2023-11-10T10:17:09-06:00 2022-12-31 390747409 REILLY PENNER & BENTON LLP 1233 NORTH MAYFAIR RD SUITE 302 MILWAUKEE WI 532263255 990 2022-01-01 391839654 DR JAMES E ALBRECHT FREE CLINIC DRJA 2623348339 PO BOX 632 WEST BEND WI 53095 RUTH HENKLE EXECUTIVE DIRECTOR 2623348339 2023-10-31 1 RUTH HENKLE 999009999 1 JOSHUA BIERBACH P01449255 4142717800 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z RUTH HENKLE PO BOX 632 WEST BEND WI 53095 1030958 0 X WWWW.ALBRECHTFREECLINIC.ORG X 1995 WI TO SERVE INDIVIDUALS WHO LIVE OR WORK IN WASHINGTON COUNTY, WI WHO ARE UNDERINSURED, UNINSURED OR OTHERWISE UNABLE TO AFFORD MEDICAL, DENTAL, OR BEHAVIORAL HEALTH SERVICES. 15 15 22 89 0 0 633450 622674 0 0 24619 61803 197 45290 658266 729767 0 0 0 0 433407 437848 0 0 58711 175898 182375 609305 620223 48961 109544 1585313 1773827 15937 29889 1569376 1743938 TO SERVE INDIVIDUALS WHO LIVE OR WORK IN WASHINGTON COUNTY, WI WHO ARE UNDERINSURED, UNINSURED OR OTHERWISE UNABLE TO AFFORD MEDICAL, DENTAL, OR BEHAVIORAL HEALTH SERVICES. 0 0 422082 96969 SERVICES PROVIDED INCLUDE: MEDICAL, DENTAL, BEHAVIORAL HEALTH, COMMUNITY NAVIGATOR 422082 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 22 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 WI X RUTH HENKLE 2623348339 PO BOX 632 WEST BEND WI 53095 DALE THOMA PRESIDENT 1.00 X X 0 0 0 DOUG MCMANUS VICE PRESIDENT 1.00 X X 0 0 0 AMANDA SACKS SECRETARY 1.00 X X 0 0 0 GREG HEBERER TREASURER 1.00 X X 0 0 0 GARY HERDRICH DIRECTOR 1.00 X 0 0 0 TOM ALBIERO DIRECTOR 1.00 X 0 0 0 JAMES PAULY PAST PRESIDENT 1.00 X X 0 0 0 ALLEN ERICSON DIRECTOR 1.00 X 0 0 0 TOM HOPP DIRECTOR 1.00 X 0 0 0 TAMMY MUCKERHEIDE DIRECTOR 1.00 X 0 0 0 JOHN MUTSCHELKNAUS DIRECTOR 1.00 X 0 0 0 ERIC RANSOM DIRECTOR 1.00 X 0 0 0 CLAIRE ROLFS DIRECTOR 1.00 X 0 0 0 KELLY STUEBER DIRECTOR 1.00 X 0 0 0 KIMBERLY GRENSAVITCH DIRECTOR 1.00 X 0 0 0 RUTH HENKLE EXECUTIVE DIRECTOR 40.00 X 77510 0 984 77510 0 984 0 0 0 0 0 24923 597751 8404 622674 18488 18488 21612 0 21612 21612 21612 275481 69025 283929 17262 -8448 51763 43315 51763 -8448 MEDICAID REIMBURSEMENT 900099 23594 23594 MISCELLANEOUS INCOME 900099 84 84 23678 729767 96969 0 10124 78494 51022 27472 316172 238178 53550 24444 6705 1461 3228 2016 3868 2350 1011 507 32609 19811 8526 4272 11225 8980 2245 2811 2811 4805 3844 961 1885 1696 189 11216 10095 1121 29048 26143 2905 32146 28932 3214 57974 52177 5797 8706 6094 2612 DENTAL SUPPLIES AND SER 11103 11103 MEDICAL SUPPLIES AND SE 4962 4962 OTHER SUPPLIES AND SERV 3562 3562 DUES AND SUBSCRIPTIONS 2352 2117 235 580 577 3 620223 422082 139430 58711 193780 352397 464368 135509 119590 56975 21150 5017 4428 627844 266975 392336 360869 472837 779884 1585313 1773827 15937 24889 5000 15937 29889 X 1494376 1541074 75000 202864 1569376 1743938 1585313 1773827 109544 -75826 140844 0 X X 0 1 X 1 0 X 633012 535954 588594 633450 622674 3013684 633012 535954 588594 633450 622674 3013684 768592 2245092 12611 14253 17742 24619 31652 100877 130 21865 130 197 84 22406 3136967 75357 0.71570 0.74680 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 81700 81700 386544 164353 222191 159600 102622 56978 360869 X 777483 -75826 126353 50527 726956 2811 2811 729767 743765 126353 126353 617412 2811 2811 620223 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED EXEMPT-FUNCTION INCOME UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS BEEN CLASSIFIED AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION. THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS SUPPORT AND REVENUES TO BE UNRELATED BUSINESS INCOME AND, ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN MANAGEMENT'S OPINION, THE ORGANIZATION HAS NOT TAKEN ANY UNCERTAIN TAX POSITIONS. RUTH HENKEL EXECUTIVE DIRECTOR OF THE ORGANIZTION 21612 SHE IS ON THE BOARD OF DIRECTORS OF THE ORGANIZATION THAT THE FILING ORGANIZATION RENTS TO 0 FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO ALL MEMBERS OF GOVERNANCE PRIOR TO FILING. A FIRST REVIEW IS DONE BY ADMINISTRATION ALONG WITH A MEMBER OF THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS, AS AVAILABLE; THEN PRIOR TO FILING OR IN THE NEXT MEETING CYCLE, A FULL FINANCE COMMITTEE REVIEW TAKES PLACE AND SUMMARY REPORTING TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE FULL BOARD OF DIRECTORS, AT AN OFFICIALLY CALLED MEETING, WILL REVIEW THE CONFLICT OF INTEREST POLICY; EACH BOARD MEMBER WILL THEN SIGN A STATEMENT OF COMPLIANCE WITH THE POLICY WHICH IS HELD ON RECORD. FORM 990, PART VI, SECTION B, LINE 15A ANNUALLY THE EXECUITIVE COMMITTEE ASKS THE FULL BOARD FOR FEEDBACK ON THE EXECUTIVE DIRECTOR PERFORMANCE AND EQUITABLE COMPENSATION. THEN THE BOARD PRESIDENT WILL MEET WITH THE EXECUTIVE DIRECTOR AND SET SALARY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC AT ITS PRINCIPAL ADMINISTRATIVE OFFICES DURING NORMAL BUSINESS HOURS, AND IN RESPONSE TO WRITTEN REQUESTS RECEIVED AT ITS PRINCIPAL ADMINISTRATIVE OFFICES. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS. PART XI LINE 8 THE BEGINNING NET ASSETS WITH DONOR RESTRICTIONS HAVE BEEN ADJUSTED DUE TO PROMISES TO GIVE THAT WERE UNRECORDED IN THE PRIOR YEAR. THE TOTAL CHANGE IN BEGINNING NET ASSETS WITH DONOR RESTRICTIONS IS $140,844.