2017-11-14T14:33:59-06:00 2016-12-31 390758449 Wipfli LLP 3703 Oakwood Hills Parkway Eau Claire WI 54701 990 2016-01-01 396040444 Grace Lutheran Foundation Inc GRAC 7158323003 3410 Sky Park Blvd PO Box 287 Eau Claire WI 54702 MIKE Christensen CEO 7158323003 2017-11-14 1 HOLLY POKRANDT CPA P00449155 7158323407 2017-11-13 216.54.158.12 2017-11-14 09:06:45 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 88C093A45B44E7609F7EF3B03A58D76319306555 2016 2017-02-10 21:41:12Z Mike Christensen 3410 Sky Park Blvd PO Box 287 Eau Claire WI 54702 22697616 0 X WWW.GRACELUTHFOUND.COM X 1961 WI GRACE LUTHERAN FOUNDATION, Inc. (the "Foundation") IS ORGANIZED TO ENGAGE IN CHARITABLE, RELIGIOUS, EDUCATIONAL, AND SCIENTIFIC ACTIVITIES IN ACCORDANCE WITH THE AIMS OF GRACE LUTHERAN CONGREGATION, A RELIGIOUS CORPORATION LOCATED IN EAU CLAIRE, Wisconsin. THE FOUNDATION OPERATES A SKILLED NURSING FACILITY, ADULT DAY CARE PROGRAMS, ASSISTED LIVING FACILITIES, AND SENIOR HOUSING FACILITIES WITH THE GOAL OF ENHANCING HUMAN DIGNITY AND GROWTH BY PROVIDING HIGH QUALITY CHRISTIAN-BASED SERVICE TO RESIDENTS OF THE CHIPPEWA VALLEY. 12 12 744 100 504573 -164716 5464 19725 16576042 22526761 153424 104899 23798 35752 16758728 22687137 75000 75000 0 0 9886573 13753012 0 0 0 6327096 10339885 16288669 24167897 470059 -1480760 27751266 36957907 13020019 23588581 14731247 13369326 X THE MISSION OF GRACE LUTHERAN FOUNDATION, INC., AS A COMPLIMENTARY ARM OF GRACE LUTHERAN CHURCH, IS TO RESPOND TO THE SPIRITUAL, PHYSICAL, AND SOCIAL NEEDS OF THE PEOPLE IN ORDER TO ENHANCE HUMAN DIGNITY AND GROWTH BY PROVIDING HIGH QUALITY CHRISTIAN-BASED SERVICE. 1 0 14624332 14995642 Grace Lutheran Foundation, Inc. provides skilled nursing services for those in need under its faith based plan of care programs at Syverson Lutheran Home, Grace River Pines, and Grace Prairie Point in Eau Claire, Wisconsin. Syverson Lutheran Home is a 58-bed skilled nursing facility and 25,364 days of resident care were provided in 2016. Grace River Pines is a 50-bed skilled nursing facility that opened in July of 2016 and provided 6,907 days of resident care in 2016. Grace Prairie Pointe is a 40-bed skilled nursing facility that became certified to admit residents in December 2016. The nursing homes offer skilled nursing, IV therapy, physical therapy, occupational therapy, speech therapy, and medication management among their many programs and services. The nursing homes offer services for both short-term rehabilitation and long-term care options for residents depending upon their needs. Recreational activities are also provided to residents to offer an enjoyable atmosphere while care is monitored by trained professionals. The majority of the residents receive assistance under the Wisconsin Medicaid program. GRACE LUTHERAN FOUNDATION, INC. ALSO PROVIDES CARE TO RESIDENTS IN EAU CLAIRE, MARSHFIELD, AND WAUSAU, WI THROUGH AN AGREEMENT WITH MARSHFIELD CLINIC. THE MARSHFIELD CLINIC COMFORT & RECOVERY SUITES ARE OPERATED BY GRACE LUTHERAN FOUNDATION, INC. AND PROVIDE 24-HOUR ACCESS TO CARE AND MEDICAL STAFF, INCLUDING PHYSICIANS AND NURSES. 4955920 5081750 Grace Lutheran Foundation, Inc. provides assisted living services in two types of certified facilities, Community Based Residential Facilities (CBRF) and Residential Care Apartment Complexes (RCAC). The Foundation operates Grace Edgewood and Willowbrook assisted living apartments in Eau Claire, Wisconsin which combine independent living with the convenience of monitored assisted living care plans to offer residents the option of living independently while at the same time having the comfort of knowing that additional care is available as needed. The Foundation also operates Grace Woodlands CBRF in Eau Claire, Wisconsin which is a memory care assisted living facility for those adults who suffer from memory loss or other conditions which require some assistance with day to day living activities. Services offered at these facilities include housekeeping, laundry, nursing assistance with activities of daily living, dietary services, medication management, and other nursing supervision and care services. A large portion of the facilities' residents receive services under community options and family care programs as a part of the Wisconsin Medicaid programs. 980867 1005772 Grace Lutheran Foundation, Inc. provides adult day care services in two facilities to offer the convenience of outpatient care in two communities in the Eau Claire, Wisconsin surrounding areas. One facility is located in Altoona, Wisconsin and the other is located in Chippewa Falls, Wisconsin. A large portion of the services are provided under County and state of Wisconsin community options programs funding assistance. 