2024-03-19T12:40:13-05:00 2023-05-31 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2022-06-01 264321839 LAKESHORE COMMUNITY HEALTH CARE INC LAKE 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 KRISTIN BLANCHARD STEARNS CEO 9207836633 2024-01-26 1 KRISTIN BLANCHARD STEARNS 999009999 0 SOLOMON MARDAKHAEV P01806552 6105653930 2024-01-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KRISTIN BLANCHARD STEARNS 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 16782389 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 11 198 17 0 0 3879833 4208382 10188055 12424643 69407 101665 20557 29742 14157852 16764432 0 0 0 0 10621967 11781035 10424 0 0 4142574 5012623 14774965 16793658 -617113 -29226 15901105 15947200 4527711 4603030 11373394 11344170 X LAKESHORE COMMUNITY HEALTH CARE PROVIDES ACCESS TO COMPREHENSIVE, INTEGRATED HEALTH CARE, REGARDLESS OF ABILITY TO PAY, ELIMINATING HEALTH DISPARITIES AMONG THE UNDERSERVED. 0 0 12484617 0 12424643 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 11,774 UNDUPLICATED PATIENTS IN OUR FY2023. THESE PATIENTS WERE SEEN FOR 26,938 DENTAL VISITS (3,514 OF THOSE THROUGH OUR SCHOOL-BASED DENTAL PROGRAM), 5,955 MEDICAL VISITS, 8,684 BEHAVIORAL HEALTH VISITS (5,043 OF THOSE THROUGH OUR SCHOOL-BASED PATH PROGRAM), AND 3,997 CHIROPRACTIC VISITS. LAKESHORE ALSO PROVIDED 28,897 PRESCRIPTIONS TO OUR PATIENTS THROUGH OUR 340B PHARMACY PROGRAM. 12484617 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 26 0 198 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X CALEB JENSEMA CFO 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 KRISTIN BLANCHARD STEARNS CEO 40.00 1.00 X 188728 0 41648 PAJ NTAUB VANG MD FAMILY PHYSICIAN 40.00 X 199123 0 21691 CASEY WILSON DDS DENTAL DIRECTOR 40.00 X 176149 0 19856 OLAIFA TURNER DDS DENTIST 40.00 X 174775 0 13391 DIANA MUELLER CHIS MANAGER 40.00 X 159574 0 15188 DIANE OPPENEER NP NURSE PRACTITIONER 40.00 X 151009 0 16526 MICHELE SCHMITT COO 40.00 X 122400 0 18011 CALEB JENSEMA CFO 40.00 X 106663 0 8392 RACHEL LABORDE PRESIDENT (THRU MAY 2023) 2.00 X X 0 0 0 LEIGHANNE MATTER-JENSEN PRESIDENT (FROM MAY 2023) 2.00 1.00 X X 0 0 0 DIANE LIEBENTHAL VICE PRESIDENT (THRU JUNE 2022) 2.00 X X 0 0 0 DENISE WITTSTOCK VICE PRESIDENT (FROM JUNE 2022) 2.00 X X 0 0 0 GERALYN LEANNAH TREASURER (THRU JUNE 2022) 2.00 X X 0 0 0 WILLIAM PFEFFERKORN TREASURER 2.00 X X 0 0 0 JOE RUPNICK TREASURER (THRU MAY 2023) 2.00 X X 0 0 0 KELYN NETZ SECRETARY 2.00 X X 0 0 0 SHERRIE BOETTCHER BOARD MEMBER 2.00 X 0 0 0 HEATHER FEEST BOARD MEMBER 2.00 X 0 0 0 SCOTT HAYES BOARD MEMBER (THRU JUNE 2022) 2.00 X 0 0 0 RUTH HENKLE BOARD MEMBER 2.00 X 0 0 0 SHENITA SALAAM BOARD MEMBER 2.00 X 0 0 0 PENNY SENKBEIL BOARD MEMBER (THRU NOV 2022) 2.00 X 0 0 0 BRENDA SMITH BOARD MEMBER 2.00 X 0 0 0 AMALIA VARGAS BOARD MEMBER 2.00 X 0 0 0 ROBERT ZIEGELBAUER BOARD MEMBER 2.00 X 0 0 0 1278421 0 154703 19 0 1 0 