2020-02-21T10:39:22-06:00 2019-06-30 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2018-07-01 391034534 BAY AREA LUTHERAN HOMES INC BAYA 9204991481 1040 PILGRIM WAY GREEN BAY WI 54304 NICOLE LUCKOW DIRECTOR OF FINANCE 9204991481 2020-02-15 1 TERRI REXRODE CPA MST P00096513 9206620016 2020-02-15 74.87.127.216 2020-02-15 09:28:39 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 7D2FE2EA17AC540A2D29D4112E82844D375299C1 2018 2020-09-23 17:36:50Z WOODSIDE SENIOR COMMUNITIES NICOLE LUCKOW 1040 PILGRIM WAY GREEN BAY WI 54304 25372646 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 11 547 75 0 0 57555 18962 20277861 20591745 414534 611959 -1982 3642 20747968 21226308 0 0 0 0 11102345 11660065 0 0 0 8355492 8380421 19457837 20040486 1290131 1185822 40203588 41383463 13772121 13635265 26431467 27748198 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 13608182 14037139 WOODSIDE LUTHERAN HOME IS A 130-BED FACILITY THAT OFFERS LONG-TERM SKILLED NURSING CARE AND SHORT-TERM REHABILITATION CARE. IN FISCAL YEAR 2019, WOODSIDE LUTHERAN HOME PROVIDED APPROXIMATELY 42,500 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. 3769378 4929081 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 2019, WOODSIDE MANOR PROVIDED APPROXIMATELY 31,900 DAYS OF CARE. 572947 1323376 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. 17950507 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 22 0 547 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 LUCKOW 9204991481 1040 PILGRIM WAY GREEN BAY WI 54304 SUE MAY PRESIDENT 0.50 0.50 X X 0 0 0 RANDY FRAILING VICE-PRESIDENT 0.50 0.50 X X 0 0 0 SHARON BARCHACKY SECRETARY 0.50 0.50 X X 0 0 0 RONALD PIGEON BOARD MEMBER 0.50 0.00 X 0 0 0 BARB BRAUN BOARD MEMBER 0.50 0.50 X 0 0 0 JEFFREY MARTINSON TREASURER 0.50 0.50 X X 0 0 0 PHYLLIS HOPPE BOARD MEMBER 0.50 0.50 X 0 0 0 LARRY FRAZIER BOARD MEMBER 0.50 0.50 X 0 0 0 MAX ROTH BOARD MEMBER 0.50 1.00 X 0 0 0 JOYCE MCCOLLUM BOARD MEMBER 0.50 0.00 X 0 0 0 JUDY KNEIZEL BOARD MEMBER 0.50 0.50 X 0 0 0 SCOTT ROSS EXECUTIVE DIRECTOR 36.00 4.00 X 178189 0 2783 NICOLE LUCKOW DIRECTOR OF FINANCE 36.00 4.00 X 9614 0 0 LORI GLYNN FORMER DIRECTOR OF FINANCE 36.00 4.00 X 69109 0 26933 MEGHAN MEHLBERG FUSS HOME ADMINISTRATOR 40.00 0.00 X 116690 0 2814 373602 0 32530 2 0 1 0 REHABCARE GROUP INC PO BOX 503534 ST LOUIS MO 631503534 REHAB SERVICES FOR RESIDENTS 1559468 BSG MAINTENANCE INC PO BOX 165 NEWBURG WI 53060 HOUSEKEEPING AND LAUNDRY SERVICES 533733 OUT OF THE WOODWORK 2453 BASSWOOD STREET GREEN BAY WI 54313 CONSTRUCTION 201555 A&L CONSTRUCTION MANAGEMENT 2453 BASSWOOD STREET GREEN BAY WI 54313 CONSTRUCTION 109933 4 8276 10686 18962 WOODSIDE LUTHERAN HOME 623000 13983738 13983738 WOODSIDE MANOR 623000 4929081 4929081 WOODSIDE VILLA 623000 1323376 1323376 OTHER OPERATING INCOME 623000 302149 302149 AFFILIATE ADMIN REVENUE 623000 53401 53401 20591745 278952 278952 4470573 4067533 70033 403040 -70033 333007 333007 12414 8276 8772 3642 3642 21226308 20289596 0 917750 X 286628 286628 9540392 8683728 856664 77018 70183 6835 1040920 947027 93893 715107 633827 81280 22712 3891 18821 28680 28680 42999 42999 2407235 2406406 829 52777 52777 2314933 2170140 144793 312764 305442 7322 450174 377062 73112 38766 28535 10231 46407 25295 21112 397614 333038 64576 1664424 1394106 270318 217379 142838 74541 PROVIDER TAX 208041 208041 BAD DEBT EXPENSE 121262 121262 DUES AND LICENSES 25715 25715 RECRUITMENT 20195 20195 8344 3910 4434 20040486 17950507 2089979 0 43520 43319 5584728 5462248 2031506 1715210 23251 30854 762553 204204 39196487 16775944 21870860 22420543 9836970 11435967 50200 71118 40203588 41383463 1504594 1648341 12267527 11986924 13772121 13635265 X 26431467 27748198 26431467 27748198 40203588 41383463 1185822 130909 0 X X 0 1 X 1 0 X 6373 5270 6946 57555 18962 95106 14295902 16762510 19429765 20032334 20289596 90810107 202567 261237 265628 252003 314563 1295998 14504842 17029017 19702339 20341892 20623121 92201211 0 670783 344704 1015487 670783 344704 1015487 91185724 187457 198228 210869 227234 278952 1102740 187457 198228 210869 227234 278952 1102740 14692299 17227245 19913208 20569126 20902073 93303951 0.97730 0.98770 0.01180 0.01230 X 0 0 0 0 0 0 0 0 1 3128 3128 0 PART II-B, LINE 1: LEADING AGE MEMBERSHIP FEES OF $3,128 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 34453800 14259545 20194255 1022837 658799 364038 2943176 1698929 1244247 713456 158671 554785 22420543 21260817 130909 130909 21129908 42999 53401 96400 21226308 19944086 0 19944086 42999 53401 96400 20040486 PART XI, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE ADMIN FEES 53,401. PART XII, LINE 4B - OTHER ADJUSTMENTS: AFFILIATE ADMIN FEE 53,401. TAILGATE 20690 8276 12414 540 5125 1275 1832 20690 8276 12414 540 5125 1275 1832 8772 3642 X X X X 0 0 0 0 0 0 0 0 0 SCOTT ROSS EXECUTIVE DIRECTOR 173189 0 5000 0 0 0 2165 0 618 0 180972 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. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 NONEAVAIL 2014-07-11 13000000 FINANCE RENOVATIONS TO HEALTH CARE FACILITY 0 0 0 A 308688 13000000 20000 13000000 2016 0 0 1 1 A 0 0 1 1 0 0 0 1 A 0 1 0 0 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 PHARMACY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 426,497. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 426,497. THERAPY CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,558,708. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,558,708. HOUSEKEEPING CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 351,835. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 351,835. NURSING CONTRACT LABOR: PROGRAM SERVICE EXPENSES 5,080. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,080. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 64,286. MANAGEMENT AND GENERAL EXPENSES 829. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,115. FORM 990, PART XII, LINE 2C: 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 12445123 ACTUAL VALUE