2019-01-15T13:09:01-06:00 2018-02-28 390758449 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2017-03-01 391789874 KENOSHA COMMUNITY HEALTH CENTER INC KENO 2627643608 625 57TH STREET NO 700 KENOSHA WI 53140 JEFFERY GRANT CHIEF FINANCIAL OFFICER 2627643608 2019-01-15 1 DAVE GLOBIG P01356041 4144319300 2019-01-15 207.250.78.130 2019-01-15 10:05:05 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CC322FB1B7FC8ED290785ACCB7D2994D8745AEAD 2017 2019-02-21 02:37:17Z ALAN MARSHALL 625 57TH STREET NO 700 KENOSHA WI 53140 11230546 0 X WWW.KENOSHACHC.ORG X 1994 WI TO ESTABLISH, MAINTAIN AND OPERATE A HEALTH CENTER IN ORDER TO PROVIDE PRIMARY CARE & REFERRAL HEALTH SERVICES TO DISADVANTAGED & UNDERSERVED POPULATIONS IN KENOSHA, WISCONSIN; AND TO PROMOTE, FOSTER AND ENSURE THAT BASIC PRIMARY HEALTH SERVICES ARE AVAILABLE & ACCESSIBLE TO UNINSURED AND/OR UNDERINSURED RESIDENTS OF KENOSHA, WISCONSIN IN COORDINATION WITH OTHER LEVELS OF HEALTH CARE AND SUPPORT SERVICES IN THE COMMUNITY. 11 11 143 11 0 0 2846771 3129166 7079574 8055578 154 119 170937 45683 10097436 11230546 335602 330070 0 0 7128297 7135622 0 0 0 4247093 3729917 11710992 11195609 -1613556 34937 8643868 8727598 3855053 3903846 4788815 4823752 X TO PROMOTE AND IMPROVE THE HEALTH OF THE MEDICALLY UNDERSERVED POPULATION IN AND AROUND THE CITY OF KENOSHA AND OTHER AREAS OF KENOSHA COUNTY BY PRIMARILY PROVIDING PREVENTIVE, PRIMARY AND SUPPLEMENTAL HEALTH CARE SERVICES (INCLUDING, BUT NOT LIMITED TO, DENTAL, PSYCHIATRIC, GYNECOLOGICAL, ADULT MEDICINE, AND RELATED SERVICES) AND HEALTH EDUCATION SERVICES TO SUCH POPULATION IN A MANNER WHICH WILL BEST MEET THEIR NEEDS AND REGARDLESS OF A PATIENT'S ABILITY TO PAY; TO ENGAGE IN ANY LAWFUL ACT IN WHICH A CORPORATION INCORPORATED UNDER THE WISCONSIN NONPROFIT CORPORATION ACT MAY ENGAGE; TO ESTABLISH AND MAINTAIN COLLABORATIVE RELATIONSHIPS WITH OTHER HEALTH CARE PROVIDERS IN THE SERVICE AREA. 0 0 5082499 0 4788872 INCREASE ACCESS TO COMPREHENSIVE DENTAL CARE FOR MEDICAID ENROLLEES AND THE UNINSURED. 4191604 330070 3065690 INCREASE ACCESS TO COMPREHENSIVE MEDICAL HEALTH CARE FOR MEDICAID ENROLLEES AND THE UNINSURED. 516386 0 201016 INCREASE ACCESS TO COMPREHENSIVE BEHAVIORAL HEALTH CARE FOR MEDICAID ENROLLEES AND THE UNINSURED. 9790489 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 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 13 0 143 1 0 0 0 0 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 JEFFERY GRANT 2627643608 625 57TH STREET SUITE 700 KENOSHA WI 53140 SUE GERBER BOARD MEMBER 1.00 X 0 0 0 JOSEPH MICHAELIS BOARD MEMBER 1.00 X 0 0 0 COVETRUS O'NEAL BOARD MEMBER 1.00 X 0 0 0 NANCY PHILLIPS BOARD MEMBER 1.00 X 0 0 0 WILLIAM ROBERTS PRESIDENT 1.00 X X 0 0 0 DOUG KOCH VICE PRESIDENT (THRU 03/17)/BOARD MEMBER 1.00 X X 0 0 0 LAVETTA ARRINGTON BOARD MEMBER/VICE PRESIDENT (BEG 4/17) 1.00 X X 0 0 0 MARILYN MASI SECRETARY (THRU 3/17)/BOARD MEMBER 1.00 X X 0 0 0 HEIDI GOTTFRIED-ARVOLD BOARD MEMBER/SECRETARY (BEG 4/17) 1.00 X X 0 0 0 DANIEL HEYDEN TREASURER (THRU 3/17)/BOARD MEMBER 1.00 X X 0 0 0 JOSEPH CLARK BOARD MEMBER/TREASURER (BEG 4/17) 1.00 X X 0 0 0 MARY COFFEY CHIEF EXECUTIVE OFFICER (THRU 7/17) 40.00 X 120441 0 0 BRENT RAFFERTY CHIEF EXECUTIVE OFFICER (THRU 4/18) 40.00 X 59108 0 0 SHEILA MORAN INTERIM CHIEF FINANCIAL OFFICER (THRU 6/17) 40.00 X 96250 0 0 JEFFERY GRANT CHIEF FINANCIAL