2023-11-03T10:06:45-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2022-01-01 813724993 LAKELAND CARE INCORPORATED LAKE 9209065100 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 9209065100 2023-10-26 1 SARA MUHLBAUER 999009999 0 KRISTEN DONLEVY P01670215 4144761880 2023-10-26 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z SARA MUHLBAUER N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 377399342 0 X WWW.LAKELANDCAREINC.COM X 2000 WI ENRICHES LIVES OF ITS MEMBERS AND THEIR FAMILIES BY PROVIDING COORDINATED LONG-TERM HEALTH. 10 10 678 0 3186 0 307199654 343228508 51806892 33791623 8294 372186 9649 7025 359024489 377399342 0 0 0 0 41859998 42669510 0 0 0 307675746 320963979 349535744 363633489 9488745 13765853 68677020 89759641 31870938 39187706 36806082 50571935 X EMPOWERING INDIVIDUALS. STRENGTHENING COMMUNITIES. INSPIRING FUTURES. 0 0 347556529 33791623 LAKELAND CARE, INC. IS A LOCAL, MISSION DRIVEN NON-PROFIT ORGANIZATION THAT PROVIDES THE FAMILY CARE BENEFIT TO ELIGIBLE WISCONSINITES IN 22 COUNTIES ACROSS NORTHEAST AND NORTH CENTRAL WISCONSIN. THE FAMILY CARE PROGRAM SUPPORTS INDIVIDUALS WITH DIFFERENT ABILITIES AND ELDERLY INDIVIDUALS THAT REQUIRE A LEVEL OF SUPPORT TO REMAIN LIVING INDEPENDENTLY IN THEIR COMMUNITY. LAKELAND CARE SUPPORTS MORE THAN 7,323 MEMBERS, CONTRACTS WITH OVER 1,000 PROVIDERS AND EMPLOYS OVER 500 PEOPLE. THE FAMILY CARE PROGRAM IS NOW AN ENTITLEMENT PROGRAM OFFERED THROUGH THE WISCONSIN DEPARTMENT OF HEALTH SERVICES AND IS A 1915(C) WAIVER THAT ALLOWS STATES TO USE NURSING HOME FUNDING TO SUPPORT INDIVIDUALS IN THEIR COMMUNITY. LAKELAND CARE, INC. PROVIDES THE SERVICE OF CARE MANAGEMENT TO ENROLL MEMBERS OF THE PROGRAM. CARE MANAGEMENT INCLUDES COORDINATION OF CARE, FINDING SERVICES AND PROVIDERS TO ASSIST IN MEETING INDIVIDUAL NEEDS AS WELL AS COORDINATING NATURAL SUPPORTS FOR AN INDIVIDUAL. LAKELAND CARE, INC. USES APPROXIMATELY $0.93 OF EVERY $1.00 ON MEMBER SERVICES, $0.05 OF EVERY $1.00 ON ADMINISTRATIVE SERVICES AND THE REMAINING $0.02 OF EVERY DOLLAR IS REINVESTED BACK INTO THE PROGRAM. 347556529 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 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 1 1 0 0 0 1 54 0 678 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DAN BIZUB 2622272445 1530 PAMME COURT WEST BEND WI 53090 JIM BREY PAST PRESIDENT 1.00 X X 250 0 0 ALLEN BUECHEL SECRETARY/TREASURER THROUGH MAR 2022 1.00 X X 300 0 0 JUDY RIGGIRELIO DIRECTOR 1.00 X 400 0 0 JIM KOZICZKOWSKI PAST VICE-PRESIDENT 1.00 X X 0 0 0 LARRY LAUTENSCHLAGER DIRECTOR 1.00 X 450 0 0 TODD MOELY VICE PRESIDENT 1.00 X X 450 0 0 MIKE KONECHNY PRESIDENT 1.00 X X 400 0 0 BARB LARSON-HERBER DIRECTOR 1.00 X 400 0 0 JUDY GOLDSMITH DIRECTOR THROUGH JAN 2022 1.00 X 350 0 0 BOB ZIEGELBAUER SECRETARY/TREASURER 1.00 X X 0 0 0 SUSAN WAUKAU DIRECTOR THROUGH MAR 2022 1.00 X 0 0 0 STUART KUZIK DIRECTOR 1.00 X 0 0 0 JULIE SPANBAUER DIRECTOR 1.00 X 0 0 0 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 40.00 X 250672 0 37690 DANIEL BIZUB CHIEF FINANCIAL OFFICER 40.00 X 180746 0 34813 SUZANNE SINJAKOVIC CHIEF ADMINISTRATIVE OFFIC 40.00 X 179199 0 34806 JEN HARRISON CHIEF OPERATING OFFICER 40.00 X 181663 0 20050 LYNN ABRAHAM ORG EFF DIR/CM DIR 40.00 X 118545 0 27974 DEB KUREK PREV, WELL & BP DIR 40.00 X 119824 0 29034 CASEY PENROD IT DIRECTOR 40.00 X 116393 0 28924 1150042 0 213291 11 0 1 0 HOMES FOR INDEPENDENT LIVING PO BOX 278 DOUSMAN WI 53118 RESIDENTIAL SERVICES 19840954 CLARITY CARE INC 424 WASHINGTON AVENUE OSHKOSH WI 54901 COMMUNITY BASED RESIDENTIAL FACILITY 12587269 LKICHOICE 106 S BEAUMONT RD PRAIRIE DU CHIEN WI 53821 SELF DIRECTED