2024-11-13T11:50:54-06:00 2023-12-31 391742997 O'CONNOR WELLS & VANDER WERFF LLC 111 E MAIN STREET WAUPUN WI 53963 990 2023-01-01 391759669 CHURCH HEALTH SERVICES INC CHUR 9208871766 115 N CENTER STREET BEAVER DAM WI 53916 THEA O'CONNOR EXECUTIVE DIRECTOR 9208871766 2024-11-12 1 0 DIANE BANCROFT-DEYOUNG P00195537 9203249711 2024-11-12 X 2023 2024-10-15 13:58:12Z STEVE VESSEY 115 N CENTER STREET BEAVER DAM WI 53916 1199043 0 X WWW.CHURCHCLINIC.ORG X 1993 WI CHURCH HEALTH SERVICES IS A FAITH BASED HEALTH CARE ORGANIZATION THAT CONDUCTS DENTAL AND MENTAL HEALTH CLINICS FOR THE POOR, UNINSURED OR UNDERINSURED. 13 13 37 30 0 0 943537 806006 352451 392117 8919 920 0 -36 1304907 1199007 0 0 0 0 924686 955689 0 0 117427 160656 208893 1085342 1164582 219565 34425 1680519 1675775 148671 48584 1531848 1627191 CHURCH HEALTH SERVICES IS A FAITH BASED HEALTH CARE ORGANIZATION THAT CONDUCTS DENTAL AND MENTAL HEALTH CLINICS FOR THE POOR, UNINSURED OR UNDERINSURED. 0 0 816489 393037 CHURCH HEALTH SERVICES IS A FAITH BASED HEALTH CARE ORGANIZATION THAT CONDUCTS PRIMARY, DENTAL AND MENTAL HEALTH CLINICS FOR THE POOR, UNINSURED OR UNDERINSURED. 816489 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 37 1 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 0 0 0 0 0 0 WI X THEA O'CONNOR 9208871766 115 N CENTER STREET BEAVER DAM WI 53916 THEA O'CONNOR EXECUTIVE DIRECTOR 35.00 X 87500 0 10656 STEVE VESSEY PRESIDENT/BOARD MEMBER 1.00 X X 0 0 0 MARY VOGL RAUSCHER VICE PRESIDENT/BOARD MEMBE 1.00 X X 0 0 0 RICH ZIEMAN TREASURER/BOARD MEMBER 1.00 X X 0 0 0 RICK VANT HOFF SECRETARY/BOARD MEMBER 1.00 X X 0 0 0 JENNIFER CAMPBELL BOARD MEMBER 1.00 X 0 0 0 KAREN COLEY BOARD MEMBER 1.00 X 0 0 0 JOHN PRYME BOARD MEMBER 1.00 X 0 0 0 TOM HEFFRON BOARD MEMBER 1.00 X 0 0 0 CATHY NELSON BOARD MEMBER 1.00 X 0 0 0 JIM HANKES BOARD MEMBER 1.00 X 0 0 0 EDWIN RODRIGUEZ GUZMAN BOARD MEMBER 1.00 X 0 0 0 CASSANDRA SCHMIDT BOARD MEMBER 1.00 X 0 0 0 HEIDI WEISS BOARD MEMBER 1.00 X 0 0 0 MIKE AUGUSTSON BOARD MEMBER 1.00 X 0 0 0 87500 0 10656 0 0 0 0 0 650 9750 795606 806006 PROGRAM REVENUES 624100 392117 392117 392117 920 920 0 650 36 -36 -36 1199007 393037 0 -36 87500 13125 43750 30625 755124 641857 49898 63369 33668 1616 18930 13122 79397 59291 9795 10311 75 75 12224 12224 3826 3826 18158 7197 10961 57311 28655 28656 37191 14593 22598 1198 1198 1223 1223 10245 5123 5122 20192 13052 7140 14613 14613 MEDICAL SUPPLIES/SERVIC 26541 26541 MISCELLANEOUS EXPENSE 3418 390 3028 PRINTING, PUBLICATIONS, 2678 2678 1164582 816489 230666 117427 566603 115321 516 13429 4000 7000 25166 40066 1506176 314615 488507 1191561 595727 308398 1680519 1675775 63671 48584 85000 0 148671 48584 X 993348 1542178 538500 85013 1531848 1627191 1680519 1675775 X 34425 725716 -664798 X 0 1 X 1 0 X 533038 610066 849155 1295988 1198123 4486370 533038 610066 849155 1295988 1198123 4486370 686292 3800078 447 273 215 165 920 2020 -17 -46 3 8754 8694 4497084 0.84500 0.86590 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: LOSS ON SALE OF SECURITIES - 2019 AMOUNT: $ -17. 2020 AMOUNT: $ -46. GAIN ON SALE OF SECURITIES - 2021 AMOUNT: $ 3. 2022 AMOUNT: $ 8,754. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 595727 66458 348246 5541 308398 764549 -125997 35000 7825 595727 36682 705000 -756 5704 764549 32500 4587 405 36682 1.00000 1 0 15000 15000 1351815 177379 1174436 139361 137236 2125 1191561 BENEFICIAL INTEREST IN FUNDS HELD BY COMMUNITY FOUNDATION 308398 308398 X 1985677 725716 60954 786670 1199007 0 1199007 1890334 725716 36 725752 1164582 0 1164582 PART V, LINE 4: THE FUNDS ARE ESTABLISHED FOR THE THE PURPOSE OF SUPPORTING THE ORGANIZATION AS DEEMED NECESSARY ACCORDING TO THE SPENDING POLICY. PART X, LINE 2: THE ORGANIZATION IS A NON-PROFIT CORPORATION THAT IS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS INCOME, IF ANY. THE ORGANIZATION HAD NO UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE ORGANIZATION'S TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY TAX POSITIONS IT HAS TAKEN THAT ARE SUBJECT TO A SIGNIFICANT DEGREE OF UNCERTAINTY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN FUNDS HELD BY COMMUNITY FOUNDATION 60,918. SPECIAL EVENTS EXPENSE (NETTED IN REVENUE ON 990) 36. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSE (NETTED IN REVENUE ON 990) 36. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED AND SIGNED BY AN OFFICER AND EXECUTIVE DIRECTOR PRIOR TO ELECTONIC FILING. THE FORM 990 IS AVAILABLE FOR REVIEW BY ALL BOARD MEMBERS AT THE NEXT MEETING. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL DATA AND GOVERNING DOCUMENTS OF THE ORGANIZATION ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: DONATED SERVICES EXPENSE -725,716. CHANGE IN VALUE - BENEFICIAL INTEREST IN FUNDS HELD BY COMMUNITY FOUNDATION 60,918.