2022-01-18T14:48:10-06:00 2021-02-28 363168081 SIKICH LLP 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2020-03-01 391789874 KENOSHA COMMUNITY HEALTH CENTER INC KENO 2627643608 625 57TH STREET NO 700 KENOSHA WI 53140 GARY MOSS CHIEF FINANCIAL OFFICER 2627643608 2022-01-18 1 GARY MOSS 999009999 JILL M BOYLE CPA P01246734 2627549400 2022-01-18 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z MARY OUIMET 625 57TH STREET NO 700 KENOSHA WI 53140 11602341 0 X WWW.KENOSHACHC.ORG X 1994 WI TO PROVIDE ACCESS TO HEALTH CARE SERVICES AND REDUCE HEALTH DISPARITIES FOR THE UNDERSERVED PEOPLE. 13 12 152 14 0 0 3885806 6920754 7057806 4673053 423 77 46384 8457 10990419 11602341 0 0 0 0 7251207 7475120 0 0 0 3247105 3391201 10498312 10866321 492107 736020 7966895 10428339 3338396 5063820 4628499 5364519 KENOSHA COMMUNITY HEALTH CENTER, INC.'S PURPOSE IS TO PROVIDE PRIMARY CARE AND REFERRAL HEALTH SERVICES TO DISADVANTAGED AND UNDERSERVED POPULATIONS AND PROMOTE AND ENSURE THAT BASIC PRIMARY HEALTH SERVICES ARE ACCESSIBLE TO UNINSURED AND UNDERINSURED RESIDENTS OF KENOSHA, WI. 0 0 4792264 2416336 DENTAL CAREINCREASE ACCESS TO COMPREHENSIVE DENTAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 3864985 2089486 MEDICAL CAREINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 518421 167231 BEHAVIORAL HEALTH SERVICESINCREASE ACCESS TO COMPREHENSIVE MEDICAL CARE FOR BEHAVIORAL HEALTH CARE SERVICES FOR MEDICAID ENROLLEES AND THE UNINSURED. 9175670 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 22 0 152 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X GARY MOSS 2627643619 625 57TH STREET SUITE 700 KENOSHA WI 53140 MARY OUIMET CHIEF EXECUTIVE OFFICER 40.00 X 196341 0 14930 MIHAELA POPA CHIEF DENTAL OFFICER 40.00 X 158478 0 35951 JOSEPH BARTA DENTIST 40.00 X 168023 0 20739 DAVID CONNELL DENTIST 40.00 X 160866 0 23665 GARY MOSS CHIEF FINANCIAL OFFICER 40.00 X 159442 0 20136 PATRYCJA WIERZBICKI DENTIST 40.00 X 144057 0 20136 HEATHER MATEJKA DENTIST 40.00 X 137953 0 6140 SACHIN VERMA DENTIST 40.00 X 133567 0 0 NICOLE MUBANGA CHIEF MEDICAL OFFICER 40.00 X 112293 0 9587 TAMARRA COLEMAN BOARD MEMBER & BOARD PRES 1.00 X X 0 0 0 ANITA JOHNSON BOARD MEMBER & BOARD VP 1.00 X X 0 0 0 JOSEPH CLARK BOARD MEMBER & TREASURER 1.00 X X 0 0 0 DANA BERRY BOARD MEMBER & SECRETARY 1.00 X X 0 0 0 PAUL SPOTTSWOOD BOARD MEMBER 1.00 X 0 0 0 LAVETTA ARRINGTON BOARD MEMBER 1.00 X 0 0 0 SUE GERBER BOARD MEMBER 1.00 X 0 0 0 SHANNON BREHMER BOARD MEMBER 1.00 X 0 0 0 JEFFERY ZELLER BOARD MEMBER 1.00 X 0 0 0 TERRY ROSE BOARD MEMBER 1.00 X 0 0 0 JOHN ROCHA II BOARD MEMBER 1.00 X 0 0 0 KATHLEEN WOESTE BOARD MEMBER 1.00 X 0 0 0 VENKATA THOTA BOARD MEMBER 1.00 X 0 0 0 KATHERINE MARKS BOARD MEMBER THRU 2/28/21 1.00 X 0 0 0 1371020 0 151284 14 0 1 0 PLATINUM SYSTEMS INC 4600 GREEN BAY ROAD KENOSHA WI 53144 IT SERVICES 249522 PLEXUS HEALTH SOLUTIONS INC PO BOX 0655 KENOSHA WI 531410655 BILLING AND COLLECTION SERVICES 211180 GREENWAY HEALTH PO BOX 203658 DALLAS TX 753203658 ELECTRONIC HEALTH RECORDS 196930 RILEY CONSTRUCTION CO INC 5301 99TH AVENUE KENOSHA WI 53144 CONSTRUCTION SERVICES 176070 CLEAN & GREEN SOLUTIONS 5008 GREEN BAY ROAD KENOSHA WI 53144 JANITORIAL SERVICES 111264 6 6886491 34263 