SERVICES 10829892 REM WISCONSIN II INC 2005 W BELTLINE HWY MADISON WI 53713 RESIDENTIAL SERVICES 8648808 INNOVATIVE WISCONSIN LCC 2321 SAN LUIS PLACE GREEN BAY WI 54304 RESIDENTIAL SERVICES 8407082 382 343228508 343228508 ROOM AND BOARD 900099 26384630 26384630 COST SHARE 900099 9232113 9232113 CONTRACT REVENUE 900099 887557 887557 COST SETTLEMENT 900099 358862 358862 INSURANCE PAYMENTS 900099 34707 34707 -3106246 -3106246 33791623 372186 372186 MICE REVENUE 900099 4046 3186 860 MISCELLANEOUS REVENUE 900099 2964 2964 REFUNDS/REIMBURSEMENTS 900099 15 15 7025 377399342 33791623 3186 376025 506921 76038 430883 30645066 23577601 7067465 1094478 839449 255029 8188520 6337930 1850590 2234525 1713848 520677 162721 162721 166662 166662 17606 17606 2735331 2735331 122198 122198 110692 110692 953977 734486 219491 1272394 378456 893938 58428 58428 709443 553365 156078 19446 19446 927757 673854 253903 46099 46099 PROVIDER CARE FAMILY SE 282142859 282142859 IBNR CLAIMS EXPENSE 30528643 30528643 NONMEMBER SERVICE EXPEN 176212 176212 SUPPLIES EXPENSE 34396 34396 779115 779115 363633489 347556529 16076960 0 45684754 54516577 6042567 6298166 13589255 2979963 875150 1761190 7541189 5114164 2407431 2427025 20265553 77863 1511167 68677020 89759641 31870938 39187706 31870938 39187706 X 30763515 43674765 6042567 6897170 36806082 50571935 68677020 89759641 13765853 0 X X 0 1 X 1 0 X 205312044 248030279 308914796 307134663 343228508 1412620290 205312044 248030279 308914796 307134663 343228508 1412620290 1412620290 29094 44461 29256 8294 372186 483291 4746 4746 681677 903873 1574030 4202565 7025 7369170 1420477497 191289138 0.99450 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2018 AMOUNT: $ 681,677. 2019 AMOUNT: $ 903,873. 2020 AMOUNT: $ 1,574,030. 2021 AMOUNT: $ 4,202,565. 2022 AMOUNT: $ 7,025. 866261 782939 83322 6674928 4331225 2343703 2427025 377381736 0 377381736 17606 17606 377399342 363615883 0 363615883 17606 17606 363633489 1 X X X 0 0 0 0 0 0 0 0 0 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 250672 0 0 0 0 0 9994 0 27696 0 288362 0 0 0 DANIEL BIZUB CHIEF FINANCIAL OFFICER 180746 0 0 0 0 0 7134 0 27679 0 215559 0 0 0 SUZANNE SINJAKOVIC CHIEF ADMINISTRATIVE OFFIC 179199 0 0 0 0 0 7127 0 27679 0 214005 0 0 0 JEN HARRISON CHIEF OPERATING OFFICER 181663 0 0 0 0 0 7200 0 12850 0 201713 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND THE CHIEF EXECUTIVE OFFICER PRIOR TO SUBMITTING TO CLA. THE GOVERNING BODY, CHIEF OPERATIONS OFFICER AND CHIEF ADMINISTRATIVE OFFICER WILL REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THROUGH ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO STAFF AND BOARD MEMBERS. ALL NEW HIRES RECEIVE UPON HIRE. ADDITIONALLY, THROUGH LCI'S CONFLICT OF INTEREST POLICY, STAFF AND BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTS OF INTERESTS THAT ARISE DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 15 CHIEF EXECUTIVE OFFICER SALARY ADMINISTRATION PROCEDURE: GENERAL REQUIREMENTS 1. INCREASE GUIDELINES A. CEO SALARY INCREASES SHALL OCCUR ANNUALLY AND COINCIDE WITH THE CEO EVALUATION PROCESS. B. AN INDEPENDENT THIRD PARTY THAT IS RECOGNIZED TO HAVE THE REQUISITE BACKGROUND, EXPERIENCE, AND QUALIFICATIONS TO PROVIDE LAKELAND CARE, INC.'S BOARD OF DIRECTORS (THE "BOARD OF DIRECTORS") WITH THE NECESSARY INFORMATION TO APPROVE THE COMPENSATION OF LAKELAND CARE, INC.'S CHIEF EXECUTIVE OFFICER ("CEO") SHALL REVIEW, AT LEAST BIENNIALLY, THE COMPENSATION OF THE CEO AND REPORT ITS FINDINGS TO THE BOARD OF DIRECTORS. UPON COMPLETION OF SUCH REVIEW BY AN INDEPENDENT THIRD PARTY AND RECEIPT OF THE THIRD PARTY REPORT, IF ANY, THE BOARD OF DIRECTORS