2022-04-27T10:31:14-05:00 2021-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-07-01 391034534 BAY AREA LUTHERAN HOMES INC BAYA 9204991481 1040 PILGRIM WAY GREEN BAY WI 54304 NICOLE BOLDT DIRECTOR OF FINANCE 9204991481 2022-04-25 1 NICOLE BOLDT 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2022-04-25 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z WOODSIDE SENIOR COMMUNITIES NICOLE BOLDT 1040 PILGRIM WAY GREEN BAY WI 54304 28024249 0 9386 X WWW.WOODSIDESENIORCOMMUNITIES.ORG X 1968 WI PROVIDING SUPERVISED CARE FOR ELDERLY RESIDENTS THROUGH A REHABILITATION/SKILLED NURSING FACILITY AND AN ASSISTED LIVING FACILITY. 13 13 544 75 0 0 24721 3569965 21389329 19488623 550364 672602 -190 0 21964224 23731190 0 0 0 0 12484249 12832431 0 0 0 8669637 8812619 21153886 21645050 810338 2086140 44962302 44925361 16296710 13043018 28665592 31882343 X TO BE THE LEADER IN DELIVERING AND ADVANCING SENIOR CARE AND/OR REHABILITATION FOR GREEN BAY AND THE SURROUNDING COMMUNITIES BY MEETING THE NEEDS OF THE WHOLE SENIOR PERSON; SOCIAL, MEDICAL, PSYCHOLOGICAL, COGNITIVE, AND SPIRITUAL, MAXIMIZING EACH INDIVIDUAL'S HIGHEST LEVEL OF INDEPENDENCE. 0 0 13332128 0 13163386 WOODSIDE LUTHERAN HOME IS A 130-BED FACILITY THAT OFFERS LONG-TERM SKILLED NURSING CARE AND SHORT-TERM REHABILITATION CARE. IN FISCAL YEAR 2021, WOODSIDE LUTHERAN HOME PROVIDED APPROXIMATELY 36,500 TOTAL DAYS OF CARE. OF THAT, OVER 38% OF THOSE RESIDENTS SERVED WERE THROUGH THE WISCONSIN MEDICAID PROGRAM, WHICH REIMBURSES THE HOME AT DEEPLY DISCOUNTED RATES. WOODSIDE IS UNIQUE IN THAT IT IS THE ONLY FAITH-BASED NONPROFIT SENIOR LIVING CAMPUS IN THE GREATER GREEN BAY AREA. AS SUCH, WOODSIDE EMPLOYS A FULL-TIME CHAPLAIN TO SERVE THE SPIRITUAL NEEDS OF THE WOODSIDE COMMUNITY. 6104750 0 6006832 WOODSIDE MANOR IS A 80-UNIT APARTMENT FACILITY THAT OFFERS CLASS C CBRF SERVICES, INCLUDING SUPERVISION AND DISPENSING OF MEDICATIONS AND ASSISTANCE WITH DAILY LIVING ACTIVITIES. WOODSIDE VILLA IS A 37-UNIT APARTMENT FACILITY THAT OFFERS CLASS C CBRF SERVICES, INCLUDING SUPERVISION AND DISPENSING OF MEDICATIONS AND ASSISTANCE WITH DAILY LIVING ACTIVITIES. THE POPULATION SERVED IN THIS SETTING ARE LARGELY THOSE WITH MEMORY ISSUES.IN FISCAL YEAR 2021, WOODSIDE MANOR & VILLA PROVIDED APPROXIMATELY 35,500 DAYS OF CARE. 19436878 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 22 0 544 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X NICOLE BOLDT 9204991481 1040 PILGRIM WAY GREEN BAY WI 54304 SUE MAY PRESIDENT 0.50 X X 0 0 0 LARRY FRAZIER VICE PRESIDENT 0.50 0.50 X X 0 0 0 AMY HARDTKE SECRETARY/TREASURER 0.50 0.50 X X 0 0 0 BARB BRAUN SECRETARY (TERMED 12/20) 0.50 0.50 X X 0 0 0 JEFFREY MARTINSON TREASURER (TERMED 12/20) 0.50 0.50 X X 0 0 0 PAM ANDERSON BOARD MEMBER 0.50 0.50 X 0 0 0 HELENE BURMEISTER BOARD MEMBER 0.50 0.50 X 0 0 0 JOHN FILCHER BOARD MEMBER 0.50 X 0 0 0 PHYLLIS HOPPE BOARD MEMBER 0.50 0.50 X 0 0 0 JUDY KNEIZEL BOARD MEMBER 0.50 1.00 X 0 0 0 JUDY KNUDSEN BOARD MEMBER 0.50 0.50 X 0 0 0 PASTOR RUFUS KUDEE BOARD MEMBER 0.50 X 0 0 0 JOYCE MCCOLLUM BOARD MEMBER 0.50 0.50 X 0 0 0 KATHY PLETCHER BOARD MEMBER 0.50 X 0 0 0 MAX ROTH BOARD MEMBER 0.50 1.00 X 0 0 0 MEGHAN MEHBERG FUSS HOME ADMINISTRATOR 40.00 X 137008 0 3321 NICOLE BOLDT DIRECTOR OF FINANCE 36.00 4.00 X 120094 0 19442 POLLY GRETZINGER DIRECTOR OF HUMAN RESOURCES 40.00 X 120681 0 7724 JESSICA ATKINSON MANOR/VILLA ADMINISTRATOR 38.00 2.00 X 113451 0 39768 SCOTT ROSS FORMER EXECUTIVE DIRECTOR 40.00 X 139939 0 862 631173 0 71117 5 1 1 0 OUT OF THE