2018-01-16T14:44:48-06:00 2017-02-28 390758449 Wipfli LLP 10000 Innovation Drive Suite 250 Milwaukee WI 532264837 990 2016-03-01 391789874 Kenosha Community Health Center Inc KENO 2627643608 625 57th Street No 700 Kenosha WI 53140 Brent Rafferty Chief Executive Officer 2627643608 2018-01-16 1 DAVE GLOBIG P01356041 4144319300 2018-01-16 207.250.78.130 2018-01-16 14:44:46 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 51EE487FFA723F16933CF5B8BD3577F2E9FFA893 2016 2021-01-29 14:40:06Z Brent Rafferty 625 57th Street No 700 Kenosha WI 53140 10920725 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 11 156 11 0 0 2376140 2846771 11135490 7902861 458 154 29248 170939 13541336 10920725 0 0 0 0 8829441 7128297 0 0 0 3847406 4582695 12676847 11710992 864489 -790267 10384641 9467156 3982270 3855052 6402371 5612104 To provide access to comprehensive health care services and to reduce health disparities for the underserved people of Kenosha County, Wisconsin, without regard to ability to pay and in a sustainable manner. 0 0 4691892 0 4519553 Increase access to comprehensive dental care for Medicaid enrollees and the uninsured. 3199182 0 2515626 Increase access to comprehensive medical and behavioral health care for Medicaid enrollees and the uninsured. 739826 0 871705 Increase access to comprehensive behavioral health care for Medicaid enrollees and the uninsured. 335602 148711 335602 148711 8966502 1 1 0 0 0 0 0 0 1 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 0 1 0 0 0 1 0 0 0 0 1 9 0 1 156 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 Nancy McCoy 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 Roxane Rohani Board Member/Quality Chair 1.00 X 0 0 0 Shebaniah Muhammad President 1.00 X X 0 0 0 Nicole Bardwell Vice President 1.00 X X 0 0 0 William Roberts Secretary 1.00 X X 0 0 0 Daniel Heyden Treasurer 1.00 X X 0 0 0 Mary Coffey Chief Executive Officer 40.00 X 159752 0 16261 Julia Harris Robinson CFO (Thru 5/27/16) 40.00 X 50502 0 8680 Arthur Jablonski Interim CFO (5/3/16 - 9/22/16) 40.00 X 80000 0 0 Sheila Moran Interim CFO (BEG 9/26/16) 40.00 X 60000 0 0 Alan Marshall Chief Operation Officer 40.00 X 58087 0 5724 Joseph Barta Dentist 40.00 X 149178 0 18241 David Connell Dentist 40.00 X 155702 0 0 Thomas Jazwiecki Dentist 40.00 X 143985 0 4080 Sapna Patel Physician 40.00 X 172738 0 1431 Phuoc Vuong Dentist 40.00 X 140559 0 0 1170503 0 54417 8 0 1 0 Office Team 12400 Collections Center Drive Chicago IL 60693 Staffing Agency 264481 Greenway Health PO Box 204485 Dallas TX 75320 Electronic Healthcare System 251610 Patterson Dental Supply N30 W22383 Green Road Waukesah WI 53186 Dental Supplies & Services 230909 Lifeline Mobile 2050 McGaw Road Columbus OH 43310 Mobile Unit 205893 McKesson Medical One Post Street San Francisco CA 94104 Medical Supplies 183938 10 2453297 393474 335602 2846771 Patient Service Fees 621110 7902861 7902861 7902861 154 154 170939 152734 18205 170939 10920725 8055595 0 18359 X 472606 472606 5168647 4715531 453116 180136 147735 32401 797868 676973 120895 509040 432610 76430 69970 69970 92211 27654 64557 1278169 431105 847064 14710 10082 4628 761156 490492 270664 122660 122660 596211 455565 140646 15728 6512 9216 43819 27475 16344 116989 116989 597101 577420 19681 26102 17427 8675 Medical & Lab Supplies 814237 814237 Dues & Subscriptions 20051 5064 14987 13581 7960 5621 11710992 8966502 2744490 0 1008519 715616 103 103 90340 395429 3480416 3260262 193341 194317 9633388 4731959 5470097 4901429 141825 0 10384641 9467156 1077680 1217781 160204 147998 30098 0 2714288 2489273 3982270 3855052 X 6393399 5612104 8972 0 6402371 5612104 10384641 9467156 -790267 0 X X 0 1 X 1 1 1 X 1670762 1455056 1770345 2367140 2846771 10110074 1670762 1455056 1770345 2367140 2846771 10110074 10110074 491 576 735 458 154 2414 10112488 49672106 0.99980 0.99970 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 181473 33475 147998 1 X 159200 159200 3690002 850483 2839519 2229483 887890 1341593 3528055 2993586 534469 26648 26648 4901429 X 10585123 0 10585123 335602 335602 10920725 11375390 0 11375390 335602 335602 11710992 Part IV, Line 2b: The Corporation had an agreement with an unrelated entity to establish and maintain an account that provided funds for breast cancer care through the Kenosha Community Health Center. During the tax year, the corporation returned the funds to the unrelated entity and no longer serves as trustee. 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 335,602. Part XII, Line 4b - Other Adjustments: Noncash contributions 335,602. X X X 0 0 0 0 0 0 0 0 0 Mary Coffey Chief Executive Officer 159152 0 0 0 600 0 0 0 16261 0 176013 0 0 0 Joseph Barta Dentist 147708 0 1470 0 0 0 0 0 18241 0 167419 0 0 0 David Connell Dentist 155702 0 0 0 0 0 0 0 0 0 155702 0 0 0 Sapna Patel Physician 166042 0 6696 0 0 0 0 0 1431 0 174169 0 0 0 X 24 335602 Actual cost 0 0 1 0 Form 990, Part VI, Section B, line 11b The form 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. Form 990, Part IX, line 11g Other Fees: Program service expenses 431,105. Management and general expenses 847,064. Fundraising expenses 0. Total expenses 1,278,169. Form 990, Part XII, Line 2C The process has not changed from the prior year. KCHC Real Estate LLC 4536 22nd Avenue Kenosha WI 53140 391789874 Real estate holding WI 232613 3062788 Kenosha Community Health Center Inc