2024-05-08T07:34:16-05:00 2023-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-01-01 391319766 GOOD SHEPHERD SERVICES LTD GOOD 9208336856 607 E BRONSON RD SEYMOUR WI 54165 CAYLA PIEHL EXECUTIVE DIRECTOR 9208336856 2024-05-08 1 CAYLA PIEHL 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-07 3 AAL1 IAL1 2023 2023-04-26 12:10:37Z CAYLA PIEHL 607 E BRONSON RD SEYMOUR WI 54165 9965808 0 X GOODSHEPHERDSERVICES.ORG X 1982 WI TO PROVIDE CARE FOR THE ELDERLY, CHILDREN, AND DISABLED. 8 8 245 9 0 0 496112 324784 8219749 9476109 102875 69784 12701 17128 8831437 9887805 0 0 0 0 6667241 6651818 0 0 200 2680025 2776694 9347266 9428512 -515829 459293 7455978 7554060 2343352 1831858 5112626 5722202 X GOOD SHEPHERD SERVICES IS A FAITH-BASED CAMPUS THAT PROVIDES HEALTH AND SOCIAL SERVICES TO THOSE WE SERVE INCLUDING OUR COMMUNITY. WE ARE DEDICATED TO SERVING THOSE ENTRUSTED TO US WITH DIGNITY, RESPECT AND COMPASSION, IN A SAFE AND WELCOMING ENVIRONMENT. WE STRIVE TO PROVIDE EXTRAORDINARY CARE, WHILE CREATING MOMENTS OF JOY AND A SENSE OF BELONGING. 0 0 4157798 0 4379792 50 BED NURSING HOME PROVIDING SKILLED NURSING SERVICES TO THE ELDERLY, DISABLED, AMONG OTHER POPULATIONS. GOOD SHEPHERD SERVICES IS A FAITH-BASED CAMPUS THAT PROVIDES HEALTH AND SOCIAL SERVICES TO THOSE WE SERVE INCLUDING OUR COMMUNITY. WE ARE DEDICATED TO SERVING THOSE ENTRUSTED TO US WITH DIGNITY, RESPECT AND COMPASSION, IN A SAFE AND WELCOMING ENVIRONMENT. WE STRIVE TO PROVIDE EXTRAORDINARY CARE, WHILE CREATING MOMENTS OF JOY AND A SENSE OF BELONGING. TO ENSURE RESIDENT CHOICE IN THEIR DAILY LIVES WE HAVE ASSIMILATED THE FOLLOWING PROGRAMS, A "NO WAKE" PROGRAM, DAILY WELLNESS CLASSES, BUFFET DINING, EXTENDED DINING HOURS, 24 HOUR ALA CARTE DINING, A RESIDENT DIRECTED ACTIVITY PROGRAM CALLED "COME SEE" (LITERALLY, AS WHATEVER IS GOING ON CAN CHANGE ON RESIDENT DIRECTION AT ANY TIME). WE ENCOURAGE RESIDENTS TO MAINTAIN THEIR SOCIAL LIVES.OUR MEMORY CARE VILLAGE SUPPORTS THE CARE OF APPROXIMATELY 16 OLDER ADULTS WITH COGNITIVE IMPAIRMENTS. CEDAR LANE PROVIDES 11 PRIVATE ROOMS WITH PRIVATE BATHROOM AND SHOWER AREA FOR OUR RESIDENTS WHO COME TO STAY WITH US FOR A SHORT REHABILITATION STAY. OUR ENVIRONMENT ALSO HAS HAD MANY OTHER UPGRADES IN RECENT YEARS INCLUDING SPA BATHROOMS, LARGE ACTIVITY AREA CALLED THE FRIENDSHIP ROOM, UPGRADES TO SHARED SPACES INCLUDING FIREPLACES AND WARM, COMFORTABLE SEATING. WE CONTINUE TO PROVIDE EXCELLENT CARE AS NOTED BY OUR CONSISTENT EXCELLENT STATE NURSING HOME SURVEYS AND POSITIVE QUALITY INDICATOR TRENDS. WE HAVE CONSISTENTLY MAINTAINED A 5-STAR RATING AWARDED BY CMS. GOOD SHEPHERD HOME HAS BEEN AWARDED "BEST NURSING HOME" BY US NEWS AND WORLD REPORT MANY TIMES. 1586398 0 1975244 THE MEADOW WOOD APARTMENTS PROVIDE FOUR TWO-BEDROOM AND 32 ONE-BEDROOM APARTMENTS FOR COMMUNITY MEMBERS IN NEED OF ASSISTED LIVING SERVICES. THROUGHOUT 2023, MEADOW WOOD RENDERED SERVICES TO 54 TENANTS. DURING 2023, MEADOW WOOD HAD 18 ADMISSIONS AND 16 DISCHARGES, 11 OF WHICH WERE ADMITTED TO THE NURSING HOME OR CBRF, THUS SUPPORTING THE CONTINUITY OF SERVICE CONCEPT WITHIN THE ORGANIZATION. 