WOODWORK CUSTOM CARPENTRY & R 1223 GERHARDT LANE GREEN BAY WI 54313 CONSTRUCTION 1414882 GREENFIELD REHABILITATION AGENCY INC 19395 W CAPITAL DRIVE SUITE 200 BROOKFIELD WI 53045 THERAPY SERVICES 1284869 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM WI 19020 HOUSEKEEPING SERVICES 840115 HOFFMAN PD & C INC PO BOX 8034 APPLETON WI 54912 CONSTRUCTION 550710 METZLER ELECTRIC 1658 CASS STREET GREEN BAY WI 54302 ELECTRICAL SERVICES 196915 5 3543126 26839 3569965 NURSING HOME REVENUE 623000 13118286 13118286 WOODSIDE MANOR 623000 6006832 6006832 OTHER OPERATING INCOME 623000 318405 318405 AFFILIATE ADMIN FEES 623000 45100 45100 19488623 270666 270666 4694995 4291872 1187 403123 -1187 401936 401936 23731190 19170218 0 991007 X 702290 702290 10356670 9783963 572707 80476 80476 881371 839312 42059 811624 722699 88925 17710 2177 15533 32109 32109 52680 52680 2884287 2809628 74659 65804 65804 1945166 1840866 104300 372682 372682 411335 344530 66805 26901 25729 1172 27259 24368 2891 400733 335650 65083 1944506 1628700 315806 335149 261791 73358 PROVIDER TAX 214770 214770 BAD DEBT EXPENSE 30669 30669 DUES & SUBSCRIPTIONS 27378 384 26994 RECRUITMENT 22436 22436 1045 1045 21645050 19436878 2208172 0 44730 45320 8268267 5778705 1594208 1585772 31281 39541 85422 75185 43627279 20006092 22897022 23621187 11999167 13742791 42205 36860 44962302 44925361 1960842 1308175 12627544 11396028 1183324 0 525000 338815 16296710 13043018 X 28665592 31882343 28665592 31882343 44962302 44925361 2086140 1130611 0 X 0 1 X 1 0 X 6946 57555 18962 24721 3569965 3678149 19429765 20032334 20289596 21135004 19170218 100056917 265628 252003 314563 265455 318405 1416054 19702339 20341892 20623121 21425180 23058588 105151120 0 670783 344704 690523 637357 2343367 670783 344704 690523 637357 2343367 102807753 210869 227234 278952 330029 270666 1317750 210869 227234 278952 330029 270666 1317750 19913208 20569126 20902073 21755209 23329254 106468870 0.96560 0.97060 0.01240 0.01240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3197 3197 0 PART II-B, LINE 1: LEADING AGE MEMBERSHIP FEES OF $3,197 USED FOR LOBBYING ACTIVITIES. LEADING AGE IS AN ORGANIZATION THAT EDUCATES LONG-TERM CARE ORGANIZATIONS ON VARIOUS TOPICS INCLUDING TRENDS IN THE INDUSTRY AND REGULATORY MATTERS. AS LEGISLATION IS BEING DEBATED/INTRODUCED, LEADINGAGE REVIEWS LEGISLATION AND ADVOCATES FOR THE LONG-TERM CARE INDUSTRY. BOTH STATE AND FEDERAL MATTERS ARE MONITORED. 0 0 63218 63218 38445589 16912699 21532890 1064067 775262 288805 3720121 2128483 1591638 334284 189648 144636 23621187 MEDICARE ADVANCE LOAN 338815 338815 24764021 1130611 1130611 23633410 52680 45100 97780 23731190 21547270 0 21547270 52680 45100 97780 21645050 PART XI, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE ADMIN FEES 45,100. PART XII, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE ADMIN FEES 45,100. X X X X 1 0 0 0 0 0 0 0 0 JESSICA ATKINSON MANOR/VILLA ADMINISTRATOR 94951 0 18500 0 0 0 2358 0 37410 0 153219 0 0 0 SCOTT ROSS FORMER EXECUTIVE DIRECTOR 42441 0 5000 0 92498 0 707 0 155 0 140801 0 0 0 PART I, LINE 3 THE ORGANIZATION UTILIZES LEADING AGE DATA FOR ALL EMPLOYEE COMPENSATION (COMPARABLE DATA). THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE DIRECTOR COMPENSATION. THE FULL BOARD OF DIRECTORS APPROVES THE WAGE RANGE FOR EMPLOYEES. THE EXECUTIVE DIRECTOR HAS DISCRETION TO DETERMINE AND APPROVE OTHER OFFICERS AND KEY EMPLOYEE COMPENSATION THROUGH THE BOARD-APPROVED WAGE RANGE. THESE DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT OF INTEREST AND DOCUMENTATION IS KEPT FOR ALL DECISIONS MADE. PART I, LINE 4A DURING FISCAL 2021, SCOTT ROSS RECEIVED SEVERANCE PAYMENTS TOTALING $42,691. PART II: SCOTT ROSS RESIGNED FROM BAY AREA LUTHERAN HOMES, INC. