2021-12-02T13:41:15-06:00 2021-06-30 430352985 KERBER ECK & BRAECKEL LLP 125 SOUTH 84TH STREET SUITE 100 MILWAUKEE WI 53214 990 2020-07-01 390826123 ST MARY'S HOME FOR THE AGED INC STMA 9206847171 1635 S 21ST ST MANITOWOC WI 542205652 FRANK SOLTYS PRESIDENT/CEO 9206847171 2021-11-29 1 FRANK SOLTYS 999009999 CHRISTIAN A SLAATS CPA P00963303 4144561099 2021-11-29 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z FRANK SOLTYS 1635 S 21ST ST MANITOWOC WI 542205652 14560811 0 0928 X WWW.FELICIANVILLAGE.ORG X 1956 WI TO CONTINUE THE HEALING MINISTRY OF JESUS WITH PARTICULAR ATTENTION TO THE NEEDS OF THE POOR, AS WE PROVIDE SKILLED NURSING CARE AND HOUSING FOR SENIORS. 12 10 396 50 0 0 500152 3237386 14768422 11281741 21707 41684 0 0 15290281 14560811 0 0 0 0 8610475 6134290 0 0 123041 6195302 5593392 14805777 11727682 484504 2833129 30779909 31064713 27316537 24599741 3463372 6464972 X AS A FACILITY THAT PROVIDES SKILLED NURSING, REHABILITATION, ASSISTED LIVING, AND INDEPENDENT LIVING, ST. MARY'S CONTINUES THE HEALING MINISTRY OF JESUS BY PROVIDING COMPASSIONATE CARE THAT SUPPORTS THE VALUES OF RESPECT FOR HUMAN DIGNITY, COMPASSION, TRANSFORMATION, SOLIDARITY WITH THE POOR AND JUSTICE AND PEACE. 0 0 9995817 11281741 ST. MARY'S EMPLOYS 396 PEOPLE IN DIRECT CARE AND SUPPORT RESPONSIBILITIES, REPRESENTING APPROXIMATELY 84,000 RESIDENT DAYS PER YEAR. CARE IS PROVIDED IN SKILLED NURSING, ASSISTED LIVING AND INDEPENDENT LIVING. SIGNIFICANT COMMUNITY SERVICE IS PROVIDED BY BOTH INDIVIDUALS SERVING ON BOARDS AND COMMITTEES AND BY THE ORGANIZATION SERVING AS A CLINICAL SITE FOR CURRICULUM REQUIREMENTS AND TRAINING FOR REGIONAL POST-SECONDARY EDUCATIONAL INSTITUTIONS IN ADDITION TO HOSTING VARIOUS OTHER EDUCATIONAL PROGRAMS.DURING 2020--2021, ST. MARY'S HOME PROVIDED IN EXCESS OF $2.1 MILLION IN UNREIMBURSED SERVICES FOR MEDICAID, FAMILY CARE, MEDICARE, AND MANAGED CARE RESIDENTS. IN ADDITION, HUNDREDS OF HOURS WERE DONATED TO AREA AGENCIES IN SUPPORT OF COMMUNITY ORGANIZATIONS AND EVENTS THAT BENEFIT RESIDENTS OF MANITOWOC COUNTY AND THE SURROUNDING AREAS. AMONG THE ORGANIZATIONS SUPPORTED THROUGH STAFF INVOLVEMENT ARE: AGING & DISABILITY RESOURCE CENTER, ROTARY MANITOWOC, LAKESHORE TECHNICAL COLLEGE, AURORA HEALTH CARE, HOLY FAMILY MEMORIAL, FIRST PRESBYTERIAN CHURCH, ALZHEIMER'S ASSOCIATION, HEALTHIEST MANITOWOC COUNTY 2020, CHAMBER OF MANITOWOC COUNTY, LEADING AGE- WISCONSIN, NATIONAL ASSOCIATION OF CATHOLIC CHAPLAINS, HOPE HOUSE, INCOURAGE DOMESTIC VIOLENCE SHELTER, LAKESHORE CAP SUPPORTIVE HOUSING PROGRAM, LUTHERAN SOCIAL SERVICES/RAYS, PAINTING PATHWAYS CLUBHOUSE, SOUTHFIELD NEIGHBORHOOD NETWORK LEARNING CENTER, TEE-BOX TRANSITIONAL SOBER LIVING, THE HAVEN OF MANITOWOC COUNTY, AND THE CROSSING. ST. MARY'S SERVED AS A CLINICAL SITE FOR LP NURSING STUDENTS ATTENDING LAKESHORE TECHNICAL COLLEGE.FINALLY, ESTIMATED COSTS TO PROVIDE ALL THE ABOVE OPPORTUNITIES IS $17,060. 