809654 0 847091 GOOD SHEPHERD CHILDREN'S CENTER SERVES CHILDREN FROM 6 WEEKS TO 11 YEARS OLD. FAMILIES ARE ABLE TO ENROLL THEIR CHILDREN FULL TIME AND PART TIME IN THE CENTER AND IN A BEFORE AND/OR AFTER SCHOOL PROGRAM. IN 2023, 115 CHILDREN WERE ENROLLED IN OUR CENTER. GOOD SHEPHERD CHILDREN'S CENTER DOES PARTICIPATE IN THE WISCONSIN DEPARTMENT OF CHILDREN AND FAMILIES' YOUNG STAR PROGRAM. THE YOUNG STAR PROGRAM IS A 5 STAR QUALITY RATING AND IMPROVEMENT SYSTEM FOR CHILD CARE PROVIDERS. IT BASES A CHILD CARE CENTER'S RATING ON LEARNING ENVIRONMENT & CURRICULUM, EDUCATION, HEALTH AND WELLBEING OF THE CHILD AND BUSINESS & PROFESSIONAL PRACTICES. THE CHILDREN'S CENTER CONTINUES THE 3K PROGRAM THAT WAS ESTABLISHED IN 2017. THE PROGRAM TEACHES IMPORTANT SOCIAL SKILLS AND PROVIDES A VARIETY OF LEARNING AND PLAY EXPERIENCES. THE PROGRAM RUNS ON MORNINGS FOUR DAYS A WEEK AND HAD 20 CHILDREN ENROLLED IN 2023. 778720 0 929387 FOREST GLEN CBRF OFFERS 20 APARTMENTS TO THOSE OLDER ADULTS THAT REQUIRE SUPERVISION OR ASSISTANCE. FOREST GLEN HAS ONE AND TWO BEDROOM APARTMENTS AVAILABLE. FOREST GLEN PROVIDES MEDICAL MANAGEMENT, PERSONAL CARE, HOUSEKEEPING, LAUNDRY, ACTIVITIES, APARTMENT AND DINING SERVICES FOR A MONTHLY FLAT FEE. EACH APARTMENT PROVIDES A BEDROOM AREA, A LIVING AREA AND A PRIVATE BATH WITH SHOWER. IN 2023, FOREST GLEN RENDERED SERVICES TO 32 RESIDENTS. FOREST GLEN ENDED THE YEAR WITH AN AVERAGE CENSUS OF 18.35. 752871 0 851104 THE SHEPHERDS INN OFFERS 20 APARTMENTS TO THOSE OLDER ADULTS THAT REQUIRE SUPERVISION OR ASSISTANCE. THE INN HAS ONE AND TWO BEDROOM APARTMENTS AVAILABLE. THE SHEPHERDS INN PROVIDES MEDICAL MANAGEMENT, PERSONAL CARE, HOUSEKEEPING, LAUNDRY, ACTIVITIES, APARTMENT AND DINING SERVICES FOR A MONTHLY FLAT FEE. EACH APARTMENT PROVIDES A BEDROOM AREA, A LIVING AREA AND A PRIVATE BATH WITH SHOWER. IN 2023, THE SHEPHERDS INN RENDERED SERVICES TO 26 RESIDENTS. THE SHEPHERDS INN ENDED THE YEAR WITH AN AVERAGE CENSUS OF 18.04. 205934 0 284656 GOOD SHEPHERD SERVICES REHAB CLINIC OFFERS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES TO THOSE THAT LIVE IN OUR RESIDENTIAL PROGRAMS AND TO THE COMMUNITY ON AN OUTPATIENT BASIS. A TOTAL OF 130 PEOPLE WERE RENDERED SERVICES IN 2023. 75 WERE MEDICARE PART A AND INSURANCE INPATIENT RESIDENTS, 22 WERE MEDICARE PART B INPATIENT RESIDENTS AND 33 WERE OUTPATIENT CLIENTS. 1737525 0 2065147 8291375 1 1 0 1 0 0 0 0 1 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 0 0 0 0 0 0 1 45 0 245 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 WI X DAWN GILLIAM 9208336856 607 BRONSON ROAD SEYMOUR WI 54165 LISA RICKERT PRESIDENT 0.25 X X 0 0 0 PAT KLASS VICE PRESIDENT 0.25 X X 0 0 0 LORRIE JACOBETTI TREASURER 0.25 X X 0 0 0 LAURA BRILL BOARD MEMBER 0.25 X 0 0 0 ASHLEY LYMAN BOARD MEMBER 0.25 X 0 0 0 WANDA MARCEILLE BOARD MEMBER 0.25 X 0 0 0 PASTOR TY STONEBURNER BOARD MEMBER 0.25 X 0 0 0 JOEL WALTERS BOARD MEMBER 0.25 X 0 0 0 DEBORAH CAPTAIN EXECUTIVE DIRECTOR 40.00 X 185400 0 16854 DAWN GILLIAM