2023-12-20T09:13:06-06:00 2023-03-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2022-04-01 391181480 LA CLINICA DE LOS CAMPESINOS INC LACL 9207875514 400 S TOWNLINE ROAD WAUTOMA WI 54982 LAURA WALDVOGEL PRESIDENT & CEO 9207875514 2023-12-19 1 LAURA WALDVOGEL 999009999 1 TERRI REXRODE CPA MST P00096513 9206620016 2023-12-19 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z FAMILY HEALTH LA CLINICA LAURA WALDVOGEL 400 S TOWNLINE ROAD WAUTOMA WI 54982 31289728 0 X WWW.FAMHEALTH.ORG X 1973 WI TO ENSURE ACCESS TO HIGH QUALITY INTEGRATED HEALTHCARE AND PROMOTE THE WELL-BEING OF OUR PATIENTS, STAFF, AND COMMUNITIES. 13 13 271 15 0 0 8186618 7019299 10795355 24176432 1207 93997 0 0 18983180 31289728 8000 10000 0 0 14074753 15542304 0 0 0 5221121 5984725 19303874 21537029 -320694 9752699 10404383 21538371 1947481 3353259 8456902 18185112 TO ENSURE ACCESS TO HIGH QUALITY INTEGRATED HEALTHCARE AND PROMOTE THE WELL-BEING OF OUR PATIENTS, STAFF, AND COMMUNITIES. 0 0 16305094 10000 24176432 COMMUNITY AND MIGRANT HEALTH CLINIC CENTER THAT PROVIDES PRIMARY MEDICAL, BEHAVIORAL HEALTH, AND DENTAL HEALTH SERVICES TO COMMUNITY RESIDENTS AND MIGRANT PATIENTS. THE WISCONSIN COMMUNITY HEALTH CENTER GRANT ENABLES LA CLINICA TO PROVIDE COMMUNITY AND MIGRANT PATIENTS ACCESS TO MEDICAL AND DENTAL SERVICES. IN ADDITION, BEHAVIORAL HEALTH SERVICES ARE PROVIDED WHICH INCLUDE MEDICATION ASSISTED TREATMENT FOR SUBSTANCE AND ALCOHOL ABUSE. 318116 0 0 THE WOMEN, INFANT, AND CHILDREN'S GRANT ALLOWS LA CLINICA TO PROVIDE SUPPLEMENTAL NUTRITION AND EDUCATION TO CLIENTS IN THE PROGRAM SERVICES AREA. 16623210 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 32 0 271 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X TOM KAMINSKI 9207875514 400 S TOWNLINE ROAD WAUTOMA WI 54982 PAUL THEYEL CHAIR 1.00 X X 0 0 0 ALMA DELIA TORRES VICE CHAIR 1.00 X X 0 0 0 AMANDA DEDERICH SECRETARY (THRU OCT) 1.00 X X 0 0 0 AARON WILLIAMS SECRETARY 1.00 X X 0 0 0 SHEILA SHAW TREASURER 1.00 X X 0 0 0 LORA BLASIUS DIRECTOR 1.00 X 0 0 0 HEIDI DELGADILLO DIRECTOR 1.00 X 0 0 0 PETER GIERACH DIRECTOR 1.00 X 0 0 0 BRENDA HENKE DIRECTOR 1.00 X 0 0 0 ROSEANNE HENNING DIRECTOR 1.00 X 0 0 0 FRED JOHANNES DIRECTOR 1.00 X 0 0 0 PATSY MBUGHUNI DIRECTOR (THRU MAY) 1.00 X 0 0 0 PAUL MOTT DIRECTOR 1.00 X 0 0 0 JUANITA 'TERRY' OLIVAS DIRECTOR 1.00 X 0 0 0 DAMARIS THOME DIRECTOR 1.00 X 0 0 0 LAURA WALDVOGEL PRESIDENT & CEO 40.00 X 233450 0 60415 THOMAS KAMINSKI CFO 40.00 X 193716 0 49932 KEVIN THAO PHYSICIAN 28.00 X 213374 0 44693 JAVIER RINCON PHYSICIAN 28.00 X 210176 0 24020 TRACY HOPKINS DENTIST 40.00 X 187091 0 33496 SAVITA BIMARTHI CDO/DENTIST 40.00 X 165700 0 45404 NATHAN DAILY DENTIST 32.00 X 166009 0 44161 1369516 0 302121 21 0 1 0 OCHIN INC 1881 SW NATIONAL PKWAY PORTLAND OR 97201 SOFTWARE AND CONSULTING 344387 UTSCHIG INC N1040 CRAFTSMEN DRIVE GREENSVILLE WI 54942 CONSTRUCTION SERVICES 298572 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 02241 PROVIDER RECRUITING 263933 APPLIED TECH SOLUTIONS PO BOX 650823 DALLAS TX 75265 IT NETWORK SUPPORT 122488 DURACLEAN SPECIALISTS 2801 POST ROAD PLOVER WI 54467 CLEANING 120782 6 7007528 11771 7019299 PATIENT SERVICE REVENUE 621110 23877186 23877186 340B PROGRAM REVENUE 900099 139356 139356 159890 159890 24176432 93997 93997 31289728 24176432 0 93997 10000 10000 537513 537513 11592412 9551785 2040627 