KENOSHA COMMUNITY HEALTH CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: KENOSHA COMMUNITY HEALTH CENTER INC (EIN 39-1789874)
Tax period: 2012-03-01 to 2013-02-28
Filed: 2013-11-14
IRS object ID: 201303189349306205
Schema version: 2012v2.1
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-14T15:51:36-06:00	Timestamp
Tax Period End Date	2013-02-28	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	390758449	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WIPFLI LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	10000 INNOVATION DRIVE SUITE 250	AddressLine1
City	MILWAUKEE	City
State	WI	State
ZIP Code	532264837	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-03-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	391789874	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	KENOSHA COMMUNITY HEALTH CENTER INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	KENO	NameControl
Phone	2626560044	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	625 57TH STREET NO 700	AddressLine1
City	KENOSHA	City
State	WI	State
ZIP Code	53140	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	JULIA HARRIS ROBINSON	Name
Title	CHIEF FINANCIAL OFFICER	Title
Phone	2626560044	Phone
Date Signed	2013-11-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	DAVE GLOBIG	Name
PTIN	P01356041	PTIN
Phone	4144319300	Phone
Date Prepared	2013-11-14	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	JULIA HARRIS ROBINSON	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	625 57TH STREET NO 700	AddressLine1
City	KENOSHA	City
State	WI	State
ZIP Code	53140	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	12082263	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.KENOSHACHC.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1994	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE ACCESS TO COMPREHENSIVE HEALTH CARE SERVICES AND TO REDUCE HEALTH DISPARITIES FOR THE UNDERSERVED PEOPLE OF KENOSHA COUNTY, WI, WITHOUT REGARD TO ABILITY TO PAY AND IN A SUSTAINABLE MANNER.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	182	TotalNbrEmployees
Total Nbr Volunteers	31	TotalNbrVolunteers
Total Gross UBI	79949	TotalGrossUBI
Net Unrelated Business Txbl Income	-5998	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	4007947	ContributionsGrantsPriorYear
Contributions Grants Current Year	1670762	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	8533323	ProgramServiceRevenuePriorYear
Program Service Revenue CY	10171164	ProgramServiceRevenueCY
Investment Income Prior Year	1029	InvestmentIncomePriorYear
Investment Income Current Year	491	InvestmentIncomeCurrentYear
Other Revenue Prior Year	19271	OtherRevenuePriorYear
Other Revenue Current Year	239846	OtherRevenueCurrentYear
Total Revenue Prior Year	12561570	TotalRevenuePriorYear
Total Revenue Current Year	12082263	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	630	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	7053326	SalariesEtcPriorYear
Salaries Etc Current Year	8196343	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2878898	OtherExpensePriorYear
Other Expenses Current Year	3988905	OtherExpensesCurrentYear
Total Expenses Prior Year	9932854	TotalExpensesPriorYear
Total Expenses Current Year	12185248	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	2628716	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-102985	RevenuesLessExpensesCY
Total Assets BOY	10577632	TotalAssetsBOY
Total Assets EOY	10407749	TotalAssetsEOY
Total Liabilities BOY	4064627	TotalLiabilitiesBOY
Total Liabilities EOY	3997729	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	6513005	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	6410020	NetAssetsOrFundBalancesEOY
Mission Description	TO PROVIDE ACCESS TO COMPREHENSIVE HEALTH CARE SERVICES AND TO REDUCE HEALTH DISPARITIES FOR THE UNDERSERVED PEOPLE OF KENOSHA COUNTY, WI, WITHOUT REGARD TO ABILITY TO PAY AND IN A SUSTAINABLE MANNER.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	2992485	Expense
Revenue	3098258	Revenue
Description	INCREASE ACCESS TO COMPREHENSIVE MEDICAL AND BEHAVIORAL HEALTH CARE FOR MEDICAID ENROLLEES AND THE UNINSURED.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	6022777	Expense
Revenue	7232803	Revenue
Description	INCREASE ACCESS TO COMPREHENSIVE DENTAL CARE FOR MEDICAID ENROLLEES AND THE UNINSURED.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	9015262	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	1	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	11	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	182	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	11	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	0	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	WI	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RIA CROOK	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	2626560044	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	625 57TH STREET SUITE 700	AddressLine1
City	KENOSHA	City
State	WI	State
ZIP Code	53140	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
CYNTHIA H JOHNSON
MEMBER	1.00	X	0	0	0
JO A WYNN
MEMBER	1.00	X	0	0	0
JACKIE BUSH
MEMBER	1.00	X	0	0	0
DANIEL HEYDEN
MEMBER	1.00	X	0	0	0
LORETTE MITCHELL
MEMBER	1.00	X	0	0	0
SHEBANIAH MUHAMAD
MEMBER	1.00	X	0	0	0
ANGELA CUNNINGHAM
MEMBER	1.00	X	0	0	0
AHMAD LANDRUM
MEMBER	1.00	X	0	0	0
JAY A CASHMORE
PRESIDENT	1.00	X	0	0	0	X
LATASHA JONES
VICE PRESIDENT	1.00	X	0	0	0	X
PAMELA HALBACH
SECRETARY	1.00	X	0	0	0	X
FRANK LUDOWISE
TREASURER	1.00	X	0	0	0	X
JACK WATERS
CHIEF EXECUTIVE OFFICER	40.00		124491	0	6885	X
BETH RUHLAND
CHIEF OPERATING OFFICER	40.00		113058	0	14666	X
DAVID HUGHES
CHIEF FINANCIAL OFFICER	40.00		148495	0	13144	X
ALESSANDRO SAVAGLIO JR
DENTAL MANAGER	40.00		273725	0	12780		X
UMAIR SHARIH
PEDIATRICIAN	40.00		167313	0	18409		X
BRADLEY SMITH
DENTIST	40.00		171949	0	6247		X
PRZEMYSLAW KOLANKO
PHYSICIAN	40.00		162209	0	22527		X
CARLOS MIRO
DENTIST	40.00		148329	0	5321		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1309569	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	99979	TotalOtherCompensation
Number Individuals GT100 K	18	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
PLEXUS HEALTH SOLUTIONS
PO BOX 0655	KENOSHA	WI	53141	A/R BILLING	271822
IN-HOUSE INFORMATION SYSTEMS
423 MELVIN AVE	RACINE	WI	53402	COMPUTER SUPPORT	212771

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	2	NumberOfContractorsGT100K
Government Grants	1565644	GovernmentGrants
All Other Contributions	105118	AllOtherContributions
Total Contributions	1670762	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE FEES	621110	10083488	10083488
CONSULTING REVENUE	621110	79949		79949
MEDICAL RECORDS FEES	621110	7727	7727

Field	Value	IRS element (for citing)
Total Program Service Revenue	10171164	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	491	TotalRevenueColumn
Exclusion	$491	ExclusionAmount

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	MISCELLANEOUS REVENUE	Description
Business Code	900099	BusinessCode
Total Revenue Column	239846	TotalRevenueColumn
Related Or Exempt Function Income	239846	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	239846	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	12082263	TotalRevenueColumn
Related Or Exempt Function Income	10331061	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	79949	UnrelatedBusinessRevenue
Exclusion	$491	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	386044	Total
Management And General	386044	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	6307169	Total
Program Services	5016440	ProgramServices
Management And General	1290729	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	159518	Total
Program Services	123428	ProgramServices
Management And General	36090	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	773653	Total
Program Services	527339	ProgramServices
Management And General	246314	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	569959	Total
Program Services	416142	ProgramServices
Management And General	153817	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	116210	Total
Program Services	45921	ProgramServices
Management And General	70289	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	38835	Total
Program Services	3403	ProgramServices
Management And General	35432	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	633815	Total
Program Services	237742	ProgramServices
Management And General	396073	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	24808	Total
Program Services	22219	ProgramServices
Management And General	2589	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1149905	Total
Program Services	1101280	ProgramServices
Management And General	48625	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	45106	Total
Program Services	22786	ProgramServices
Management And General	22320	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	441760	Total
Program Services	322970	ProgramServices
Management And General	118790	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	28770	Total
Program Services	9419	ProgramServices
Management And General	19351	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	40595	Total
Program Services	18423	ProgramServices
Management And General	22172	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	143775	Total
Management And General	143775	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	774218	Total
Program Services	723981	ProgramServices
Management And General	50237	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	19856	Total
Program Services	13618	ProgramServices
Management And General	6238	ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
DUES & SUBSCRIPTIONS	17854	3333	14521
POSTAGE AND SHIPPING	6959	5852	1107
PATIENT EDUCATION	1446	1446