9995817 1 1 0 0 0 0 0 0 1 1 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 1 0 0 0 1 28 0 1 396 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X X JOANNE BARTZ 9206847171 1635 SOUTH 21ST STREET MANITOWOC WI 54220 DAVID WARD DIRECTOR 2.00 40.00 X 0 252183 47467 BETSY BENZ CHAIR 1.00 X 0 0 0 DR CAMERON GOETZ DIRECTOR 1.00 X 0 0 0 JILL HENNESSEY DIRECTOR 1.00 X 0 0 0 JON DANFORTH DIRECTOR 1.00 X 0 0 0 SISTER RAMONA DOMBROWSKI DIRECTOR 1.00 X 0 0 0 MICHAEL ETHERIDGE VICE-CHAIR 1.00 X 0 0 0 REV GERALD FOLEY EMERITUS 1.00 X 0 0 0 DENNIS SWETLIK DIRECTOR 1.00 X 0 0 0 THOMAS VEESER DIRECTOR 1.00 X 0 0 0 MARY MAURER DIRECTOR 1.00 X 0 0 0 FRANK SOLTYS CEO/PRESIDENT 40.00 X 223934 0 18659 JOANNE BARTZ TREASURER 40.00 X 78534 0 23529 302468 252183 89655 1 0 1 0 SYSCO EASTERN WISCONSIN ONE SYSCO DRIVE JACKSON WI 530379226 FOOD SERVICE 723020 GREENFIELD REHAB AGENCY 19395 W CAPITOL DR SUITE 200 BROOKFIELD WI 53045 PATIENT THERAPY 534107 GUNDERSON 41 MAIN STREET MENASHA WI 549523198 LAUNDRY 182272 MCKESSON MEDICAL-SURGICAL PO BOX 630693 CINCINNATI OH 452630693 MEDICAL SUPPLIES 141932 OMNICARE INC DEPT 781668 PO BOX 78000 DETROIT MI 482781668 PHARMACY 119691 5 50000 2981087 206299 3237386 RESIDENT CARE SERVICES 623000 11281741 11281741 11281741 41684 41684 14560811 11281741 0 41684 302469 302469 4303717 3762744 473699 67274 34809 28435 5866 508 1102932 900973 185850 16109 390363 318884 65778 5701 9633 9633 52588 52588 427425 427425 112761 104364 2317 6080 289426 183807 99907 5712 42474 42474 702479 606697 88847 6935 6580 5639 699 242 20385 375 20010 744073 709997 31609 2467 1584111 1543337 37822 2952 124791 109386 14290 1115 FOOD SERVICE 658898 655701 3197 0 RESIDENT CARE SERVICES 446132 434715 11417 0 HR/FINANCE SERVICES 293761 148505 145256 0 BAD DEBT -23746 -23746 0 0 101621 78579 15096 7946 11727682 9995817 1608824 123041 5337111 5642874 35451 44676 45450 45450 350048 236528 124525 966550 47594746 24368082 24192244 23226664 695080 901971 30779909 31064713 1575675 1229205 9836 8082 25731026 23362454 27316537 24599741 X 2432702 5279273 1030670 1185699 3463372 6464972 30779909 31064713 2833129 168471 0 X 0 1 X 1 0 X 360036 259992 147636 500152 3237386 4505202 11356239 13181484 14916229 14768422 11281741 65504115 11716275 13441476 15063865 15268574 14519127 70009317 0 0 0 70009317 7785 44480 11136 21707 41684 126792 7785 44480 11136 21707 41684 126792 11724060 13485956 15075001 15290281 14560811 70136109 0.99820 0.99870 0.00180 0.00130 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 730536 27353 188758 946647 506038 216238 8260 730536 473652 15990 16396 506038 424282 33773 15597 473652 285410 123918 14954 424282 1.00000 1 0 593771 593771 43564919 21906226 21658693 3436056 2461856 974200 23226664 X 16476716 168471 1747434 1915905 14560811 0 14560811 13475116 1747434 1747434 11727682 0 11727682 PART IV, LINE 2B: THE ORGANIZATION HOLDS CASH ON BEHALF OF CERTAIN RESIDENTS IN A SEPARATE CHECKING ACCOUNT, WHICH IS USED TO PAY FOR THE RESIDENTS' INCIDENTAL EXPENSES. PART V, LINE 4: THE HOME ESTABLISHED THE ST. MARY'S HOME ENDOWMENT FUND AS A PERMANENTLY RESTRICTED PERPETUAL ENDOWMENT FUND TO PROVIDE SUPPORT TO THE CHARITABLE MISSIONS OF ST. MARY'S AT FELICIAN VILLAGE, THE COURT AT FELICIAN VILLAGE, THE VILLA AT FELICIAN VILLAGE, AND THE GARDENS AT FELICIAN VILLAGE. THE ENDOWMENT CONSISTS OF INVESTMENTS ESTABLISHED TO FUND ITS MISSIONS AND IS DONOR-RESTRICTED. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. PART X, LINE 2: ST. MARY'S HOME FOR THE AGED, INC., IS A NOT FOR PROFIT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE CODE. THE HOME FOLLOWS THE ACCOUNTING STANDARDS FOR UNCERTAINTY IN INCOME TAXES. THESE STANDARDS REQUIRE ENTITIES TO DISCLOSE IN THEIR FINANCIAL STATEMENTS THE NATURE OF ANY UNCERTAINTIES IN THEIR TAX POSITION. AREAS THAT THE INTERNAL REVENUE SERVICE AND STATE TAX AUTHORITIES CONSIDER WHEN EXAMINING TAX AND INFORMATION RETURNS OF A TAX-EXEMPT ENTITY INCLUDE, BUT ARE NOT LIMITED TO, TAX-EXEMPT STATUS AND THE EXISTENCE AND AMOUNT OF UNRELATED BUSINESS INCOME. THE HOME DOES NOT BELIEVE THAT IT HAS ANY UNCERTAIN TAX POSITIONS WITH RESPECT TO THESE OR OTHER MATTERS, AND HAS NOT RECORDED ANY UNRECOGNIZED TAX BENEFITS OR LIABILITY FOR PENALTIES OR INTEREST. PART XI, LINE 2D - OTHER ADJUSTMENTS: PRESENTATION OF ERC AND FFCRA CREDITS 1,747,434. PART XII, LINE 2D - OTHER ADJUSTMENTS: PRESENTATION OF ERC AND FFCRA CREDITS 1,747,434. X X 0 0 0 0 0 0 0 0 0 DAVID WARD DIRECTOR 0 252183 0 0 0 0 0 16577 0 30890 0 299650 0 0 FRANK SOLTYS CEO/PRESIDENT 223934 0 0 0 0 0 2025 0 16634 0 242593 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER (FELICIAN SERVICES, INC.) HOLDS RESERVED POWERS IN ELECTING MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBER (FELICIAN SERVICES, INC.) HOLDS RESERVED POWERS REGARDING SPECIFIC DECISIONS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, FORM 990 WAS DISTRIBUTED VIA EMAIL TO EACH DIRECTOR FOR REVIEW AND COMMENT. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS OR TRUSTEES AND KEY EMPLOYEES MUST PROVIDE WRITTEN DISCLOSURE REGARDING INTERESTS THAT COULD GIVE RISE TO CONFLICT DURING THE ANNUAL BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE CORPORATE MEMBER (FELICIAN SERVICES, INC.) OBTAINED COMPARABILITY DATA IN DETERMINING COMPENSATION OF THE CEO AND TOP MANAGEMENT OFFICIALS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS WILL BE MADE AVAILABLE UPON WRITTEN REQUEST TO THE CONTACT LISTED IN PART VI, SECTION C, LINE 20. FELICIAN SERVICES INC 3800 W PETERSON AVENUE CHICAGO IL 60659 363685438 SOLE CORPORATE MEMBER OF NON-PROFIT RELIGIOUS SPONSORED ENTITIES IL 501(C)(3) LINE 1 CONGREGATION OF THE SISTERS OF ST FELIX OF CANTALICE 0 FELICIAN SISTERS OF NORTH AMERICA INC 871 MERCER ROAD BEAVER FALLS PA 05010 271282473 RELIGIOUS CONGREGATION PA 501(C)(3) LINE 1 N/A 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 0 SCHEDULE R, PART II, COLUMN A THE REPORTING ORGANIZATION AND ALL RELATED ORGANIZATIONS OF THE CONGREGATION OF THE SISTERS OF ST. FELIX OF CANTALICE ARE INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY.