2021-02-11T09:29:45-06:00 2020-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2019-07-01 391034534 BAY AREA LUTHERAN HOMES INC BAYA 9204991481 1040 PILGRIM WAY GREEN BAY WI 54304 NICOLE BOLDT DIRECTOR OF FINANCE 9204991481 2021-02-10 1 TERRI REXRODE CPA MST P00096513 9206620016 2020-12-17 2019 2022-09-23 18:48:47Z WOODSIDE SENIOR COMMUNITIES NICOLE BOLDT 1040 PILGRIM WAY GREEN BAY WI 54304 26444788 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. 11 11 564 75 0 0 18962 24721 20591745 21389329 611959 550364 3642 -190 21226308 21964224 0 0 0 0 11660065 12484249 0 0 0 8380421 8669637 20040486 21153886 1185822 810338 41383463 44962302 13635265 16296710 27748198 28665592 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 13571723 14735448 WOODSIDE LUTHERAN HOME IS A 130-BED FACILITY THAT OFFERS LONG-TERM SKILLED NURSING CARE AND SHORT-TERM REHABILITATION CARE. IN FISCAL YEAR 2020, WOODSIDE LUTHERAN HOME PROVIDED APPROXIMATELY 42,100 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. 5308180 6399556 WOODSIDE MANOR IS A 97-UNIT APARTMENT FACILITY THAT OFFERS CLASS C CBRF SERVICES, INCLUDING SUPERVISION AND DISPENSING OF MEDICATIONS AND ASSISTANCE WITH DAILY LIVING ACTIVITIES. IN FISCAL YEAR 2020, WOODSIDE MANOR PROVIDED APPROXIMATELY 33,500 DAYS OF CARE. WOODSIDE VILLA IS A 20-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. 18879903 1 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 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 24 0 564 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 11 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 SCOTT ROSS FORMER EXECUTIVE DIRECTOR 36.00 4.00 X 183305 0 4134 MEGHAN MEHLBERG FUSS HOME ADMINISTRATOR 40.00 X 121332 0 2907 NICOLE BOLDT DIRECTOR OF FINANCE 36.00 4.00 X 100912 0 13179 POLLY GRETZINGER DIRECTOR OF HUMAN RESOURCES 40.00 X 92612 0 9026 JESSICA ATKINSON MANOR/VILLA ADMINISTRATOR 35.00 5.00 X 86269 0 36804 SUE MAY PRESIDENT 0.50 X X 0 0 0 LARRY FRAZIER VICE PRESIDENT 0.50 0.50 X X 0 0 0 BARB BRAUN SECRETARY 0.50 0.50 X X 0 0 0 JEFFREY MARTINSON TREASURER 0.50 0.50 X X 0 0 0 MAX ROTH BOARD MEMBER 0.50 1.00 X 0 0 0 JUDY KNEIZEL BOARD MEMBER 0.50 0.50 X 0 0 0 PHYLLIS HOPPE BOARD MEMBER 0.50 0.50 X 0 0 0 JOYCE MCCOLLUM BOARD MEMBER 0.50 0.50 X 0 0 0 HELENE BURMEISTER BOARD MEMBER 0.50 0.50 X 0 0 0 AMY HARDKE BOARD MEMBER 0.50 0.50 X 0 0 0 JUDY KNUDSEN BOARD MEMBER 0.50 0.50 X 0 0 0 584430 0 66050 3 0 1 0 GREENFIELD REHABILITATION AGENCY INC 19395 W CAPITAL DRIVE SUITE 200 BROOKFIELD WI 53045 THERAPY SERVICES 842671 REHABCARE GROUP INC PO BOX 503534 ST LOUIS WI 631503534 THERAPY SERVICES 667090 OUT OF THE WOODWORK CUSTOM CARPENTRY & R 1223 GERHARDT LANE GREEN BAY WI 54313 CONSTRUCTION 656714 BSG MAINTEANANCE INC PO BOX 165 NEWBURG WI 53060 HOUSEKEEPING & LAUNDRY SERVICES 511057 HOFFMAN PD & C INC PO BOX 8034 APPLETON WI 54912 CONSTRUCTION 218256 7 8300 16421 24721 NURSING HOME REVENUE 623000 14677248 14677248 WOODSIDE MANOR 623000 6399556 6399556 OTHER OPERATING INCOME 623000 254325 254325 AFFILIATE ADMIN FEES 623000 58200 58200 21389329 330029 330029 4689579 4469244 220335 220335 220335 11130 8300 11320 -190 -190 21964224 21135004 0 804499 X 650480 650480 10055235 9379636 675599 87583 77211 10372 912315 846168 66147 778636 686424 92212 15138 4438 10700 29421 29421 48424 48424 2512027 2502227 9800 26936 26936 2348768 2187719 161049 341978 339168 2810 395251 331059 64192 34427 21784 12643 22448 15304 7144 392500 328754 63746 1787496 1497190 290306 340826 272630 68196 PROVIDER TAX 204387 204387 BAD DEBT EXPENSE 107351 107351 DUES & SUBSCRIPTIONS 29206 29206 RECRUITMENT 20064 20064 12989 3093 9896 21153886 18879903 2273983 0 43319 44730 5462248 8268267 1715210 1594208 30854 31281 204204 85422 41215017 18317995 22420543 22897022 11435967 11999167 71118 42205 41383463 44962302 1648341 1960842 11986924 12627544 1183324 0 525000 13635265 16296710 X 27748198 28665592 27748198 28665592 41383463 44962302 810338 107056 0 X X 0 1 X 1 0 X 5270 6946 57555 18962 24721 113454 16762510 19429765 20032334 20289596 21135004 97649209 261237 265628 252003 314563 265455 1358886 17029017 19702339 20341892 20623121 21425180 99121549 0 670783 344704 690523 1706010 670783 344704 690523 1706010 97415539 198228 210869 227234 278952 330029 1245312 198228 210869 227234 278952 330029 1245312 17227245 19913208 20569126 20902073 21755209 100366861 0.97060 0.98820 0.01240 0.01180 X 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 36192946 15630077 20562869 1057502 717552 339950 3038206 1794257 1243949 863145 176109 687036 22897022 MEDICARE ADVANCE LOAN 525000 525000 21964656 107056 107056 21857600 48424 58200 106624 21964224 21047262 0 21047262 48424 58200 106624 21153886 PART XI, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE ADMIN FEES 58,200. PART XII, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE ADMIN FEES 58,200. TAILGATE 19430 8300 11130 9964 1356 19430 8300 11130 9964 1356 11320 -190 X X X X 1 0 0 0 0 0 0 0 0 SCOTT ROSS FORMER EXECUTIVE DIRECTOR 178305 0 5000 0 0 0 3516 0 618 0 187439 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 2020, SCOTT ROSS RECEIVED SEVERANCE PAYMENTS TOTALING $49,806. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 2014-07-11 13000000 FINANCE RENOVATIONS TO HEALTH CARE FACILITY 0 0 0 A 317774 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 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/23/2019 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 PHARMACY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 438,610. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 438,610. THERAPY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,528,266. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,528,266. HOUSEKEEPING CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 328,430. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 328,430. NURSING CONTRACT LABOR: PROGRAM SERVICE EXPENSES 11,480. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,480. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 195,441. MANAGEMENT AND GENERAL EXPENSES 9,800. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 205,241. PART XII, LINE 2C EXPLANATION THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 WOODSIDE OAKS INC E 11809575 ACTUAL VALUE