397432 326170 71262 2152331 1740896 411435 862616 670305 192311 33280 33280 88463 88463 1340803 872051 468752 72717 21757 50960 813520 666202 147318 547854 425716 122138 520544 317441 203103 234707 156979 77728 41187 32005 9182 45500 18435 27065 626774 425318 201456 126453 20333 106120 MEDICAL SUPPLIES 812828 812828 BAD DEBT EXPENSE 250250 250250 REPAIRS & MAINTENANCE 204690 137923 66767 340B EXPENSES 113556 113556 111599 53260 58339 21537029 16623210 4913819 0 2621394 10984785 277483 277853 361950 237702 1316008 1120692 23069 169059 14325522 6069787 5506128 8255735 298351 492545 10404383 21538371 1185652 1513308 761829 1577961 0 261990 1947481 3353259 X 8024424 17813246 432478 371866 8456902 18185112 10404383 21538371 9752699 -24489 X X 0 1 X 1 1 1 X PART I, LINE 3 LA CLINICA DE LOS CAMPESINOS IS A NOT-FOR-PROFIT CORPORATION THAT PROVIDES HEALTHCARE SERVICES THROUGH MEDICAL, BEHAVIORAL AND DENTAL CLINICS. IT IS NOT REQUIRED TO BE LICENSED AS A HOSPITAL AND THEREFORE IS NOT REQUIRED TO COMPLETE SCHEDULE H. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 64059 64059 5532329 1987746 3544583 92571 8977 83594 3933156 3159982 773174 4703407 913082 3790325 8255735 RIGHT OF USE OBLIGATION - OPERATING LEASE 261990 261990 X 30901433 -363806 -363806 31265239 24489 24489 31289728 21173223 0 21173223 363806 363806 21537029 PART X, LINE 2: TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE CLINIC DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES BASED ON THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE CLINIC HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. PART XI, LINE 2D - OTHER ADJUSTMENTS: 340B EXPENSES -113,556. BAD DEBT EXPENSE -250,250. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN COMMUNITY FUND 24,489. PART XII, LINE 4B - OTHER ADJUSTMENTS: 340B EXPENSES 113,556. BAD DEBT EXPENSE 250,250. 1 SCHOLARSHIP 1 10000 CASH PART I, LINE 2: THE SCHOLARSHIPS AWARDED ARE MANAGED BY AN OUTSIDE FOUNDATION. THE FOUNDATION MAINTAINS THE RECORDS AND ENSURES THE RECIPIENTS MEET THE ELIGIBILITY REQUIREMENTS. X X 0 0 0 0 0 0 0 0 0 LAURA WALDVOGEL PRESIDENT & CEO 227658 0 5000 0 792 0 12250 0 48165 0 293865 0 0 0 KEVIN THAO PHYSICIAN 179646 0 3620 0 30108 0 7578 0 37115 0 258067 0 0 0 THOMAS KAMINSKI CFO 176625 0 5360 0 11731 0 10067 0 39865 0 243648 0 0 0 JAVIER RINCON PHYSICIAN 194724 0 15452 0 0 0 0 0 24020 0 234196 0 0 0 TRACY HOPKINS DENTIST 179775 0 5000 0 2316 0 9185 0 24311 0 220587 0 0 0 SAVITA BIMARTHI CDO/DENTIST 160484 0 5000 0 216 0 8289 0 37115 0 211104 0 0 0 NATHAN DAILY DENTIST 161541 0 4360 0 108 0 8518 0 35643 0 210170 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE PREPARED FORM 990 IS REVIEWED BY THE CFO AND CEO AND APPROVED BY THE BOARD OF DIRECTORS BEFORE THE RETURN IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL DIRECTORS AND OFFICERS DISCLOSE ALL INFORMATION REGARDING THEIR INTERESTS AND THOSE OF THEIR FAMILY MEMBERS THAT COULD GIVE RISE TO CONFLICTS THE MEMBERS OF GOVERNING BODY MAKE DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW ACTUAL CONFLICTS. ANY PERSON WITH A CONFLICT IS PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS ANNUALLY DETERMINE THE CEO'S COMPENSATION USING DATA ON COMPENSATION PAID BY COMPARABLE ORGANIZATIONS IN SIMILAR COMMUNITIES FOR SIMILAR SERVICES FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.