2019-11-13T14:53:49-06:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP PO BOX 23819 GREEN BAY WI 543053819 990 2018-01-01 813724993 LAKELAND CARE INCORPORATED LAKE 9209065100 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 DAN BIZUB CHIEF FINANCIAL OFFICER 9209065100 2019-11-05 1 DAVID L MACCOUX P01250277 9204367800 2019-11-05 67.137.57.251 2019-11-05 11:54:48 CS P 201AC506A6DA8D9D4516FED2DD8E9342B88F33A9 7FB4EC4025D2242128540F5A5D600BED339AACD0 2018 2020-03-31 21:24:44Z DAN BIZUB N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 240128382 0 X WWW.LAKELANDCAREINC.COM X 2000 WI ENRICHES LIVES OF ITS MEMBERS AND THEIR FAMILIES BY PROVIDING COORDINATED LONG-TERM HEALTH. 11 11 390 0 0 0 178479899 205312044 25882564 34105567 13057 29094 3333421 681677 207708941 240128382 0 0 0 0 23526344 27870249 0 0 0 181874240 215253112 205400584 243123361 2308357 -2994979 34473160 36942588 18423827 23888234 16049333 13054354 X ENRICHING INDIVIDUAL'S LIVES BY HONORING THEIR VALUES THROUGH HIGH QUALITY, COST EFFECTIVE CARE AND SUPPORT. 0 0 232054331 34105567 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 18 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 5,900 MEMBERS THROUGHOUT 22 COUNTIES IN THE FOX VALLEY, NORTHEAST AND NORTH CENTRAL WISCONSIN. 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. 232054331 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 87 0 1 390 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 0 1 1 1 1 1 1 0 0 X DAN BIZUB 9209065100 N6654 ROLLING MEADOWS DRIVE FOND DU LAC WI 54937 JIM BREY CHAIR 1.00 X X 1204 0 0 ALLEN BUECHEL SECRETARY 1.00 X X 400 0 0 JUDY GOLDSMITH DIRECTOR 1.00 X 626 0 0 JIM KOZICZKOWSKI CO-CHAIR 1.00 X X 899 0 0 LARRY LAUTENSCHLAGER DIRECTOR 1.00 X 591 0 0 TODD MOELY DIRECTOR 1.00 X 600 0 0 TOM OTTO DIRECTOR 1.00 X 600 0 0 JUDY RUGGIRELLO DIRECTOR 1.00 X 778 0 0 BOB ZIEGELBAUER DIRECTOR 1.00 X 523 0 0 MIKE KONECNY DIRECTOR 1.00 X 1270 0 0 BARB LARSON-HERBER DIRECTOR 1.00 X 1295 0 0 KATIE MNUK CHIEF EXECUTIVE OFFICER 40.00 X 195989 0 24500 DANIEL BIZUB CHIEF FINANCIAL OFFICER 40.00 X 132737 0 18500 SARA MUHLBAUER CHIEF OPERATING OFFICER 40.00 X 133668 0 9733 SUZANNE SINJAKOVIC CHIEF TECHNOLOGY COMMERCIA 40.00 X 117805 0 7251 DEB KUREK CM DIRECTOR 40.00 X 104026 0 7081 693011 0 67065 5 0 1 0 HOMES FOR INDEPENDENT LIVING POBOX 278 DOUSMAN WI 53118 ADULT FAMILY HOME, 3-4 BEDS 13833961 CLARITY CARE INC 424 WASHINGTON AVENUE OSHKOSH WI 54901 COMMUNITY BASED RESIDENTIAL FACILITY 11021340 REM WISCONSIN II INC 2005 W BELTLINE HWY STE 203 MADISON WI 53713 ADULT FAMILY HOME, 3-4 BEDS 7622672 INNOVATIVE WISCONSIN INC 445 S MADISON STREET GREEN BAY WI 54304 ADULT FAMILY HOME, 3-4 BEDS 6482676 GT FINANCIAL SERVICES 215 BRODUS STREET STURGIS MI 49091 SELF-DIRECTED PERSONAL CARE SERVICES 4995607 298 205312044 205312044 ROOM AND BOARD 900099 19802098 19802098 COST SHARE 900099 7843827 7843827 RETRO RATE ADJUSTMENTS 900099 6359560 6359560 THIRD PARTY 900099 100082 100082 34105567 29094 29094 MISCELLANEOUS REVENUE 900099 681677 681677 681677 240128382 34105567 0 710771 380512 57077 323435 19151428 16121103 3030325 757256 339879 417377 6103095 2739250 3363845 1477958 663352 814606 112682 25917 86765 53970 12413 41557 1406051 39040 1367011 89705 20632 69073 77206 17756 59450 991622 699642 291980 1244274 572367 671907 109120 25098 84022 774912 630395 144517 9204 2117 7087 365157 248307 116850 50173 19610 30563 PROVIDER CARE FAMILY SE 189804198 189804198 IBNR CLAIMS EXPENSE 19945783 19945783 SUPPLIES EXPENSE 100342 23079 77263 RENTAL EQUIPMENT 57458 26408 31050 61255 20908 40347 243123361 232054331 11069030 0 25843828 22810862 2893771 3192928 4415958 9396890 257398 322985 3200498 2052072 991708 1148426 70497 70497 34473160 36942588 18419484 23888234 4343 0 18423827 23888234 X 12126452 8869508 3922881 4184846 16049333 13054354 34473160 36942588 -2994979 0 X 0 1 X 0 0 X 178479899 205312044 383791943 178479899 205312044 383791943 383791943 13057 29094 42151 3333421 681677 4015098 387849192 59988131 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2017 AMOUNT: $ 3,333,421. 2018 AMOUNT: $ 681,677. 702035 259429 442606 2498463 1792643 705820 1148426 X 240128382 0 240128382 0 240128382 243123361 0 243123361 0 243123361 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 195989 0 0 0 0 0 0 0 24500 0 220489 0 0 0 DANIEL BIZUB CHIEF FINANCIAL OFFICER 132737 0 0 0 0 0 0 0 18500 0 151237 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE 990 AND ITS CONTENTS IS REVIEWED BY THE BOARD FOLLOWING CONFIRMATION OF THE FILING OF FORM. 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 15A 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.