2018-09-10T11:30:37-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2017-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 1045 HILL STREET WATERTOWN WI 53098 TERRY SCHLEIF CHAIR 9209219520 2018-08-28 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2018-08-24 67.137.57.251 2018-08-28 16:47:23 CD P B71DF8EF734977C0D9AF27883840492912BFA7BF 90489CCCB48CA921216AF0EAC3CB5906D8522E9A 2017 2018-06-14 16:35:46Z TERRY SCHLEIF 1045 HILL STREET WATERTOWN WI 53098 8545055 0 X WWW.LUTHERANHOMESFONDDULAC.ORG X 1939 WI FOND DU LAC LUTHERAN HOME, AS PART OF LUTHERAN HOMES AND HEALTH SERVICES, PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS, AND COMMUNITIES. 10 10 207 100 0 0 0 5 7758109 8468120 857 -982 51766 76127 7810732 8543270 0 0 0 0 4074817 4510467 0 0 0 3831606 4182083 7906423 8692550 -95691 -149280 5953399 5660116 2081360 1937357 3872039 3722759 X FOND DU LAC LUTHERAN HOME, AS PART OF LUTHERAN HOMES AND HEALTH SERVICES, PROVIDES A CHRISTIAN-BASED INNOVATIVE APPROACH TO AGING THROUGH COMPREHENSIVE SERVICES, PROGRAMS, AND COMMUNITIES. 0 0 6557189 8522991 LUTHERAN HOMES AND HEALTH SERVICES, INC ENCOMPASSES A VARIETY OF PROGRAMS DESIGNED TO ASSIST SENIORS IN ACTIVELY AGING. THE FOND DU LAC LUTHERAN HOME, INC, A LHHS ENTITY, PROVIDES SKILLED NURSING, SHORT-TERM REHABILITATION, AND ASSISTED LIVING IN A CHRISTIAN-BASED ENVIRONMENT FOR PEOPLE OF ALL FAITHS SHORT-TERM REHAB. THE FOND DU LAC LUTHERAN HOME IS KNOWN FOR DELIVERING HIGH-QUALITY SHORT-TERM REHABILITATION. OUR SKILLED THERAPISTS UTILIZE STATE OF THE ART METHODS AND EQUIPMENT TO PROVIDE PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY ON AN INPATIENT OR OUTPATIENT BASIS. THE FOND DU LAC LUTHERAN HOME HAS PROVIDED HIGH QUALITY SKILLED NURSING CARE FOR OVER SEVENTY YEARS. IT SERVES PEOPLE OF ALL FAITHS AND FINANCIAL MEANS. THE HOME'S COMFORTABLE, INVITING ATMOSPHERE AS WELL AS THE TALENTED, COMPASSIONATE AND KNOWLEDGABLE STAFF MAKES THE PROGRAM A SUCCESS. FOND DU LAC LUTHERAN HOME PROVIDED 20,269 MEDICAID DAYS, 2,106 MEDICARE DAYS AND 30,143 TOTAL NURSING HOME DAYS IN 2017. ASSISTED LIVING THE FOND DU LAC LUTHERAN HOME'S ASSISTED LIVING PROGRAM TARFA TERRACE PROVIDES THE FLEXIBILITY AND SUPPORT TO MEET A VARIETY OF NEEDS FOR ITS PATIENTS IN AN ENVIRONMENT THAT ENHANCES AND ENCOURAGES INDEPENDENCE. THIS PROGRAM HAD A TOTAL OF 10,392 BED DAYS IN 2017. 6557189 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 207 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X JULIE MARKS 9203228527 1045 HILL STREET WATERTOWN WI 53098 X TERRY SCHLEIF CHAIR 0.67 1.33 X X 0 0 0 KIM SUHS VICE CHAIR 1.00 2.00 X X 0 0 0 TERRI EMANUEL SECRETARY 0.67 1.33 X X 0 0 0 JIM NEUMANN TREASURER 0.67 1.33 X X 0 0 0 STEVE DILLING BOARD MEMBER 0.17 0.33 X 0 0 0 JIM FETT BOARD MEMBER 0.17 0.33 X 0 0 0 RUSS KAMPHUIS BOARD MEMBER 0.17 0.33 X 0 0 0 MIKE KROLCZYK BOARD MEMBER 0.17 0.33 X 0 0 0 BETH MANNEBACH BOARD MEMBER 0.17 0.33 X 0 0 0 STEVE HUFF BOARD MEMBER 0.17 0.33 X 0 0 0 0 0 0 0 0 0 0 MARQUARDT VILLAGE 1045 HILL STREET WATERTOWN WI 53098 MANAGEMENT SERVICES 1868419 NEW HORIZON PO BOX 860246 MINNEAPOLIS MN 55486 FOOD SERVICES 1357687 SYMBRIA REHAB 28100 TORCH PARKWAY SUITE 600 WARRENVILLE IL 60555 THERAPY PROVIDER 890806 OMNICARE INC PO BOX 78000 DETROIT MI 48278 PHARMACY 446932 NEBAT 130 MAIN STREET FOND DU LAC WI 54935 BANKING 404148 9 5 5 NURSING HOME 623000 7185354 7185354 RESIDENTIAL FACILITY 623000 1261510 1261510 BEAUTY SHOP REVENUE 900099 21256 21256 8468120 803 803 1785 -1785 -1785 -1785 MISC REVENUE 623000 76127 76127 76127 8543270 8522991 0 20274 X 3594160 3168262 425898 17931 17931 228377 228177 200 669999 590606 79393 589947 589947 84908 84908 