FINANCE DIRECTOR 40.00 X 105066 0 16293 290466 0 33147 2 0 1 0 GEMINO HEALTHCARE FBO MJCARE PO BOX 6584 CAROL STREAM IL 601976584 CONTRACTED THERAPY SERVICES 190209 MAXIM HEALTHCARE STAFFING SERVICES 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACTED NURSING STAFF 101086 2 271219 53565 324784 NURSING HOME 623000 4379792 4379792 MEADOW WOOD 623000 1975244 1975244 FOREST GLEN 623000 929387 929387 SHEPHERD'S INN 623000 851104 851104 CHILD CARE CENTER 624410 847091 847091 493491 284656 208835 9476109 56501 56501 95131 78003 17128 17128 17128 13283 0 13283 13283 13283 9887805 9267274 0 295747 323613 16181 307432 5588943 5225571 363372 28803 28803 278502 278502 431957 405439 26518 4567 4567 30515 30515 725 725 14332 14332 387937 378361 9576 36056 2881 33175 45574 -6850 52424 118787 29278 89509 401002 401002 1204 1017 187 16529 16237 292 72751 61570 11181 598918 489395 109523 119543 57335 62208 DIETARY EXPENSE 768579 768579 ROOM TAX ASSESSMENT 102000 102000 DUES AND SUBSCRIPTIONS 22253 947 21306 BAD DEBTS 16254 16254 19168 18873 95 200 9428512 8291375 1136937 200 408972 751137 54008 109021 473526 664292 28566 29878 54101 39889 18286543 13956827 4703557 4329716 1728340 1625335 4908 4792 7455978 7554060 728007 786163 4907 4792 1610438 1040903 2343352 1831858 X 5092626 5702202 20000 20000 5112626 5722202 7455978 7554060 459293 150283 0 X 1 X 0 1 0 X 52678 1287723 1438471 496112 324784 3599768 8163317 7975515 7355891 7979758 9267274 40741755 332166 149430 202278 239991 208835 1132700 8548161 9412668 8996640 8715861 9800893 45474223 0 133781 268076 176590 151979 336160 1066586 133781 268076 176590 151979 336160 1066586 44407637 131774 122746 125975 135948 151632 668075 131774 122746 125975 135948 151632 668075 8679935 9535414 9122615 8851809 9952525 46142298 0.96240 0.96620 0.01450 0.01420 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 725 725 0 PART II-B, LINE 1: PART OF LEADING AGE (STATE AND NATIONAL ASSOCIATION DUES) GOES TOWARDS LOBBYING EFFORTS FOR LTC. LEADINGAGE MAINTAINS RELATIONSHIPS ACROSS WASHINGTON, DC AND THE STATE OF WISCONSIN, TO ENSURE THAT POLICYMAKERS UNDERSTAND HOW TO BEST CRAFT AND SUPPORT LEGISLATION AND REGULATION TO SUPPORT AGING SERVICES, OLDER ADULTS, AND FAMILIES ACROSS THE COUNTRY. 0 1 X 20000 2289 2289 20000 20000 299 299 20000 20000 199 199 20000 20000 111 111 20000 20000 1567 1567 20000 0.00000 1.00000 0.00000 0 0 162776 162776 13296363 10224250 3072113 4827404 3732577 1094827 4329716 10101759 150283 150283 9951476 14332 -78003 -63671 9887805 9492183 78003 78003 9414180 14332 14332 9428512 PART IV, LINE 2B: THE ORGANIZATION HAS RESIDENT FUNDS HELD IN TRUST. RESIDENTS' FUNDS HELD IN TRUST CONSIST OF AMOUNTS ON DEPOSIT WITH THE FACILITY BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY THE RESIDENTS. PART V, LINE 4: DURING 1993, A PERMANENTLY RESTRICTED ENDOWMENT WAS CREATED FROM A SINGLE DONATION OF $20,000. THE EARNINGS FROM THIS ENDOWMENT ARE RESTRICTED FOR THE USE OF THE BENEFIT OF THE RESIDENTS OF GOOD SHEPHERD. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSE ALLOCATED TO RENTAL INCOME -78,003. