2021-11-12T15:43:25-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 1660 OSHKOSH AVE SUITE 200 OSHKOSH WI 54902 990 2020-01-01 813724993 LAKELAND CARE INCORPORATED LAKE 9209065100 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 9209065100 2021-11-10 1 SARA MUHLBAUER 999009999 SARAH HOFKENS P01297845 9202315890 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SARA MUHLBAUER N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 351842352 0 X WWW.LAKELANDCAREINC.COM X 2000 WI ENRICHES LIVES OF ITS MEMBERS AND THEIR FAMILIES BY PROVIDING COORDINATED LONG-TERM HEALTH. 11 11 482 0 0 0 248030279 308914796 34388711 41324270 44461 29256 903873 1574030 283367324 351842352 0 0 0 0 32635295 40179070 0 0 0 244713952 303418376 277349247 343597446 6018077 8244906 46562741 55488367 27490310 28171030 19072431 27317337 X EMPOWERING INDIVIDUALS. STRENGTHENING COMMUNITIES. INSPIRING FUTURES. ENRICHES LIVES OF ITS MEMBERS AND THEIR FAMILIES BY PROVIDING COORDINATED LONG-TERM HEALTH. 0 0 327923234 41324270 LAKELAND CARE, INC. IS A NONPROFIT ORGANIZATION THAT IS MEMBER-CENTERED AND MISSION DRIVEN. LAKELAND CARE WAS ONE OF THE FIRST MANAGED CARE ORGANIZATIONS TO PROVIDE THE FAMILY CARE PROGRAM IN THE STATE OF WISCONSIN MORE THAN 20 YEARS AGO. FAMILY CARE HELPS ELIGIBLE ELDERS AND ADULTS WITH DISABILITIES LIVE INDEPENDENTLY AT HOME AND IN THEIR COMMUNITY. OUR MEMBERS PARTNER WITH CARE TEAMS AND LOCAL PROVIDERS TO GET THE SUPPORT AND SERVICES THEY NEED TO ACHIEVE THEIR GOALS. MEMBERS MAY CHOOSE TO SELF-DIRECT MOST SERVICES, AND INVITE FAMILY MEMBERS OR OTHERS TO BE PART OF THEIR CARE TEAM. LAKELAND CARE SERVES MORE THAN 7,000 MEMBERS THROUGHOUT 22 COUNTIES IN THE FOX VALLEY, NORTHEAST AND NORTH CENTRAL WISCONSIN. LAKELAND CARE CONTINUES TO BE THE FASTEST GROWING MANAGER CARE ORGANIZATION IN WISCONSIN. OVER NINETY-FIVE CENTS OF EVERY FAMILY CARE DOLLAR DIRECTLY SUPPORTS CARE FOR OUR MEMBERS. OUR FAMILY CARE PROGRAM OFFERS A WIDE ARRAY OF BENEFITS AND SERVICES TO MEET LONG-TERM CARE NEEDS. EXAMPLES OF SERVICES INCLUDE: CARE MANAGEMENT SERVICES PERSONAL CARE (BATH, DRESSING, ETC.) TRANSPORTATION MEAL PREP MONEY MANAGEMENT MEDICAL EQUIPMENT AND SUPPLIES THERAPY SERVICES HOME HEALTH SERVICES OUTPATIENT MENTAL HEALTH SERVICES NURSING HOME CARE SUPPORTIVE HOME CARE RESIDENTIAL CAREWHEN MEMBERS ENROLL WITH LAKELAND CARE, THEY WILL HAVE ACCESS TO AN EXTENSIVE NETWORK OF PROVIDERS ALLOWING THEM TO HAVE CHOICES FOR THE SERVICES THEY NEED. LAKELAND CARE PARTNERS WITH OVER 1,000 PROVIDERS THROUGHOUT TWENTY-TWO COUNTIES. LAKELAND CARE HAS CONSISTENTLY RECEIVED HIGH MARKS FROM THE STATE'S EXTERNAL QUALITY REVIEW ORGANIZATION, BOTH FOR QUALITY CARE STANDARDS AND MEMBER RECORDS. LAKELAND CARE'S MISSION IS TO ENRICH INDIVIDUALS' LIVES BY HONORING THEIR VALUES THROUGH HIGH QUALITY, COST EFFECTIVE CARE AND SUPPORTS. LAKELAND CARE IS A PERSON-CENTERED ORGANIZATION THAT COORDINATES CARE AND SUPPORTS TO BUILD AND SUSTAIN INDIVIDUALS' SUCCESS BY: DELIVERING HIGH QUALITY, COST-EFFECTIVE OPTIONS EXPANDING INDIVIDUALS' ACCESS AND CHOICES ENHANCING PARTNERSHIPS AND RESOURCES IMPROVING THE HEALTH AND WELL-BEING OF INDIVIDUALS, FAMILIES AND COMMUNITIESEVERYONE AT LAKELAND CARE FOLLOWS THE GUIDING PRINCIPLES OF