23966 23966 1049228 1030050 19178 11970 1963 10007 373904 1932 371972 633033 633033 4584 4475 109 19683 19683 58518 58518 430734 430734 110157 31234 78923 SUPPLIES 231342 231342 BED ASSESSMENT 207570 207570 MISC OTHER 144232 11170 133062 BAD DEBT EXPENSE 132981 114156 18825 75326 3606 71720 8692550 6557189 2135361 0 1252790 778316 668352 924682 86679 13358 14834723 11287710 3840638 3547013 104940 396747 5953399 5660116 526487 578318 651388 648867 903485 710172 2081360 1937357 X 3872039 3722759 3872039 3722759 5953399 5660116 -149280 0 X X 0 1 X 1 0 X 1300682 462 5 1301149 7976587 7674197 7612907 7758109 8468120 39489920 9277269 7674659 7612907 7758109 8468125 40791069 0 178226 215880 255224 649330 178226 215880 255224 649330 40141739 883 775 697 640 803 3798 883 775 697 640 803 3798 45748 145500 51797 51766 76122 370933 9323900 7820934 7665401 7810515 8545050 41165800 0.97510 0.98300 0.00010 0.00010 X 60413 60413 10731958 7840002 2891956 3922621 3360301 562320 119731 87407 32324 3547013 UNEMPLOYMENT COMP DEPOSIT 354711 DUE FROM RETIREMENT HOUSING 1951 DUE FROM HILLS AT CORTLAND RIDGE 15495 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION 16444 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES 8146 396747 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SINGLE CLASS OF MEMBERS, AND THE SOLE MEMBER OF THAT CLASS IS LUTHERAN HOMES & HEALTH SERVICES, INC, A WISCONSIN NONSTOCK CORPORATION (THE "MEMBER"). FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE BOARD OF DIRECTORS SHALL BE APPOINTED BY THE MEMBER WITH CONSIDERATION GIVEN TO THEIR CHARACTER, CONCERN FOR THE PRINCIPLES AND PROGRAMS OF THE CORPORATION, AND THE SINGULAR CONTRIBUTIONS THEY COULD RENDER TO THE INCREASED EFFECTIVENESS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS GIVEN TO EACH BOARD MEMBER TO REVIEW AND COMMENT ON BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. THE CEO AND THE CFO ALSO REVIEW AND APPROVE THE 990 RETURNS BEFORE THEY ARE FILED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY THE BOARD MUST ATTEST THAT THEY DO NOT HAVE ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST; OR THEY MUST DISCLOSE ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT. SHOULD A CONFLICT ARISE, THE PERSON AFFECTED IS ASKED TO EXCUSE THEMSELVES FORM VOTING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 217,696. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 217,696. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 8,644. MANAGEMENT AND GENERAL EXPENSES 19,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,822. FOOD SERVICE CONSULTANTS: PROGRAM SERVICE EXPENSES 803,710. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 803,710. FORM 990, PART XII, LINE 2C THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. ONCE THE AUDIT COMMITTEE APPROVES THE FINANCIAL STATEMENTS, THEY SUBMIT THE FINANICAL STATEMENTS TO THE BOARD OF DIRECTORS FOR FINAL APPROVAL. THE AUDIT COMMITTEE COMPLETES A PERIODIC REVIEW OF AUDITOR SELECTION WITH ANNUAL REVIEW OF THE AUDIT ENGAGEMENT LETTER. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. LUTHERAN HOMES AND HEALTH SERVICES INC 1045 HILL STREET WATERTOWN WI 53098 392032901 PROVIDE MANAGEMENT SERVICES TO FOND DU LAC LUTHERAN HOME, INC WI 501(C)(3) LINE 10 N/A 0 LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION INC 1045 HILL STREET WATERTOWN WI 53098 391466308 FUND DEVELOPMENT WI 501(C)(3) LINE 10 LUTHERAN HOMES AND HEALTH SERVICES INC 0 THE HILLS AT CORTLAND RIDGE 1045 HILL STREET WATERTOWN WI 53098 611517711 REAL ESTATE DEVELOPMENT WI 501(C)(3) LINE 10 LUTHERAN HOMES AND HEALTH SERVICES INC 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0