2020-11-13T15:43:33-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 100 CITY CENTER PO BOX 2886 OSHKOSH WI 54903 990 2019-01-01 813724993 LAKELAND CARE INCORPORATED LAKE 9209065100 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 9209065100 2020-11-12 1 SARAH HOFKENS P01297845 9202315890 2020-11-11 67.137.57.251 2020-11-12 14:31:39 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FFF55F81A3F3AE4ED99EA4C7BC73FF4637EEDE99 2019 2021-01-29 14:40:06Z SARA MUHLBAUER N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 283367324 0 X WWW.LAKELANDCAREINC.COM X 2000 WI ENRICHES LIVES OF ITS MEMBERS AND THEIR FAMILIES BY PROVIDING COORDINATED LONG-TERM HEALTH. 11 11 447 1 0 0 205312044 248030279 34105567 34388711 29094 44461 681677 903873 240128382 283367324 0 0 0 0 27870249 32635295 0 0 0 215253112 244713952 243123361 277349247 -2994979 6018077 36942588 46562741 23888234 27490310 13054354 19072431 X ENRICHING INDIVIDUAL'S LIVES BY HONORING THEIR VALUES THROUGH HIGH QUALITY, COST EFFECTIVE CARE AND SUPPORT. 0 0 265646701 34388711 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. 265646701 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 99 0 447 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAN BIZUB 9209065100 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 JIM BREY PRESIDENT 1.00 X X 550 0 0 ALLEN BUECHEL SECRETARY/TREASURER 1.00 X X 450 0 0 JUDY GOLDSMITH DIRECTOR 1.00 X 600 0 0 JIM KOZICZKOWSKI VICE-PRESIDENT 1.00 X X 650 0 0 LARRY LAUTENSCHLAGER DIRECTOR 1.00 X 400 0 0 TODD MOELY DIRECTOR 1.00 X 500 0 0 TOM OTTO DIRECTOR 1.00 X 550 0 0 JUDY RUGGIRELLO DIRECTOR 1.00 X 650 0 0 BOB ZIEGELBAUER DIRECTOR 1.00 X 0 0 0 MIKE KONECNY DIRECTOR 1.00 X 450 0 0 BARB LARSON-HERBER DIRECTOR 1.00 X 600 0 0 KATIE MNUK CHIEF EXECUTIVE OFFICER (FORMER) 40.00 X 198963 0 767 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 40.00 X 152208 0 25781 DANIEL BIZUB CHIEF FINANCIAL OFFICER 40.00 X 139480 0 25781 SUZANNE SINJAKOVIC CAO 40.00 X 128688 0 25781 DEB KUREK SENIOR LEADER 40.00 X 106513 0 25781 JEN HARRISON CHIEF OPERATING OFFICER 40.00 X 108267 0 25781 TERRY SCHMID SENIOR LEADER 40.00 X 101235 0 25781 MIKE KRISTMANN SENIOR LEADER 40.00 X 102860 0 25781 1043614 0 181234 8 0 1 0 HOMES FOR INDEPENDENT LIVING PO BOX 278 DOUSMAN WI 53118 ADULT FAMILY HOME, 3-4 BEDS 11861782 CLARITY CARE INC 424 WASHINGTON AVENUE OSHKOSH WI 54901 COMMUNITY BASED RESIDENTIAL FACILITY 8978341 REM WISCONSIN II INC 2839 E FRONTAGE RD ABRAMS WI 54101 ADULT FAMILY HOME, 3-4 BEDS 6813843 GT FINANCIAL SERVICES 215 BROADUS STREET STURGIS MI 49091 SELF-DIRECTED PERSONAL CARE SERVICES 5301344 INNOVATIVE WISCONSIN INC 2321 SAN LUIS PL GREEN BAY WI 54304 ADULT FAMILY HOME, 3-4 BEDS 4994648 5 248030279 248030279 ROOM AND BOARD 900099 22474355 22474355 COST SHARE 900099 8970858 8970858 RETRO RATE ADJUSTMENTS 900099 2763377 2763377 THIRD PARTY 900099 180121 180121 34388711 44461 44461 MISCELLANEOUS REVENUE 900099 903873 903873 903873 283367324 34388711 0 948334 548380 82257 466123 22760589 18010103 4750486 848363 127254 721109 6664245 5744978 919267 1813718 1409768 403950 154148 154148 199719 199719 1416524 1416524 81292 81292 108228 108228 1216783 936923 279860 1381229 414369 966860 102749 102749 914583 713375 201208 2268 2268 7406 7406 557177 388464 168713 42300 42300 PROVIDER CARE FAMILY SE 214103403 214103403 IBNR CLAIMS EXPENSE 23715807 23715807 SUPPLIES EXPENSE 33785 33785 676551 676551 277349247 265646701 11702546 0 22810862 30612779 3192928 4766480 9396890 8342065 322985 633256 4738896 2609248 1148426 2129648 70497 78513 36942588 46562741 23888234 27490310 23888234 27490310 X 8869508 14305951 4184846 4766480 13054354 19072431 36942588 46562741 6018077 0 X 0 1 X 0 0 X 178479899 205312044 248030279 631822222 178479899 205312044 248030279 631822222 631822222 13057 29094 44461 86612 3333421 681677 903873 4918971 636827805 94376842 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. 761062 601982 159080 3977834 2007266 1970568 2129648 X 283367324 0 283367324 0 283367324 277349247 0 277349247 0 277349247 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. X 0 0 0 0 0 0 0 0 0 KATIE MNUK CHIEF EXECUTIVE OFFICER (FORMER) 198963 0 0 0 0 0 0 0 767 0 199730 0 0 0 SARA MUHLBAUER CHIEF EXECUTIVE OFFICER 152208 0 0 0 0 0 0 0 25781 0 177989 0 0 0 DANIEL BIZUB CHIEF FINANCIAL OFFICER 139480 0 0 0 0 0 0 0 25781 0 165261 0 0 0 SUZANNE SINJAKOVIC CAO 128688 0 0 0 0 0 0 0 25781 0 154469 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE 990 FORM WILL BE SHARED WITH THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C THROUGH ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. ADDITIONALLY, THROUGH LCI'S CONFLICT OF INTEREST POLICY, STAFF 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.