TEAMWORK, RESPECT, ACCOUNTABILITY, CUSTOMER SERVICE, AND COMMUNICATION TO DELIVER OUR MISSION. LAKELAND CARE IS EXCITED TO BE WORKING WITH INDEPENDENT CARE HEALTH PLAN, A WISCONSIN-BASED, MISSION-FOCUSED PARTNER TO OFFER AN INNOVATIVE NEW MEDICARE ADVANTAGE SPECIAL NEEDS PLAN - LAKELAND CARE +HEALTH (LC +H). LC +H IS AN OPTION AVAILABLE TO ELIGIBLE LOW-INCOME MEDICARE RECIPIENTS. LAKELAND CARE'S CARE TEAM IS ABLE TO PROVIDE ENROLLED INDIVIDUALS MORE INTEGRATED CARE FOCUSING ON AN INDIVIDUAL'S HEALTH CARE AND, WHERE ELIGIBLE, LONG-TERM CARE NEEDS. 327923234 1 0 0 0 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 88 0 482 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X DAN BIZUB 9209065860 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 JIM BREY PRESIDENT 1.00 X X 719 0 0 ALLEN BUECHEL SECRETARY/TREASURER 1.00 X X 578 0 0 JUDY GOLDSMITH DIRECTOR 1.00 X 528 0 0 JIM KOZICZKOWSKI VICE-PRESIDENT 1.00 X X 638 0 0 LARRY LAUTENSCHLAGER DIRECTOR 1.00 X 558 0 0 TODD MOELY DIRECTOR 1.00 X 550 0 0 TOM OTTO DIRECTOR 1.00 X 450 0 0 JUDY RUGGIRELLO DIRECTOR 1.00 X 575 0 0 BOB ZIEGELBAUER DIRECTOR 1.00 X 167 0 0 MIKE KONECNY DIRECTOR 1.00 X 724 0 0 BARB LARSON-HERBER DIRECTOR 1.00 X 732 0 0 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 40.00 X 185000 0 12282 DANIEL BIZUB CHIEF FINANCIAL OFFICER 40.00 X 144253 0 27824 SUZANNE SINJAKOVIC CHIEF ADMINISTRATIVE OFFICER 40.00 X 139828 0 14931 JEN HARRISON CHIEF OPERATING OFFICER 40.00 X 152006 0 20095 TERRY SCHMID IT DIRECTOR 40.00 X 105647 0 29865 JULIANNE COX COMPLIANCE DIRECTOR 40.00 X 106352 0 14372 MEGHAN HYLAND QUALITY MEMBER AND SUPPORT DIRECTOR 40.00 X 113065 0 26373 952370 0 145742 7 0 1 0 HOMES FOR INDEPENDENT LIVING PO BOX 278 DOUSMAN WI 53118 RESIDENTIAL SERVICES 18344173 CLARITY CARE INC 424 WASHINGTON AVENUE OSHKOSH WI 54901 COMMUNITY BASED RESIDENTIAL FACILITY 11818363 REM WISCONSIN II INC 2005 W BELTLINE HWY MADISON WI 53713 RESIDENTIAL SERVICES 11033806 LKICHOICE 106 S BEAUMONT RD PRAIRIE DU CHIEN WI 53821 SELF DIRECTED SUPPORTS 9300906 INNOVATIVE WISCONSIN INC 2321 SAN LUIS PL GREEN BAY WI 54304 RESIDENTIAL SERVICES 8822706 389 308914796 308914796 ROOM AND BOARD 900099 26720066 26720066 COST SHARE 900099 9156971 9156971 RETRO RATE ADJUSTMENTS 900099 5304897 5304897 THIRD PARTY 900099 142336 142336 41324270 29256 29256 MISC. REVENUE-EXCLUDED-990 900099 1574030 1574030 1574030 351842352 41324270 0 1603286 375478 56322 319156 28305628 21217655 7087973 1057785 158668 899117 8163711 7032277 1131434 2276468 1768987 507481 38216 38216 138674 138674 2219787 2219787 90687 90687 87527 87527 822697 633477 189220 1359814 407944 951870 84890 84890 348155 271561 76594 34191 34191 739447 535270 204177 45496 45496 PROVIDER CARE FAMILY SE 270894753 270894753 IBNR CLAIMS EXPENSE 24946320 24946320 SUPPLIES EXPENSE 88481 88481 1479241 1479241 343597446 327923234 15674212 0 30612779 39834378 4766480 5536238 8342065 6691106 633256 861482 5838283 3348697 2129648 2489586 78513 75577 46562741 55488367 27490310 28171030 27490310 28171030 X 14305951 21781099 4766480 5536238 19072431 27317337 46562741 55488367 8244906 0 X 0 1 X 0 0 X 178479899 205312044 248030279 308914796 940737018 178479899 205312044 248030279 308914796 940737018 940737018 13057 29094 44461 29256 115868 3333421 681677 903873 1574030 6493001 947345887 135701112 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2017 AMOUNT: $ 3,333,421. 