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-07-11 13000000 FINANCE RENOVATIONS TO HEALTH CARE FACILITY 0 0 0 A 1519717 13000000 20000 1300000 2016 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF CONGREGATIONS OF THE GREEN BAY CONFERENCE OF THE EAST CENTRAL SYNOD OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. THE MEMBERSHIP OF THE ORGANIZATION MAY INCLUDE OTHER ORGANIZATIONS; HOWEVER, A MAJORITY OF THE CORPORATE MEMBERS SHALL CONSIST OF LUTHERAN CONGREGATIONS OF THE EVANGELICAL LUTHERAN CHURCH OF AMERICA, OR ITS SUCCESSOR. FORM 990, PART VI, SECTION A, LINE 7A EACH OF THE MEMBERS HAS THE ABILITY TO NOMINATE ONE OR MORE DELEGATES BASED ON THE CONGREGATION LEVELS OF EACH RESPECTIVE CHURCH. EACH DELEGATE NOMINATED HAS THE AUTHORITY TO NOMINATE ONE BOARD MEMBER. NO ONE CHURCH HAS THE ABILITY TO NOMINATE MORE THAN 50% OF THE DELEGATES. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS HAS DELEGATED THE DETAILED REVIEW OF THE FORM 990 TO MANAGEMENT. THE FORM 990 IS PRESENTED TO THE FULL BOARD OF DIRECTORS FOR REVIEW AND FINAL APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C AT LEAST ON AN ANNUAL BASIS, THE ORGANIZATIONS REQUIRE THAT A CONFLICT OF INTEREST STATEMENT BE SIGNED, WITH ALL POTENTIAL CONFLICTS LISTED AND DISCUSSED. EACH BOARD MEMBER COMPLETES THIS FORM, AND ALL POTENTIAL CONFLICTS ARE DISCUSSED DURING A BOARD MEETING. BOARD MEMBERS DECIDE THE APPROPRIATE COURSE OF ACTION FOR EACH CONFLICT. SOME CONFLICTS ARE IMMATERIAL ENOUGH TO WARRANT NO FOLLOW-UP, OTHERS ARE RESOLVED BY NOT ALLOWING THE MEMBER WITH A CONFLICT TO VOTE ON DECISIONS RELATED TO THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION UTILIZES LEADING AGE DATA FOR ALL EMPLOYEE COMPENSATION (COMPARABLE DATA). THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE DIRECTOR COMPENSATION. THE FULL BOARD OF DIRECTORS APPROVES THE WAGE RANGE FOR EMPLOYEES. THE EXECUTIVE DIRECTOR HAS DISCRETION TO DETERMINE AND APPROVE OTHER OFFICERS AND KEY EMPLOYEE COMPENSATION THROUGH THE BOARD-APPROVED WAGE RANGE. THESE DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT OF INTEREST AND DOCUMENTATION IS KEPT FOR ALL DECISIONS MADE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G NURSING CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,311. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,311. THERAPY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,414,013. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,414,013. HOUSEKEEPING CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 774,897. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 774,897. PHARMACY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 317,828. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 317,828. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 299,579. MANAGEMENT AND GENERAL EXPENSES 74,659. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 374,238. WOODSIDE OAKS INC 1040 PILGRIM WAY GREEN BAY WI 54304 421552326 SENIOR HOUSING WI 501(C)(3) LINE 10 BAY AREA LUTHERAN HOMES INC 1 WOODSIDE HAVEN INC 1040 PILGRIM WAY GREEN BAY WI 54304 300071529 HOUSING FOR LOW-INCOME, ELDERLY, OR PHYSICALLY HANDICAPPED WI 501(C)(3) LINE 10 BAY AREA LUTHERAN HOMES INC 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 WOODSIDE OAKS INC E 11480283 ACTUAL VALUE