OFFICER (BEG 3/17) 40.00 X 90926 0 0 JOSEPH BARTA DENTIST 40.00 X 147589 0 0 DAVID CONNELL DENTIST 40.00 X 156511 0 0 THOMAS JAZWIECKI DENTIST 40.00 X 169264 0 0 SAPNA PATEL PHYSICIAN 40.00 X 149549 0 0 MIHAELA POPA DENTAL DIRECTOR 40.00 X 170000 0 0 1159638 0 0 9 0 1 0 OFFICE TEAM 12400 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 STAFFING AGENCY 384854 GREENWAY HEALTH PO BOX 204485 DALLAS TX 75320 ELECTRONIC HEALTHCARE SYSTEM 334122 2 2618229 510937 330070 3129166 PATIENT SERVICE FEES 621110 8055578 8055578 8055578 119 119 45683 45683 45683 11230546 8055578 0 45802 330070 330070 481868 481868 5209958 4980511 229447 149587 149587 755081 747765 7316 539128 452872 86256 106083 38640 67443 77073 25559 51514 815317 520927 294390 33984 15294 18690 813224 481326 331898 137466 137466 628144 510646 117498 9762 5460 4302 64723 32258 32465 115064 115064 330084 311706 18378 25974 17262 8712 MEDICAL & LAB SUPPLIES 531999 528715 3284 DUES & SUBSCRIPTIONS 18585 2600 15985 22435 19957 2478 11195609 9790489 1405120 0 103 100 715617 860019 395429 203215 2436973 2896115 194317 169116 9661076 5062043 4901429 4599033 8643868 8727598 1197149 1425158 147998 68806 2489273 2398432 20633 11450 3855053 3903846 X 4788815 4823752 4788815 4823752 8643868 8727598 34937 0 X 0 1 X 1 1 1 X 1455056 1770345 2367140 2846771 3129166 11568478 1455056 1770345 2367140 2846771 3129166 11568478 11568478 576 735 458 154 119 2042 11570520 46619017 0.99980 0.99980 X 159200 159200 3690002 942733 2747269 2229483 1032641 1196842 3555742 3086669 469073 26649 26649 4599033 CAPITAL LEASE OBLIGATION 11450 11450 X 10900476 0 10900476 330070 330070 11230546 10865539 0 10865539 330070 330070 11195609 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 4B - OTHER ADJUSTMENTS: NONCASH CONTRIBUTIONS 330,070. PART XII, LINE 4B - OTHER ADJUSTMENTS: NONCASH CONTRIBUTIONS 330,070. 1 PRESCRIPTION DRUG ASSISTANCE 2442 0 330070 FMV PRESCRIPTIONS AND VACCINES PROVIDED TO CLINIC PATIENTS PART I, LINE 2: THE ORGANIZATION DOCUMENTS ALL RELEVANT INFORMATION PERTAINING TO THE MEDICAL ASSISTANCE GIVEN IN THE PATIENT'S CHART AS PART OF THEIR PERMANENT RECORD. X X X 0 0 0 0 0 0 0 0 0 DAVID CONNELL DENTIST 154442 0 2069 0 0 0 0 0 0 0 156511 0 0 0 THOMAS JAZWIECKI DENTIST 169264 0 0 0 0 0 0 0 0 0 169264 0 0 0 MIHAELA POPA DENTAL DIRECTOR 167589 0 2411 0 0 0 0 0 0 0 170000 0 0 0 X 24 330070 COST OF DONATED PROPERTY 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATION TRACKS AND REPORTS THE ACTUAL NUMBER OF CONTRIBUTIONS THAT IT RECEIVES. 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 APROVED 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 HOLDING WI 232727 3000555 KENOSHA COMMUNITY HEALTH CENTER INC THE ORGANIZATION RELIED UPON THE SYSTEMS ENLISTED FROM THEIR CERTIFIED PUBLIC ACCOUNTANT TO TRACK THE PREPARATION AND FILING OF THE EXTENSION TO FILE FOR THE FORM 990. DURING THE YEAR, THE ORGANIZATION WAS IN THE PROCESS OF AMENDING THE 2016 FORM 990 AND FILING OF THE 2017 EXTENSION TO FILE WAS INADVERTENTLY MISSED. THE ORGANIZATION WORKED WITH THEIR CERTIFIED PUBLIC ACCOUNTANT TO FILE THE 990 AS SOON AS POSSIBLE AND WOULD HAVE BEEN TIMELY FILED HAD AN EXTENSION BEEN FILED. THE ORGANIZATION HAS ALWAYS FILED THEIR FORM 990 TIMELY. THE ORGANIZATION RESPECTFULLY REQUESTS THAT THE INTERNAL REVENUE SERVICE ACCEPT THIS EXPLANATION AS REASONABLE CAUSE FOR LATE FILING.