2020-05-14T09:46:36-05:00 2019-12-31 810385940 ANDERSON ZURMUEHLEN & CO PC PO BOX 748 BUTTE MT 59703 990 2019-01-01 364016275 WISCONSIN ILLINOIS SENIOR HOUSING INC WISC 3039800611 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 ANDREW KERWIN CHAIR 2627288167 2020-05-11 1 JAMES E WOY CPA P00102054 4067820451 2020-05-11 71.92.235.238 2020-05-11 09:40:15 MD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 74BC895ED7B4AA290D25ADF29C10D62934060EB5 2019 2020-09-23 17:36:50Z ANDREW KERWIN 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 58672601 0 X WWW.WISCONSINILLINOISSENOIRHOUSING.ORG X 1994 IL SKILLED NURSING AND ASSISTED LIVING FACILITIES. 6 6 1820 0 0 -23755 52097 2831110 50364399 53859187 134010 329793 4436 -43122 50554942 56976968 0 0 0 0 31599354 34971535 0 0 0 21681937 22118139 53281291 57089674 -2726349 -112706 69284306 74442115 61397745 66527105 7886561 7915010 THE PRIMARY PURPOSE IS TO PROVIDE SKILLED NURSING AND ASSISTED LIVING FACILITIES FOR AGED INDIVIDUALS. 0 0 39750392 42558863 WISCONSIN ILLINOIS SENIOR HOUSING, INC.(WISH) OWNS AND OPERATES SKILLED NURSING FACILITIES. THE SKILLED NURSING FACILITIES CONSIST OF: EAST TROY MANOR--50 BED FACILITY, EDGERTON CARE CENTER--61 BED FACILITY, FAIR OAKS HEALTH CENTER--51 BED FACILITY, GENEVA LAKE MANOR--60 BED FACILITY, WILD ROSE MANOR--50 BED FACILITY, HOLTON MANOR--60 BED FACILITY, INGLESIDE MANOR--70 BED SKILLED NURSING, MONTELLO CARE CENTER--50 BED FACILITY, AND MAPLE RIDGE CARE CENTER--75 BED FACILITY. 10909371 11260502 WISH ALSO OWNS AND OPERATES ASSISTED AND INDEPENDENT LIVING FACILITIES. THESE FACILITIES CONSIST OF: INGLEHAVEN--16 BED COMMUNITY BASED RESIDENTIAL FACILITY, INGLEWOOD--24 BED RESIDENTIAL CARE APARTMENT COMPLEX, THE RESIDENCES ON FOREST LANE--16 BED COMMUNITY BASED RESIDENTIAL FACILITY, THE VILLAS AT MAPLE RIDGE--14 BED COMMUNITY BASED RESIDENTIAL FACILITY, BELL TOWER RESIDENCES--90 BED COMMUNITY BASED RESIDENTIAL FACILITY, AND AND THE WELLINGTON HOMES WHICH CONSIST OF SIX COMMUNITY BASED RESIDENTIAL FACILITIES WITH A COMBINED TOTAL OF 164 BEDS. 50659763 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 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 1 1 0 0 0 1 76 0 1 1820 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X CINDY DEMOYE 3039800611 13185 W GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 X LORRIE DUPONT TREASURER 1.00 X X 0 0 0 ANDREW KERWIN CHAIR 1.00 X X 0 0 0 MIRIAM GEHLER SECRETARY 1.00 X X 0 0 0 NICHOLAS LYNN MEMBER 1.00 X 0 0 0 RAJEEV KUMAR MEMBER 1.00 X 0 0 0 KAREN CARRIG MEMBER 1.00 X 0 0 0 KERI GERLACH MEMBER 1.00 X 0 0 0 ALISA PALMER DIRECTOR OF NURSING 40.00 X 107142 0 0 DENISE JOHNSON ADMINISTRATOR 40.00 X 111225 0 0 JAMIE THOMAZIN CLINICAL MANAGER 40.00 X 110791 0 0 MARY SIBBING DIRECTOR OF FACILITY OPERA 40.00 X 124000 0 0 LACY CALKINS STAFF EDUCATION MANAGER 40.00 X 106930 0 0 560088 0 0 7 0 0 0 COMMUNITY