2016-02-29T13:34:20-06:00 2015-05-31 390758449 WIPFLI LLP 10000 INNOVATION DRIVE SUITE 250 MILWAUKEE WI 532264837 990 2014-06-01 264321839 LAKESHORE COMMUNITY HEALTH CARE LAKE 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 KRISTIN BLANCHARD CEO 9207836633 2016-02-29 1 DAVE GLOBIG P01356041 4144319300 2016-02-29 2014 2016-08-17 19:52:53Z X KRISTIN BLANCHARD 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 6594675 0 X WWW.LAKESHORECOMMUNITYHC.ORG X 2009 WI TO OFFER COMPREHENSIVE, PRIMARY HEALTH SERVICES TO MEDICALLY UNDERSERVED INDIVIDUALS THROUGH THE OPERATION OF A COMMUNITY-BASED CLINIC. 10 10 74 9 0 0 1441970 2319267 2136467 4267670 706 965 48249 6773 3627392 6594675 0 0 0 0 2203574 3891200 0 0 0 1005871 1752294 3209445 5643494 417947 951181 1250621 2357978 260698 416874 989923 1941104 TO IMPROVE THE HEALTH AND WELL-BEING OF SHEBOYGAN COUNTY AND SURROUNDING COMMUNITIES, BY PROVIDING QUALITY, PATIENT-CENTERED, FAMILY-BASED HEALTH CARE, HEALTH PROMOTION AND SUPPORT SERVICES FREE FROM LINGUISTIC, CULTURAL AND ECONOMIC BARRIERS. 0 0 4018548 4269687 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 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 PROVIDE UP TO 90% DISCOUNTS FOR ANYONE WHO CANNOT AFFORD TO PAY FOR THESE SERVICES. 4018548 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 0 0 1 8 0 74 1 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 1 1 1 1 1 0 WI X DAVID HUGHES 3604836223 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 BARBARA DODGE PRESIDENT 2.00 X X 0 0 0 TAMMY HARRIS VICE PRESIDENT 2.00 X X 0 0 0 MARTIN SCHALLER TREASURER 2.00 X X 0 0 0 BABARA BECK SECRETARY (THRU APR) 2.00 X X 0 0 0 DALE HIPPENSTEEL PAST PRESIDENT 2.00 X 0 0 0 LUCY ANGULO DE ARAUJO BOARD MEMBER 2.00 X 0 0 0 DYMTRO GLAZUNOV BOARD MEMBER 2.00 X 0 0 0 JULIE HED BOARD MEMBER 2.00 X 0 0 0 STEPHANIE HUEBSCHEN BOARD MEMBER 2.00 X 0 0 0 LORI JOCHIMSON BOARD MEMBER 2.00 X 0 0 0 JAMES PALLO BOARD MEMBER (THRU SEP) 2.00 X 0 0 0 URIAH WARNER BOARD MEMBER 2.00 X 0 0 0 KRISTIN BLANCHARD CEO 40.00 X 81516 0 11433 DAVID HUGHES CFO/COO 40.00 X 126173 0 16599 BRADLEY SMITH DENTAL DIRECTOR 40.00 X 176473 0 10383 384162 0 38415 2 0 1 0 PLEXUS HEALTH SOLUTIONS PO BOX 0655 KENOSHA WI 53141 CONTRACT BILLING 129108 GREENWAY PO BOX 203658 DALLAS TX 75320 ELECTRONIC HEALTH RECORD 123775 2 42752 1165046 1111469 2319267 PATIENT REVENUE 621400 4267670 4267670 4267670 965 965 ELECTRONIC HEALTH RECO 900099 2017 2017 4756 4756 6773 6594675 4269687 0 5721 X 213229 213229 2820176 2091513 728663 143976 92970 51006 453209 292653 160556 260610 168285 92325 1287 938 349 33200 24189 9011 603374 439600 163774 82654 73942 8712 47448 39168 8280 194581 149439 45142 38280 24997 13283 26321 17188 9133 109780 84311 25469 14900 5453 9447 MEDICAL SUPPLIES 326597 311367 15230 ELECTRONIC HEALTH RECOR 122502 101127 21375 EQUIPMENT 84333 64768 19565 OTHER STAFF SUPPORT 42175 27540 14635 24862 9100 15762 5643494 4018548 1624946 0 76695 184646 245891 266350 0 1000000 471493 294745 8966 13206 775563 180339 443545 595224 4031 3807 1250621 2357978 256667 352865 4031 64009 260698 416874 X 989923 941104 0 1000000 989923 1941104 1250621 2357978 951181 0 X 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 23621 5905 17716 555052 156208 398844 196890 18226 178664 595224 CAPITAL LEASE OBLIGATION 64009 64009 X 6594675 0 6594675 0 6594675 5643494 0 5643494 0 5643494 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 ORGNAIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. TAX RETURNS FOR TAX YEARS 2012 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITY. X X X 0 0 0 0 0 0 0 0 0 BRADLEY SMITH DENTAL DIRECTOR 175783 0 0 0 690 0 8649 0 1734 0 186856 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 BOARD MEMBERS ARE GIVEN COPIES 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 DETERMINED BASED ON QUALIFICATIONS. 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 IX, LINE 11G CONTRACTED CLINICAL SERVICES: PROGRAM SERVICE EXPENSES 158,361. MANAGEMENT AND GENERAL EXPENSES 58,998. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 217,359. CONTRACTED DENTAL LABROTORY FEES: PROGRAM SERVICE EXPENSES 167,760. MANAGEMENT AND GENERAL EXPENSES 62,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 230,258. CONTRACTED BILLING SERVICES: PROGRAM SERVICE EXPENSES 97,352. MANAGEMENT AND GENERAL EXPENSES 36,269. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,621. CONTRACTED ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 9,444. MANAGEMENT AND GENERAL EXPENSES 3,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,963. ANSWERING SERVICE: PROGRAM SERVICE EXPENSES 3,771. MANAGEMENT AND GENERAL EXPENSES 1,405. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,176. TRANSLATION SERVICES: PROGRAM SERVICE EXPENSES 2,912. MANAGEMENT AND GENERAL EXPENSES 1,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,997. FORM 990 PART XII, LINE 2C. DESCRIPTION OF FINANCIAL STATEMENT REVIEW: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.