2017-11-03T11:30:38-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2016-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 1045 HILL STREET WATERTOWN WI 53098 JULIE MARKS CFO 9209219520 2017-11-02 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2017-10-27 67.137.57.251 2017-11-02 11:33:56 CD P 3E979F80BB8F399C9CB7D5D916B34B85DDD844F4 1C4AA1E388E3DC50B055405D9AA64341548DFCA7 2016 2017-02-10 21:41:12Z X JULIE MARKS 1045 HILL STREET WATERTOWN WI 53098 7810865 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 10 254 110 0 0 0 0 7612907 7758109 -1082 857 51797 51766 7663622 7810732 0 0 0 0 5375535 4074817 0 0 0 2428238 3831606 7803773 7906423 -140151 -95691 6758811 5953399 2191372 2081360 4567439 3872039 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 5974408 7783932 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 15,590 MEDICAID DAYS, 3,264 MEDICARE DAYS AND 28,086 TOTAL NURSING HOME DAYS IN 2016. 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 10,590 BED DAYS IN 2016. 5974408 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 11 0 1 254 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 1 1 0 WI X JULIE MARKS 9203228527 1045 HILL STREET WATERTOWN WI 53098 X X TERRY SCHLEIF VICE CHAIRPERSON 0.67 1.33 X X 0 0 0 KIM SUHS CHAIRPERSON 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 STEVE HUFF 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 MATTHEW MAUTHE CEO 3.33 6.67 X 0 0 0 JULIE MARKS CFO 3.33 6.67 X 0 0 0 0 0 0 0 0 0 0 MARQUARDT VILLAGE 1045 HILL STREET WATERTOWN WI 53098 MANAGEMENT SERVICES 422075 VALLEY BAY THERAPY INC 3305C NORTH BALLARD RD APPLETON WI 54911 THERAPY (PT, OT AND SPEECH) PROVIDER 420753 NEW HORIZON PO BOX 860246 MINNEAPOLIS MN 55486 FOOD SERVICES 124835 3 NURSING HOME 623000 6616457 6616457 RESIDENTIAL FACILITY 623000 1115709 1115709 BEAUTY SHOP REVENUE 900099 25943 25943 7758109 640 640 350 133 217 217 217 MISC REVENUE 623000 51766 51766 51766 7810732 7783932 0 26800 3376497 3295227 81270 40735 40735 657585 647241 10344 407280 7086 400194 21871 21871 380093 380093 6587 3032 3555 290583 290583 3901 2809 1092 74049 74049 458817 458817 18869 18869 SKILLED NURSING FACILIT 1013838 1013838 SUPPLIES 424528 424528 MISC OTHER 196162 196162 BED ASSESSMENT 191809 191809 343219 154046 189173 7906423 5974408 1932015 0 846865 1252790 793381 668352 74758 86679 14732998 10892360 4149218 3840638 894589 104940 6758811 5953399 437984 526487 651388 651388 1102000 903485 2191372 2081360 X 4500735 3872039 66704 0 4567439 3872039 6758811 5953399 X -95691 -599709 X X 0 1 X 1 0 X 1300682 462 1301144 8259222 7976587 7674197 7612907 7758109 39281022 8259222 9277269 7674659 7612907 7758109 40582166 0 178226 215880 394106 178226 215880 394106 40188060 1201 883 775 697 640 4196 1201 883 775 697 640 4196 45748 145500 51797 51766 294811 8260423 9323900 7820934 7665401 7810515 40881173 0.98300 0.98990 0.00010 0.00020 X 60413 60413 10725686 7533385 3192301 3827168 3272314 554854 119731 86661 33070 3840638 7810732 0 7810732 0 7810732 7906423 0 7906423 0 7906423 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 MANAGEMENT REVIEWS THE FORM 990. THE FORM 990 IS THEN PROVIDED TO THE BOARD MEMBERS ELECTRONICALLY FOR THEIR REVIEW IN ADVANCE OF THE BOARD MEETING AND REVIEWED AS INDICATED IN THE BOARD MINUTES, BEFORE IT IS FINALIZED. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY AT A REGULARLY SCHEDULED BOARD MEETING, ALL BOARD MEMBERS ARE GIVEN A 'CONFLICT OF INTEREST' STATEMENT TO SIGN. PRIOR TO THE SIGNING, EACH BOARD MEMBER IS BRIEFED ON THE PURPOSE AND INTENT OF THE FORM AND THE NEED TO LIST ANY PERSONAL CONTACTS AND/OR INTEREST THAT MAY CONFLICT WITH THEIR ABILITY TO SERVE AS BOARD MEMBERS. THOSE THAT HAVE NOT ATTENDED THE BOARD MEETING WOULD BE CONTACTED PERSONALLY WITH SIMILAR INSTRUCTIONS. ALL SIGNED DOCUMENTS ARE RETAINED. ALL BOARD MEMBERS SIGN AND COMPLETE THE FORM. MANAGEMENT FOLLOWS UP ON ANY CONFLICTS THAT ARE IDENTIFIED. FORM 990, PART VI, SECTION B, LINE 15 CEO REVIEW IS COMPLETED BY THE LUTHERAN HOMES & HEALTH SERVICES, INC (LHHS) BOARD WITH BOTH INDIVIDUAL AND COLLECTIVE INPUT AND DISCUSSION. REVIEW INCLUDES RESPONSE AND UPDATE TO SPECIFIC GOALS AS WELL AS ADDITIONAL EVENTS AND WORK COMPLETED THROUGHOUT THE YEAR. CEO COMPENSATION IS BASED UPON THE LEADING AGE COMPENSATION AND CHAMBER OF COMMERCE COMPENSATION REPORT. DOCUMENTATION OF EXECUTIVE SESSION MINUTES ARE ON FILE WITH THE LHHS BOARD CHAIR AND THE EXECUTIVE ASSISTANT. KEY LEADERSHIP ROLES ARE EVALUATED ANNUALLY, AT BUDGET TIME, WITH REVIEW OF POSITION DESCRIPTION, GOALS, OBJECTIVES AND WORK PLAN AND ASSOCIATED OUTCOMES. KEY LEADERSHIP COMPENSATION IS BASED UPON COMPARABLE DATA AND IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE 990 IS AVAILABLE ON THE ORGANIZATIONS WEBSITE. ALL OTHER GOVERNING DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII LUTHERAN HOMES AND HEALTH SERVICES, INC, LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC, FOND DU LAC LUTHERAN HOMES, INC AND THE HILLS AT CORTLAND RIDGE HAVE FORMED A COMMON PAY MASTER. MARI BETH BOREK'S AND GARY WAGNER'S SALARIES ARE PAID BY FOND DU LAC LUTHERAN HOME THROUGH COMMON PAY MASTER, BUT IS DEEMED PAID BY LUTHERAN HOMES AND HEALTH SERVICES, INC, LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC, AND THE HILLS AT CORTLAND RIDGE. FORM 990, PART XI, LINE 9: TRANSFER TO FOUNDATION -532,992. TRANSFER TO SENIOR HOUSING -66,717. 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 244 N MACY STREET FOND DU LAC WI 54935 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 244 N MACY STREET FOND DU LAC WI 54935 391466308 FUND DEVELOPMENT WI 501(C)(3) LINE 10 LUTHERAN HOMES AND HEALTH SERVICES INC 0 THE HILLS AT CORTLAND RIDGE 244 N MACY STREET FOND DU LAC WI 54935 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 0 1 0 0 0 0