOSE ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST. SUCH DISCLOSURE MUST BE REFLECTED IN THE MINUTES OF THE MEETING. 6. A RESPONSIBLE PERSON WHO PLANS NOT TO ATTEND A MEETING AT WHICH HE OR SHE HAS REASON TO BELIEVE THAT THE BOARD OR COMMITTEE WILL ACT ON A MATTER IN WHICH THE PERSON HAS A CONFLICT OF INTEREST SHALL DISCLOSE TO THE BOARD OR COMMITTEE CHAIR ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST. THE BOARD OR COMMITTEE CHAIR WILL REPORT THE DISCLOSURE AT THE MEETING AND THE DISCLOSURE WILL BE REFLECTED IN THE MINUTES OF THE MEETING. 7. A PERSON WHO HAS A CONFLICT OF INTEREST WILL NOT PARTICIPATE IN OR BE PERMITTED TO HEAR THE BOARD'S OR COMMITTEE'S DISCUSSION OF THE MATTER EXCEPT TO DISCLOSE MATERIAL FACTS AND TO RESPOND TO QUESTIONS. SUCH PERSON MUST NOT ATTEMPT TO EXERT HIS OR HER PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, EITHER AT OR OUTSIDE OF THE MEETING. SUCH PERSON WILL NOT BE ALLOWED TO PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF RELEVANT CONTRACTS. SUCH PERSON WILL NOT BE ALLOWED TO PARTICIPATE IN THE SELECTION, AWARD, OR ADMINISTRATION OF RELEVANT CONTRACTS. 8. A PERSON WHO HAS A CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT OR TRANSACTION THAT WILL BE VOTED ON AT A MEETING SHALL NOT BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM FOR PURPOSES OF THE VOTE. THE PERSON HAVING THE CONFLICT OF INTEREST MAY NOT VOTE ON THE CONTRACTOR TRANSACTION AND MUST NOT BE PRESENT IN THE MEETING ROOM WHEN THE VOTE IS TAKEN, UNLESS THE VOTE IS BY SECRET BALLOT. THE MEETING MINUTES MUST REFLECT THE PERSON'S INELIGIBILITY TO VOTE. 9. RESPONSIBLE PERSONS WHO ARE EMPLOYED BY LCHC, OR WHO HAVE A POTENTIAL CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT OR TRANSACTION THAT IS NOT THE SUBJECT OF BOARD OR COMMITTEE ACTION, MUST DISCLOSE THE POTENTIAL CONFLICT OF INTEREST TO THE CEO OR THE COMPLIANCE OFFICER, WHO WILL DETERMINE WHETHER THERE EXISTS A CONFLICT OF INTEREST THAT IS SUBJECT TO THIS POLICY. SUCH DISCLOSURE MUST BE MADE AS SOON AS THE RESPONSIBLE PERSON BECOMES AWARE OF THE POTENTIAL CONFLICT. THE RESPONSIBLE PERSON MUST REFRAIN FROM ANY ACTION THAT MAY AFFECT LCHC PARTICIPATION IN THE CONTRACT OR TRANSACTION. 10. PER LCHC BOARD MANUAL AND/OR LCHC STANDARDS OF CONDUCT, VIOLATION OF THIS POLICY MAY LEAD TO DISCIPLINARY ACTIONS INCLUDING TERMINATION. |
| 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 BASED ON QUALIFICATIONS AND DETERMINED BY HR AND THE CFO. THE BOARD OF DIRECTORS HAS THE POWER TO ESTABLISH AND PERIODICALLY UPDATE THE SALARY AND BENEFITS SCALES AND MOST RECENTLY APPROVED THE ENGAGEMENT WITH A CONSULTING FIRM TO CONDUCT A WAGE RANGE STUDY FOR ALL OF OUR EMPLOYEES WHICH CONCLUDED AT THE END OF 2021 AND UTILIZED DATA FROM NACHC AS WELL AS MGMA. THESE NEW SALARY RANGES FROM THIS PROPOSAL SET FORTH BY THE CONSULTING FIRM ARE ALL TO BE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS BEFORE BEING IMPLEMENTED IN ANY CAPACITY. |
| 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 | ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 40,787. MANAGEMENT AND GENERAL EXPENSES 57,058. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,845. BILLING SERVICES: PROGRAM SERVICE EXPENSES 525,706. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 525,706. CLINICAL SERVICES: PROGRAM SERVICE EXPENSES 650,135. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 650,135. DENTAL LAB SERVICES: PROGRAM SERVICE EXPENSES 256,549. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 256,549. GRANT WRITING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 55,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,781. HOUSEKEEPING SERVICES: PROGRAM SERVICE EXPENSES 90,781. MANAGEMENT AND GENERAL EXPENSES 45,916. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,697. IT SERVICES: PROGRAM SERVICE EXPENSES 17,185. MANAGEMENT AND GENERAL EXPENSES 35,964. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,149. TRANSLATION SERVICES: PROGRAM SERVICE EXPENSES 231,590. MANAGEMENT AND GENERAL EXPENSES 6,692. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,282. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF NET ASSETS UPON MERGER WITH LCHC QALICB 440,609. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LCHC QALICB INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1721 SAEMANN AVENUE | AddressLine1Txt |
| City | SHEBOYGAN | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53081 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 815453995 | EIN |
| Primary Activities | TO SUPPORT LAKESHORE COMMUNITY HEALTH CARE, INC. | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKESHORE COMMUNITY HEALTH CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| LCHC QALICB INC | ||
| K | $84,000 | CASH |
| LCHC QALICB INC | ||
| C | $50,350 | CASH |