LIVING SOLUTIONS 2801 E ENTERPRISE AVE STE 202 APPLETON WI 54913 CONSTRUCTION AND REMODEL OF FACILITIES 2207992 CARRIAGE HEALTHCARE INC 13185 WEST GREEN MOUNTAIN DRIVE LAKEWOOD CO 80228 MANAGEMENT FEES AND REIMBURSABLE EXPENSE 1774313 MARTIN BROTHERS PO BOX 69 CEDAR FALLS IA 50613 FOOD SERVICES 1260017 OMNICARE PO BOX 78000 DETROIT MI 482781668 PHARMACY, MEDICAL SUPPLIES, & CONSULTATI 885899 MEDLINE DEPT CH 14400 PALATINE IL 60055 MEDICAL SUPPLIES 722424 6 2831110 2831110 RESIDENT CARE REVENUE-SNF 623000 39969241 39969241 RESIDENT CARE REVENUE-CBRF/RCAC 623000 11260502 11260502 ANCILLARY REVENUE 623000 2169295 2169295 MISC. PATIENT BENEFIT REVENUE 623000 460149 460149 53859187 176600 176600 234542 277664 -43122 -43122 -43122 1567862 3300 1417969 0 149893 3300 153193 3300 149893 56976968 53819365 0 326493 28267751 27078437 1189314 84957 67024 17933 4283512 3167737 1115775 2335315 2121184 214131 2046084 2046084 67824 67824 295438 295438 325290 325053 237 114784 70 114714 222876 2256 220620 2348195 2133559 214636 132929 32178 100751 2769584 2769407 177 2367325 2367325 445189 408947 36242 SUPPLIES 4353743 4351136 2607 PURCHASED SERVICES AND 2073673 1601949 471724 IMPAIRMENT LOSS ON DISC 1622985 1622985 BUSINESS TAXES 1053794 1053794 1878426 564432 1313994 57089674 50659763 6429911 0 2204275 3801421 1120308 825026 4554358 4170176 141895 45523 234159 263267 75223258 21463564 48756725 53759694 2852737 3470971 6206899 4662377 102897 3212950 3340763 69284306 74442115 6615384 7173300 300 33570000 37229457 21156470 22069927 55891 54121 61397745 66527105 X 7886561 7915010 7886561 7915010 69284306 74442115 X -112706 141252 -97 X X 0 0 0 X 2858251 5567789 53981 52097 2831110 11363228 45724959 47435440 50525114 50324523 53859187 247869223 48583210 53003229 50579095 50376620 56690297 259232451 0 0 0 259232451 94375 124098 269253 280254 411142 1179122 94375 124098 269253 280254 411142 1179122 48677585 53127327 50848348 50656874 57101439 260411573 0.99550 0.99630 0.00450 0.00370 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4738460 4738460 70484798 21463564 49021234 53759694 RESTRICTED BOND RESERVES 4646377 F CERTIFICATES OF DEPOSIT 16000 F 4662377 RESIDENT TRUST ACCOUNTS 52845 OTHER LIABILITIES 1276 54121 X 55378800 141252 -573100 -431848 55810648 1166320 1166320 56976968 53215300 -1225 -1225 53216525 3873149 3873149 57089674 PART X, LINE 2: FOOTNOTE 1 TO THE FINANCIAL STATEMENTS STATES MANAGEMENT HAS REVIEWED ITS OPERATIONS FOR UNCERTAIN TAX POSITIONS AND HAS DETERMINED NO UNCERTAIN TAX POSITIONS EXIST. PART XI, LINE 2D ADJUSTMENT (1) -$573,100 - PROVISION FOR BAD DEBT IS PRESENTED IN PATIENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. PART XI, LINE 4B ADJUSTMENT (1) $-1,404 ROUNDING DIFFERENCE. ADJUSTMENT (2) -$1,622,985 - LOSS ON DISPOSAL OF FIXED ASSETS FOR THE DISCONTINUED SEGMENT IS REPORTED IN REVENUE ON THE FORM 990. ADJUSTMENT (3) $1,167,724 - DISCONTINUED SEGMENT'S OPERATING INCOME WAS INCLUDED IN REVENUES ON THE FORM 990. PART XII, LINE 2D ADJUSTMENT (1) -$1,225 ROUNDING TO THE AUDITED FINANCIAL STATEMENTS. PART XII, LINE 4B ADJUSTMENT (1) $573,133 - PROVISION FOR BAD DEBT IS PRESENTED IN PATIENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. ADJUSTMENT (2) $1,677,031 - THE DISCONTINUED SEGMENT'S TOTAL EXPENSES ARE INCLUDED IN EXPENSES ON THE FORM 990. A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DP42 2018-08-30 3695000 REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES 0 0 0 B WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DP59 2018-08-30 3735000 REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES 0 0 0 C WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DP67 2018-08-30 4780000 REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES 0 0 0 D WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DP75 2018-08-30 21360000 REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES 0 0 0 A 2018 1 0 0 1 B 2018 1 0 0 1 C 2018 1 0 0 1 D 2018 1 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 A WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2019-04-30 3659455 ACQUISITION OF BELL TOWER RESIDENCES AND RENOVATION OF FACILITIES 0 0 0 A 0 0 0 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS ENGAGED CARRIAGE HEALTHCARE INC. (CHC) TO PROVIDE MANAGEMENT SERVICES THROUGH NOVEMBER 30, 2021. CHC IS AN INDEPENDENT "FOR PROFIT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD HAS DESIGNATED THE CHAIRMAN SIGN THE 990 ON BEHALF OF THE BOARD. ALL BOARD MEMBERS REVIEW AND APPROVE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS MONITORED THROUGH THE CORPORATE COMPLIANCE PROGRAM. REPORTS ARE PROVIDED TO THE BOARD ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION AND MANAGEMENT COMPANY AGREEMENTS ARE REVIEW BY INDEPENDENT BOARD MEMBERS ON AN ANNUAL BASIS. COMPARABLE DATA IS OBTAINED IN ORDER TO ESTABLISH REASONABLE AMOUNTS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE DOCUMENTS UPON WRITTEN REQUEST TO THE COMPANY. FORM 990, PART XI, LINE 9: ROUNDING -97. FORM 990 - LINE 2C SCHEDULE XI THE ENTIRE BOARD REVIEWS AND HAS RESPONSIBILITY FOR THE FINANCIAL STATEMENTS. THIS POLICY IS UNCHANGED FROM PRIOR YEARS. BELL TOWER RESIDENCES INC 1500 ODAY STREET MERRILL WI 54452 391672100 ASSISTED LIVING FACILITY. 501(C)(3) STATUS APPLIED FOR IN 2019. WI N/A TRANSITIONS AT HOME INC 13185 W GREEN MOUNTAIN ROAD LAKEWOOD CO 80228 205835453 HOME HEALTH CARE WI 501(C)(3) LINE 10 N/A 1 0 0 0 1 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 TRANSITIONS AT HOME INC D 44390 REVIEW OF GENERAL LEDGER TRANSITIONS AT HOME INC L 47915 REVIEW OF GENERAL LEDGER TRANSITIONS AT HOME INC I 637 REVIEW OF GENERAL LEDGER TRANSITIONS AT HOME INC J 18000 REVIEW OF LEASE AGREEMENT TRANSITIONS AT HOME INC M 103824 REVIEW OF GENERAL LEDGER