WILL APPROVE THE COMPENSATION OF THE CEO. 2. EFFECTIVE DATE OF CEO'S SALARY INCREASE A. THE EFFECTIVE DATE OF THE CEO'S SALARY INCREASE IS THE PAY PERIOD CORRESPONDING TO THE FIRST PAY DATE OF JULY. SPECIFIC REQUIREMENTS 1. APPROVAL BY PERSONS WITHOUT A CONFLICT OF INTEREST A. UPON COMPLETION OF THE INDEPENDENT THIRD PARTY'S REVIEW OF THE CEO'S COMPENSATION AND RECEIPT OF THE THIRD PARTY REPORT, THE CEO'S COMPENSATION SHALL BE APPROVED BY THE BOARD OF DIRECTORS, PROVIDED THAT PERSONS WITH A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED. MEMBERS OF THE BOARD OF DIRECTORS DO NOT HAVE A CONFLICT OF INTEREST IF THEY (A) ARE NOT BENEFITTING FROM OR PARTICIPATING IN THE COMPENSATION ARRANGEMENT; (B) ARE NOT IN AN EMPLOYMENT RELATIONSHIP SUBJECT TO THE DIRECTION OR CONTROL OF ANY PERSON BENEFITTING FROM OR PARTICIPATING IN THE COMPENSATION ARRANGEMENT; (C) DO NOT RECEIVE COMPENSATION OR OTHER PAYMENTS SUBJECT TO THE APPROVAL OF ANY PERSON BENEFITTING FROM OR PARTICIPATING IN THE COMPENSATION ARRANGEMENT; (D) HAVE NO MATERIAL FINANCIAL INTEREST AFFECTED BY THE COMPENSATION ARRANGEMENT; AND (E) DO NOT APPROVE A TRANSACTION PROVIDING ECONOMIC BENEFITS TO ANY PERSON PARTICIPATING IN THE COMPENSATION ARRANGEMENT, WHO IN TURN HAS OR WILL APPROVE A TRANSACTION PROVIDING ECONOMIC BENEFITS TO THE MEMBER. 2. USE OF COMPARABILITY DATA A. IN ITS REVIEW OF THE CEO'S COMPENSATION, THE INDEPENDENT THIRD PARTY SHALL REPORT AS TO ITS RECOMMENDATION ON COMPENSATION AND ITS REASONABLENESS TO LAKELAND CARE, INC. BASED UPON INFORMATION SUFFICIENT TO DETERMINE WHETHER THE COMPENSATION IS THE AMOUNT THAT WOULD ORDINARILY BE PAID FOR LIKE POSITIONS (CHIEF EXECUTIVE LEVEL) BY LIKE ENTERPRISES, WHETHER TAXABLE OR TAX EXEMPT, UNDER LIKE CIRCUMSTANCES. RELEVANT INFORMATION INCLUDES, BUT IS NOT LIMITED TO, COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX EXEMPT, FOR FUNCTIONALLY COMPARABLE POSITIONS; THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA OF LAKELAND CARE, INC.; CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS; AND ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS COMPETING FOR THE SERVICES OF THE COMPENSATED PERSON. 3. RECORDING COMPENSATION DELIBERATIONS A. THE BOARD OF DIRECTORS' APPROVAL OF THE CEO'S COMPENSATION SHALL BE PROMPTLY RECORDED IN THE MINUTES OF ITS MEETINGS AND CONTAIN: (A) THE TERMS OF THE COMPENSATION AND THE DATE APPROVED; (B) THE NAMES OF THE MEMBERS OF THE BOARD OF DIRECTORS WHO WERE PRESENT DURING THE DISCUSSION AND THOSE WHO VOTED ON THE APPROVED COMPENSATION; (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON, AND HOW IT WAS OBTAINED; (D) ANY ACTION TAKEN WITH RESPECT TO CONSIDERATION OF THE COMPENSATION BY A MEMBER OF THE BOARD OF DIRECTORS WHO HAD A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION; AND (E) IF THE REASONABLE COMPENSATION IS HIGHER OR LOWER THAN THE RANGE OF COMPARABILITY DATA OBTAINED, THE BASIS FOR THE DECISION. SUCH MINUTES SHALL BE REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS AS REASONABLE, ACCURATE AND COMPLETE WITHIN A REASONABLE TIME AFTER THE REVIEW AND APPROVAL OF THE COMPENSATION. THE BOARD OF DIRECTORS MAY TAKE ANY STEPS NECESSARY TO ENSURE THE CONFIDENTIALITY OF ANY PROPRIETARY OR SENSITIVE INFORMATION RELATING TO THE SALARIES, DATA, MINUTES OR REPORTS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS FOR SELECTING AN INDEPENDENT ACCOUNTING FIRM HAS NOT CHANGED FROM THE PREVIOUS YEAR. LAKELAND CARE PLUS INC N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 920244112 CONSULTING SERVICES WI LAKELAND CARE INCORPORATED C 3186 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0