2025-03-13T16:51:58-05:00 2024-05-31 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2023-06-01 815453995 LCHC QALICB INC LCHC 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 KRISTIN BLANCHARD STEARNS CEO 9207836633 2025-03-13 1 1 SOLOMON MARDAKHAEV P01806552 6105653930 2025-03-13 2023 2025-03-06 01:10:19Z KRISTIN BLANCHARD STEARNS 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 2458172 0 X WWW.LAKESHORECHC.ORG X 2017 WI TO SUPPORT THE MISSION OF LAKESHORE COMMUNITY HEALTH CARE, INC. X 4 3 0 3 0 0 0 0 112000 84000 358 2374172 0 0 112358 2458172 39000 50350 0 0 0 0 0 0 0 321499 205852 360499 256202 -248141 2201970 5191435 0 6952796 0 -1761361 0 X TO HELP CARRY OUT THE MISSION OF LAKESHORE COMMUNITY HEALTH CARE, INC. (LCHC), WHICH IS TO PROVIDE ACCESS TO COMPREHENSIVE, INTEGRATED HEALTH CARE, REGARDLESS OF ABILITY TO PAY, ELIMINATING HEALTH DISPARITIES AMONG THE UNDERSERVED. 0 1 191157 50350 84000 EXPENSES INCURRED TO OPERATE FOR THE BENEFIT OF AND TO CARRY OUT THE PURPOSES OF LAKESHORE COMMUNITY HEALTH CARE, INC. ACTIVITIES INCLUDE THE ACQUISITION AND DEVELOPMENT OF A HEALTHCARE FACILITY FOR LEASING TO LCHC, AND THE MAKING OF DONATIONS TO ORGANIZATIONS THAT QUALIFY AS EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3). 191157 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 3 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X CALEB JENSEMA CFO 9207836633 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 KRISTIN BLANCHARD STEARNS PRESIDENT 1.00 40.00 X X 0 184146 46555 LEIGHANNE MATTER-JENSEN SECRETARY/TREASURER 1.00 2.00 X X 0 0 0 MICHAEL BAUER BOARD MEMBER 1.00 X 0 0 0 CINDY DROSS BOARD MEMBER 1.00 X 0 0 0 0 184146 46555 0 0 1 0 0 RENTAL INCOME 531120 84000 84000 84000 400 400 2373772 0 2373772 2373772 2373772 2458172 84000 0 2374172 50350 50350 8975 8975 67795 48092 19703 123183 92715 30468 BANK FEES 5899 5899 256202 191157 65045 0 39377 0 0 0 5152058 0 5191435 0 6952796 0 6952796 0 X -1761361 0 -1761361 0 5191435 0 X 2201970 -440609 X 0 1 X 0 0 X X X 1 LAKESHORE COMMUNITY HEALTH CARE INC 264321839 3 1 50350 0 1 50350 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 X 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 ORGANIZATION RECORDED NO ASSETS OR LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS. 1 LAKESHORE COMMUNITY HEALTH CARE INC 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 264321839 501(C)(3) 50350 0 GENERAL SUPPORT 1 0 PART I, LINE 2: THE BALANCE OF QALICB SAVINGS AT THE FISCAL YEAR END IS GIVEN BACK TO LAKESHORE COMMUNITY HEALTH CARE, INC. AS A NON-RESTRICTED DONATION. 0 0 0 0 0 0 0 0 0 KRISTIN BLANCHARD STEARNS PRESIDENT 0 183696 0 0 0 450 0 7720 0 38835 0 230701 0 0 PART III - ADDITIONAL INFORMATION PART I, LINE 3: THE TOP MANAGEMENT OFFICIAL IS COMPENSATED BY LAKESHORE COMMUNITY HEALTH CARE, INC., A RELATED ORGANIZATION OF LCHC QALICB INC. LAKESHORE COMMUNITY HEALTH CARE, INC. ESTABLISHED THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL USING THE COMPENSATION SURVEY OR STUDY METHOD AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE METHOD. LAND - 1721 SAEMANN AVE, SHEBOYGAN 2024-03-12 85000 HISTORICAL COST 264321839 LAKESHORE COMMUNITY HEALTH CARE INC 1721 SAEMANN AVE SHEBOYGAN WI 53081 501C(3) LAND IMPROVEMENTS - 1721 SAEMANN AVE, SHEBOYGAN 2024-03-12 5773049 HISTORICAL COST 264321839 LAKESHORE COMMUNITY HEALTH CARE INC 1721 SAEMANN AVE SHEBOYGAN WI 53081 501C(3) LAND IMPROVEMENTS - 1721 SAEMANN AVE, SHEBOYGAN 2024-03-12 11415 HISTORICAL COST 264321839 LAKESHORE COMMUNITY HEALTH CARE INC 1721 SAEMANN AVE SHEBOYGAN WI 53081 501C(3) DENTAL EQUIPMENT (FIXED ASSETS) 2024-03-12 898458 HISTORICAL COST 264321839 LAKESHORE COMMUNITY HEALTH CARE INC 1721 SAEMANN AVE SHEBOYGAN WI 53081 501C(3) 0 0 0 0 FORM 990, PART III, LINE 3 THE NEW MARKET TAX CREDIT THAT WAS HELD BY LCHC QALICB WAS CLOSED OUT IN MARCH OF 2024. ALL ASSETS HELD BY LCHC QALICB WERE TRANSFERRED TO LAKESHORE COMMUNITY HEALTH CARE, INC. AT THAT TIME. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS ARE GIVEN COPIES OF THE FORM 990 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 C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS UPON MERGER WITH LAKESHORE CHC -440,609. LAKESHORE COMMUNITY HEALTH CARE INC 1721 SAEMANN AVENUE SHEBOYGAN WI 53081 264321839 HEALTH CENTER WI 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0