2023-11-15T15:45:13-06:00 2022-12-31 391742997 O'CONNOR WELLS & VANDER WERFF LLC 111 E MAIN STREET WAUPUN WI 53963 990 2022-01-01 391759669 CHURCH HEALTH SERVICES INC CHUR 9208871766 115 N CENTER STREET BEAVER DAM WI 53916 THEO O'CONNOR EXECUTIVE DIRECTOR 9208871766 2023-11-15 1 THEO OCONNOR 999009999 0 DIANE BANCROFT-DEYOUNG P00195537 9203249711 2023-11-15 X 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z STEVE VESSEY 115 N CENTER STREET BEAVER DAM WI 53916 1336163 0 X WWW.CHURCHCLINIC.ORG X 1993 WI CHURCH HEALTH SERVICES IS A FAITH BASED HEALTH CARE ORGANIZATION THAT CONDUCTS PRIMARY, DENTAL AND MENTAL HEALTH CLINICS FOR THE POOR, UNINSURED OR UNDERINSURED. 10 10 33 22 0 0 1505881 943537 253403 352451 218 8919 -4404 0 1755098 1304907 137814 0 0 0 601162 924686 0 0 85762 151326 160656 890302 1085342 864796 219565 1483035 1680519 20710 148671 1462325 1531848 CHURCH HEALTH SERVICES IS A FAITH BASED HEALTH CARE ORGANIZATION THAT CONDUCTS PRIMARY, DENTAL AND MENTAL HEALTH CLINICS FOR THE POOR, UNINSURED OR UNDERINSURED. 0 0 800747 0 361370 CHURCH HEALTH SERVICES IS A FAITH BASED HEALTH CARE ORGANIZATION THAT CONDUCTS PRIMARY, DENTAL AND MENTAL HEALTH CLINICS FOR THE POOR, UNINSURED OR UNDERINSURED. 800747 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 33 1 0 0 0 0 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 0 0 0 0 0 0 WI X THEA O'CONNOR 9208871766 115 N CENTER STREET BEAVER DAM WI 53916 THEA O'CONNOR EXECUTIVE DIRECTOR 35.00 X 80000 0 5266 STEVE VESSEY PRESIDENT/BOARD MEMBER 1.00 X X 0 0 0 MARY VOGL-RAUSCHER VICE PRESIDENT/BOARD MEMBE 1.00 X X 0 0 0 RICH ZIEMAN TREASURER/BOARD MEMBER 1.00 X X 0 0 0 RICK VANT HOFF SECRETARY/BOARD MEMBER 1.00 X X 0 0 0 JENNIFER CAMPBELL BOARD MEMBER 1.00 X 0 0 0 KAREN COLEY BOARD MEMBER 1.00 X 0 0 0 HEIDI WEISS BOARD MEMBER 1.00 X 0 0 0 TOM HEFFRON BOARD MEMBER 1.00 X 0 0 0 CATHY NELSON BOARD MEMBER 1.00 X 0 0 0 JIM HANKES BOARD MEMBER 1.00 X 0 0 0 80000 0 5266 0 0 0 0 0 6789 57000 879748 13950 943537 PROGRAM REVENUES 624100 352451 352451 352451 165 165 40010 31256 8754 8754 8754 0 6789 0 0 1304907 361370 0 0 80000 12000 40000 28000 745418 651748 52063 41607 9611 4925 2616 2070 24876 822 15324 8730 64781 52367 7059 5355 75 75 11203 11203 3724 3724 11699 4486 7213 44439 22219 22220 21239 5441 15798 1715 1715 5190 5190 4829 2415 2414 20761 13621 7140 10470 10470 MEDICAL SUPPLIES/SERVIC 19662 19662 MISCELLANEOUS EXPENSE 3477 2127 1350 PRINTING, PUBLICATIONS, 2173 2173 1085342 800747 198833 85762 62225 566603 15397 516 1750 4000 95200 25166 782930 294423 509268 488507 34646 0 764549 595727 1483035 1680519 20710 63671 85000 20710 148671 X 1424910 993348 37415 538500 1462325 1531848 1483035 1680519 X 219565 -16219 600857 -734680 X 0 1 X 1 0 X 628068 533038 610066 849155 1295988 3916315 628068 533038 610066 849155 1295988 3916315 516588 3399727 381 447 273 215 165 1481 -146 -17 -46 3 8754 8548 3926344 0.86590 0.94310 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: LOSS ON SALE OF SECURITIES - 2018 AMOUNT: $ -146. 2019 AMOUNT: $ -17. 2020 AMOUNT: $ -46. GAIN ON SALE OF SECURITIES - 2021 AMOUNT: $ 3. 2022 AMOUNT: $ 8,754. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 764549 -125997 35000 7825 595727 36682 705000 -756 5704 764549 0 32500 4587 405 36682 1.00000 1 0 15000 15000 628569 161449 467120 139361 132974 6387 488507 BENEFICIAL INTEREST IN FUNDS HELD BY COMMUNITY FOUNDATION 595727 595727 X 1755722 -16219 600857 -133823 450815 1304907 0 1304907 1686199 600857 600857 1085342 0 1085342 PART V, LINE 4: THE FUNDS ARE ESTABLISHED FOR THE THE PURPOSE OF SUPPORTING THE ORGANIZATION AS DEEMED NECESSARY ACCORDING TO THE SPENDING POLICY. PART X, LINE 2: THE ORGANIZATION IS A NON-PROFIT CORPORATION THAT IS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS INCOME, IF ANY. THE ORGANIZATION HAD NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE ORGANIZATION'S TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS IT HAS TAKEN THAT ARE SUBJECT TO A SIGNIFICANT DEGREE OF UNCERTAINTY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN FUNDS HELD BY COMMUNITY FOUNDATION -133,823. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND SIGNED BY AN OFFICER AND EXECUTIVE DIRECTOR PRIOR TO ELECTONIC FILING. THE FORM 990 IS AVAILABLE FOR REVIEW BY ALL BOARD MEMBERS AT THE NEXT MEETING. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL DATA AND GOVERNING DOCUMENTS OF THE ORGANIZATION ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: DONATED SERVICES EXPENSE -600,857. CHANGE IN VALUE - BENEFICIAL INTEREST IN FUNDS HELD BY COMMUNITY FOUNDATION -133,823.