2018 AMOUNT: $ 681,677. 2019 AMOUNT: $ 903,873. 2020 AMOUNT: $ 1,574,030. 828613 687334 141279 5009670 2661363 2348307 2489586 X 351842352 0 351842352 0 351842352 343597446 0 343597446 0 343597446 PART X, LINE 2: LAKELAND CARE, INC. IS ORGANIZED AS A WISCONSIN NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER IRC SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3), QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER IRC SECTION 170(B)(1)(A)(VI), AND HAS BEEN DETERMINED NOT TO BE PRIVATE FOUNDATIONS UNDER IRC SECTION 509(A)(1). WE ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, WE ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSES. WE FILE AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS TO REPORT OUR UNRELATED BUSINESS TAXABLE INCOME. 1 X X X 0 0 0 0 0 0 0 0 0 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 185000 0 0 0 0 0 5667 0 6615 0 197282 0 0 0 JEN HARRISON CHIEF OPERATING OFFICER 152006 0 0 0 0 0 13587 0 6508 0 172101 0 0 0 DANIEL BIZUB CHIEF FINANCIAL OFFICER 144253 0 0 0 0 0 23959 0 3865 0 172077 0 0 0 SUZANNE SINJAKOVIC CHIEF ADMINISTRATIVE OFFICER 139828 0 0 0 0 0 12999 0 1932 0 154759 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B NO FORMAL COMMITTEES IN 2020 ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B DAN BIZUB, CFO, AND JEFF TEIGEN, BUSINESS DIRECTOR, ARE THE PRIMARY CONTRIBUTORS TO THE FORM 990 AND TOGETHER REVIEW ALL QUESTIONS OF THE FORM 990 BEFORE SUBMISSION TO CLA. THE OTHER EXECUTIVES WILL GET COPIES OF THE FORM 990 FOR ADDITIONAL REVIEW. THESE CONTRIBUTIONS AND REVIEW HAPPEN BEFORE FILING WITH THE IRS. LCI WILL ALSO SEND COPIES TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND CONFIRMATION, IDEALLY BEFORE SUBMISSION TO THE IRS. IN 2020 HOWEVER THAT BOARD OF DIRECTOR REVIEW WAS NOT COMPLETED PRIOR TO FILING WITH THE IRS DUE TO TIMING ISSUES AND THE EFFECTS OF A GLOBAL PANDEMIC. THE EXTENT OF THE REVIEW VARIES. DAN BIZUB AND JEFF TEIGEN WILL REVIEW EACH QUESTION AND ANSWER. THE EXECUTIVE TEAM AT LCI WILL DO SO AS WELL UPON REQUEST OF DAN BIZUB OR JEFF TEIGEN. OTHERWISE THE EXECUTIVE TEAM AND BOARD OF DIRECTORS ARE PROVIDED COPIES WITH TIME TO INDIVIDUALLY REVIEW BEFORE BEING ASKED TO CONFIRM (DOCUMENTED IN MEETING MINUTES) THEIR INDIVIDUAL REVIEWS AND IF THERE ARE ANY QUESTIONS, COMMENTS OR CONCERNS. 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 PER THE TERMS OF LCI'S CEO SALARY ADMINISTRATION PROCEDURE, IT IS LCI'S POLICY TO ESTABLISH CHIEF EXECUTIVE OFFICER COMPENSATION ACCORDING TO OBJECTIVE CRITERIA EVALUATED AND APPLIED BY PERSONS WITHOUT A CONFLICT OF INTEREST IN STRICT CONFORMANCE WITH GUIDELINES ESTABLISHED BY THE INTERNAL REVENUE SERVICE FOR TAX-EXEMPT ORGANIZATIONS. SPECIFICALLY, THE PROCESS FOR DETERMINING COMPENSATION FOR THE CEO INCLUDES: APPROVAL BY PERSONS WITHOUT A CONFLICT OF INTEREST, USE OF COMPARABILITY DATA, TIMELY SUBSTANTIATION OF THE DELIVERATION AND DECISION, AND RECORDS COMPENSATION DELIBERATIONS IN THE BOARD OF DIRECTOR'S MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.