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSE ALLOCATED TO RENTAL INCOME 78,003. X X 0 0 0 0 0 0 0 0 0 DEBORAH CAPTAIN EXECUTIVE DIRECTOR 182221 0 0 0 3179 0 1873 0 14981 0 202254 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S MEMBERSHIP CONSISTS OF CHURCH CONGREGATIONS IN THE GENERAL GEOGRAPHIC AREA OF THE CITY OF SEYMOUR, OUTAGAMIE COUNTY, WISCONSIN, HAVING VOTED TO PARTICIPATE OR WHO MAY IN THE FUTURE, ON INVITATION, VOTE TO PARTICIPATE. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS SHALL ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS SHALL ELECT THE BOARD OF DIRECTORS, APPROVE THE ARTICLES OF INCORPORATION OR RESTATEMENTS THEREOF, APPROVE ANY SALE OF MORE THAN ONE-HALF (1/2) OF THE CORPORATE ASSETS OR ANY OTHER CORPORATE ACTION CONSTITUTING A CORPORATE REORGANIZATION, INCLUDING A MERGER OR DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE EXECUTIVE DIRECTOR SHALL SIGN AND CERTIFY THAT THE IRS FORM 990 IS ACCURATE AND COMPLETE. THE FINANCE COMMITTEE SHALL DELEGATE THE REVIEW AND APPROVAL OF THE IRS FORM 990 ANNUAL TAX FILING PRIOR TO SUBMISSION TO THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD. ALSO, DIRECTORS, OFFICERS, COMMITTEE MEMBERS AND MANAGEMENT EMPLOYEES MUST COMPLETE ANNUALLY A CONFIDENTIALITY POLICY AGREEMENT & CORPORATE INTEGRITY POLICIES STATEMENT. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL INVOLVED WITH THE CONFLICT WILL RECUSE HIM/HERSELF FROM THE BOARD VOTE AND RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR IS HIRED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS HIRES AN INDEPENDENT AGENCY TO HELP WITH THE RECRUITING, INTERVIEWING AND COMPILING THE BENEFIT PACKAGE FOR THIS POSITION. ONCE HIRED, AN ANNUAL REVIEW/EVALUATION IS DONE BY THE BOARD OF DIRECTORS AND AN ANNUAL INCREASE IS AGREED UPON BY USING THE MOST CURRENT LEADING AGE NURSING HOME SALARY & BENEFITS REPORT. ANNUALLY, THE BOARD MAY ASK AN INDEPENDENT AGENCY TO EVALUATE THE COMPENSATION PACKAGE FOR THIS POSITION. THE BOARD (ONLY THOSE WITHOUT CONFLICT) VOTE ON THE ABOVE COMPENSATION AND THE DECISION IS DOCUMENTED. OTHER KEY EMPLOYEES' SALARIES ARE REVIEWED ON AN ANNUAL BASIS (INDIVIDUALLY THROUGHOUT THE YEAR) BY THE EXECUTIVE DIRECTOR. INCREASES ARE DETERMINED BY USING THE MOST CURRENT WAHSA/AAHSA NURSING HOME SALARY & BENEFITS REPORT. SALARY CHANGES ARE APPROVED BY THE BOARD OF DIRECTORS DURING THE BUDGET PROCESS, AND THE DECISION IS DOCUMENTED. SALARIES FOR KEY EMPLOYEES ARE ONLY CHANGED DURING THE BUDGET PROCESS, WHICH THE BOARD OF DIRECTORS MUST APPROVE (THOSE WITHOUT CONFLICT) AND THE DECISION IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 GOOD SHEPHERD SERVICES, LTD WILL ALLOW PUBLIC ACCESS TO IRS FORM 990. THIS ACCESS WILL BE PROVIDED IN A MANNER CONSISTENT WITH THE CURRENT IRS REGULATIONS SECTION 301.6104 (D). THE ORGANIZATION BELIEVES CERTAIN GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND THE FINANCIAL STATEMENTS ARE A PART OF THE ORGANIZATION THAT IS NOT AVAILABLE FOR PUBLIC VIEWING.