6920754 PATIENT SERVICE FEE 621110 4297743 4297743 PHARMACY REVENUE 900099 375310 375310 4673053 77 77 MISCELLANEOUS REVENUE 900099 8457 8457 8457 11602341 4673053 0 8534 752605 361684 390921 5518188 5342678 175510 769379 713714 55665 434948 384655 50293 120926 1071 119855 429685 284686 144999 72005 2898 69107 71254 62151 9103 883438 707015 176423 397570 252094 145476 2085 636 1449 2545 2545 91847 545 91302 384018 269882 114136 71096 53487 17609 MEDICAL & LAB EXPENSE 584727 575647 9080 EQUIPMENT 181533 122490 59043 DUES & SUBSCRIPTIONS 36860 7582 29278 STAFF DEVELOPMENT 35562 8615 26947 26050 24140 1910 10866321 9175670 1690651 0 600 600 538389 4755946 62009 69938 1027216 710847 155872 115765 10875007 6099764 5026212 4775243 1156597 0 7966895 10428339 1116640 1425889 17923 1540084 2203833 2097847 3338396 5063820 X 4628499 5364519 4628499 5364519 7966895 10428339 736020 0 X 0 1 X 1 1 1 X 2846771 3129166 2713480 3885806 6920754 19495977 2846771 3129166 2713480 3885806 6920754 19495977 19495977 154 119 339 423 77 1112 16690 46384 8457 71531 19568620 34161169 0.99630 0.99570 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2018 AMOUNT: $ 16,690. 2019 AMOUNT: $ 46,384. 2020 AMOUNT: $ 8,457. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 159200 159200 6086781 2671958 3414823 842220 98259 743961 3284768 2901775 382993 502038 427772 74266 4775243 X PART X, LINE 2: THE CENTER IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS OTHER THAN A PRIVATE FOUNDATION AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE LLC IS CONSIDERED A DISREGARDED ENTITY FOR INCOME TAX PURPOSES. X X X X 0 0 0 0 0 0 0 0 0 MARY OUIMET CHIEF EXECUTIVE OFFICER 196341 0 0 0 0 0 14615 0 315 0 211271 0 0 0 MIHAELA POPA CHIEF DENTAL OFFICER 158478 0 0 0 0 0 22800 0 13151 0 194429 0 0 0 JOSEPH BARTA DENTIST 168023 0 0 0 0 0 5525 0 15214 0 188762 0 0 0 DAVID CONNELL DENTIST 160866 0 0 0 0 0 18402 0 5263 0 184531 0 0 0 GARY MOSS CHIEF FINANCIAL OFFICER 159442 0 0 0 0 0 0 0 20136 0 179578 0 0 0 PATRYCJA WIERZBICKI DENTIST 144057 0 0 0 0 0 0 0 20136 0 164193 0 0 0 SHANNON BREHMER 35% CONTROLLED ENTITY OF BOARD MEMBER 211180 BILLING AND COLLECTION SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AND THE FINANCE COMMITTEE BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL NEW BOARD MEMBERS TO SIGN A CONFLICT OF INTEREST STATEMENT. BOARD MEMBERS ARE REQUIRED TO UPDATE THESE STATEMENTS ANNUALLY. SHOULD A CONFLICT ARISE, THE PERSON AFFECTED IS ASKED TO EXCUSE THEMSELVES FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES A VARIETY OF REGIONAL AND EXECUTIVE RECRUITING FIRMS FOR KEY EMPLOYEES WHO RECOMMEND COMPENSATION PACKAGES BASED ON MARKET DATA. THE ORGANIZATION ALSO PARTICIPATES IN A VARIETY OF COMPENSATION SURVEYS THROUGH NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS, WISCONSIN PRIMARY HEALTH CARE ASSOCIATION, AND GENERALIST HUMAN RESOURCES ORGANIZATIONS AND RECEIVE THOSE REPORTS. THERE ARE ALSO PERIODIC SPOT CHECKS LOCALLY FOR SPECIFIC POSITIONS. COMPENSATION FOR TOP MANAGEMENT IS APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. KCHC REAL ESTATE LLC 4536 22ND AVENUE KENOSHA WI 53140 391789874 REAL ESTATE HOLDINGS WI 232685 2793232 KENOSHA COMMUNITY HEALTH CENTER INC