PLEXUS HEALTH SOLUTIONS INC PO BOX 0655 KENOSHA WI 53141 CONTRACT BILLING SERVICES 402385 OCHIN PO BOX 8426 PORTLAND OR 97228 ELECTRIC HEALTH RECORD PROVIDER 382946 NDX LORDS PO BOX 19048 GREEN BAY WI 54307 CONTRACT DENTAL LAB 163399 SABERCOR LLC 2935 S FISH HATCHERY ROAD UNIT 283 FITCHBURG WI 53711 HOUSEKEEPING/JANITORIAL SERVICES 139241 STRATUS INDEMAND PO BOX 675248 DETROIT MI 48267 TRANSLATION SERVICES 124714 5 3421 39000 3813155 352806 4208382 PATIENT SERVICE REVENUE 621400 11539963 11539963 PHARMACY REVENUE 621400 866039 866039 18641 18641 12424643 101665 101665 32621 0 32621 32621 32621 0 3421 17957 -17957 -17957 15078 15078 15078 16764432 12424643 0 131407 492110 492110 9038407 6749677 2288730 305658 225258 80400 1260005 871340 388665 684855 489220 195635 19516 12628 6888 38230 38230 1386022 1130112 255910 49133 38525 10608 63643 48569 15074 160520 107406 53114 442268 312913 129355 95755 73044 22711 82494 51026 31468 152302 82273 70029 329695 274894 54801 44184 26460 17724 MEDICAL SUPPLIES 1093057 1093057 ELECTRONIC HEALTH RECOR 390695 390695 EQUIPMENT 320892 294911 25981 LICENSES & DUES 182603 79889 102714 161614 132720 28894 16793658 12484617 4309041 0 847388 755607 3373881 2854592 36260 39795 716560 917150 4955250 4955250 98154 76924 114485 146281 7612386 1448804 5748439 6163582 10688 38019 15901105 15947200 1075711 1225536 0 22028 3432673 3327653 19327 27813 4527711 4603030 X 10655341 10687793 718053 656377 11373394 11344170 15901105 15947200 X -29226 2 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 4640065 185722 4454343 220622 122089 98533 2751699 1140993 1610706 6163582 CAPITAL LEASE OBLIGATIONS 27813 27813 X 16743747 358 358 16743389 21043 21043 16764432 17021112 248497 248497 16772615 21043 21043 16793658 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 -112,000. LCHC QALICB INCOME 112,358. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTERCOMPANY GRANTS 39,000. FUNDRAISING EXPENSES -17,957. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY RENT ELIMINATION -112,000. LCHC QALICB EXPENSES 360,497. PART XII, LINE 4B - OTHER ADJUSTMENTS: INTERCOMPANY GRANTS 39,000. FUNDRAISING EXPENSES -17,957. X X 0 0 0 0 0 0 0 0 0 KRISTIN BLANCHARD STEARNS CEO 188278 0 0 0 450 0 7720 0 33928 0 230376 0 0 0 PAJ NTAUB VANG MD FAMILY PHYSICIAN 198883 0 0 0 240 0 8041 0 13650 0 220814 0 0 0 CASEY WILSON DDS DENTAL DIRECTOR 175879 0 0 0 270 0 7357 0 12499 0 196005 0 0 0 OLAIFA TURNER DDS DENTIST 174505 0 0 0 270 0 3531 0 9860 0 188166 0 0 0 DIANA MUELLER CHIS MANAGER 156369 0 0 0 3205 0 6315 0 8873 0 174762 0 0 0 DIANE OPPENEER NP NURSE PRACTITIONER 150319 0 0 0 690 0 6152 0 10374 0 167535 0 0 0 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 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 XI, LINE 9: ROUNDING 2. 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 LCHC QALICB INC K 112000 CASH LCHC QALICB INC C 39000 CASH