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	504993	Total
Program Services	399520	ProgramServices
Management And General	105473	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	12185248	Total
Program Services	9015262	ProgramServices
Management And General	3169986	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	704741	BOY
EOY	1183947	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	296000	BOY
EOY	100000	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2009635	BOY
EOY	2039168	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	233396	BOY
EOY	118729	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	8880790	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	2138880	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	7169601	BOY
EOY	6741910	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	164259	BOY
EOY	223995	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	10577632	BOY
EOY	10407749	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1055691	BOY
EOY	967804	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	8936	BOY
EOY	29925	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	3000000	BOY
EOY	3000000	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	4064627	BOY
EOY	3997729	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	6513005	BOY
EOY	6316951	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	93069	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6513005	BOY
EOY	6410020	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	10577632	BOY
EOY	10407749	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-102985	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Cash	X	MethodOfAccountingCash
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	1	FederalGrantAuditRequired
Federal Grant Audit Performed	1	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1117838	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1793227	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1397441	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4007947	CurrentTaxYearMinus1Year
Current Tax Year	1670762	CurrentTaxYear
Total	9987215	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1117838	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1793227	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1397441	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4007947	CurrentTaxYearMinus1Year
Current Tax Year	1670762	CurrentTaxYear
Total	9987215	Total

Field	Value	IRS element (for citing)
Public Support Total170	9987215	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4978	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3971	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1461	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1029	CurrentTaxYearMinus1Year
Current Tax Year	491	CurrentTaxYear
Total	11930	Total

Field	Value	IRS element (for citing)
Total Support	9999145	TotalSupport
Gross Receipts From Admissions Etc	32783053	GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage170	0.99880	PublicSupportPertcentage170
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	0	BeginningOfYearBalance
Contributions	93069	Contributions
End Of Year Balance	93069	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	1.00000	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.00000	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.00000	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	159200	OtherCostOrOtherBasis
Book Value	159200	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	5705785	OtherCostOrOtherBasis
Depreciation	1657397	Depreciation
Book Value	4048388	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2993613	OtherCostOrOtherBasis
Depreciation	481483	Depreciation
Book Value	2512130	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	22192	OtherCostOrOtherBasis
Book Value	22192	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	6741910	TotalOfBookValueLandBuildings
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	12082263	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	12082263	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	12082263	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	12185248	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	12185248	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	12185248	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	PART V, LINE 4:	THE INTENDED USE OF THE ENDOWMENT FUND IS TO SUPPORT THE HIRING OF TWO CASE MANAGERS TO PROVIDE MENTAL HEALTH SERVICES FOR THE MENTALLY ILL SO THAT THIS POPULATION CAN ACCESS PRIMARY MEDICAL AND DENTAL CARE SERVICES.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X, LINE 2:	IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS FASB ASC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS A FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THAT POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. TAX RETURNS FOR TAX YEARS 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITY.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	X	WrittenEmploymentContract
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	0	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID HUGHES
CHIEF FINANCIAL OFFICER	108000	0	39721	0	774	0	5949	0	7195	0	161639	0	0	0
ALESSANDRO SAVAGLIO JR
DENTAL MANAGER	175000	0	87282	0	11443	0	10932	0	1848	0	286505	0	0	0
UMAIR SHARIH
PEDIATRICIAN	155251	0	8262	0	3800	0	6780	0	11629	0	185722	0	0	0
BRADLEY SMITH
DENTIST	167530	0	4005	0	414	0	2934	0	3313	0	178196	0	0	0
PRZEMYSLAW KOLANKO
PHYSICIAN	162047	0	0	0	162	0	6642	0	15885	0	184736	0	0	0
CARLOS MIRO
DENTIST	135894	0	12435	0	0	0	5321	0	0	0	153650	0	0	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11	THE FORM IS REVIEWED BY THE BOARD FINANCE COMMITTEE BEFORE IT IS FILED.
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 NACHC, WPHCA, AND GENERALIST HR ORGANIZATIONS AND RECEIVE THOSE REPORTS. THERE ARE ALSO PERIODIC SPOT CHECKS LOCALLY FOR SPECIFIC POSITIONS.
FORM 990, PART VI, SECTION C, LINE 19	AVAILABLE UPON REQUEST

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	KCHC REAL ESTATE LLC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	4536 22ND AVENUE	AddressLine1
City	KENOSHA	City
State	WI	State
ZIP Code	53140	ZIPCode

Field	Value	IRS element (for citing)
EIN	391789874	EIN
Primary Activities	REAL ESTATE HOLDING	PrimaryActivities
Legal Domicile State	WI	LegalDomicileState
Total Income	232629	TotalIncome
EOY Assets	3396332	EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	KENOSHA COMMUNITY HEALTH CENTER INC	BusinessNameLine1