542533 75000 479404 Grace Lutheran Foundation, Inc. also operates many other programs to provide care for both community members of all ages and the elderly and disabled of the community. The Foundation operates a child care program and an apartment complex located in Eau Claire, Wisconsin. The apartment and child care programs receive a substantial portion of their funding sources through county and state assistance programs to provide care and services to those in need in the community while focusing on the mission of Grace Lutheran Church to provide high-quality Christian based services to residents of the Chippewa Valley. 542533 75000 479404 21103652 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 72 0 744 1 1 1 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 1 1 0 X MIKE CHRISTENSEN 7158323003 3410 Sky Park Blvd eau claire WI 54702 DEB SANDS BOARD MEMBER 1.00 0.50 X 0 0 0 JAN ADAMS TREASURER/SECRETARY 1.00 0.50 X X 0 0 0 KAREN BULLOCK board member 1.00 0.50 X 0 0 0 BARB EIDAHL VICE PRESIDENT 1.00 0.50 X X 0 0 0 DAVID HOVLAND board member 1.00 0.50 X 0 0 0 Cindy Bowe board member 1.00 X 0 0 0 ROGER POMPLUn board member 1.00 0.50 X 0 0 0 TOD THORPE board member 1.00 0.50 X 0 0 0 Ken Ziehr church council president 1.00 X 0 0 0 Pastor Dean Simpson Board MEMBER 1.00 X 0 0 0 MITCHell PIPER President 1.00 0.50 X X 0 0 0 KAREN HOMME BOARD MEMBER 1.00 0.50 X X 0 0 0 MIKE CHRISTENSEN CEO 40.00 1.00 X 184140 0 32981 RANDY BESTUL Director of business opera 40.00 1.00 X 112969 0 8991 297109 0 41972 2 0 1 0 MW MILLWORK CASEWORK 3030 BERLIN DRIVE LA CROSSE WI 54601 439069 IMAGINEERING 611 S FARWELL STREET EAU CLAIRE WI 54701 319228 VERONA FLOORING SALES PO BOX 930023 VERONA WI 53593 215000 ENCOMPASS GROUP PO BOX 40254 ATLANTA GA 30374 134790 CHARTER COMMUNICATIONS PO BOX 3019 MILWAUKEE WI 53201 123451 5 19725 19725 RESIDENT SERVICES 623000 21550868 21550868 MANAGEMENT SERVICES 541610 516273 11700 504573 OTHER SERVICE REVENUES 623000 459620 459620 22526761 104899 104899 46231 10479 35752 35752 22687137 21562568 504573 600271 75000 75000 339081 339081 11293240 9845205 1448035 161476 115989 45487 1128521 999707 128814 830694 707387 123307 108218 5986 102232 56650 500 56150 1078581 745470 333111 23552 434 23118 506765 346296 160469 2269 2269 3276767 3189558 87209 141339 93874 47465 1065479 968821 96658 237970 222851 15119 SUPPLIES 3295096 3270789 24307 Nursing Home Bed Assess 320764 320764 REPAIRS AND MAINTENANCE 118922 95421 23501 Professional Developmen 58903 50990 7913 48610 48610 24167897 21103652 3064245 0 5100 6400 1636677 675439 2257986 2396150 70669 69399 232108 143603 43631409 14414715 18771648 29216694 4188394 3623308 588684 826914 27751266 36957907 1713032 1907108 8882094 20762222 1533890 0 891003 919251 13020019 23588581 X 14731247 13338180 0 31146 14731247 13369326 27751266 36957907 X -1480760 143987 -25148 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 690 690 0 Part II-B, Line 1: Grace Lutheran Foundation, Inc. pays annual association dues to LeadingAge Wisconsin. These dues are primarily for access to education materials and staffing training and development. A portion of the annual dues were used in conjunction with lobbying activities with the goal of improving the overall industry environment. 1752289 1752289 25049933 9475112 15574821 6906726 4186241 2720485 9922461 753362 9169099 29216694 Refundable security deposits 33458 FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 885793 919251 ENCHANTED EVENING 45076 45076 3831 5910 699 OTHER 1155 1155 39 46231 46231 3831 5910 699 39 10479 35752 1 GRACE LUTHERAN CHURCH 202 W Grand Aevenue EAU CLAIRE WI 54701 390845281 501(C)3 75000 TITHE TO RELIGIOUS SPONSOR ORGANIZATION AND GRANT FOR PARISH NURSING PROGRAM Part I, Line 2: All grants are awarded according to the bylaws of Grace Lutheran Foundation, Inc. and are approved by the Board of Directors; No formal monitoring is required. X X X 0 0 0 0 0 0 0 0 0 MIKE CHRISTENSEN CEO 184140 0 0 0 0 0 14645 0 18336 0 217121 0 0 0 A Altoona Wisconsin 396005377 2014-12-30 5375000 Construction of new facilities 0 0 0 B VILLAGE OF ELK MOUND WI 390990065 2015-07-24 8250000 CONSTRUction of new facilities 0 0 0 C VILLAGE OF FAIRCHILD WI 391087447 2015-07-24 8250000 CONstruction of new facilities 0 0 0 A 386172 5375000 93998 3621813 1659189 2016 1 0 1 1 B 8160818 54240 8160818 2016 0 0 0 1 C 8160818 54240 8160818 2016 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0.00500 0.00500 0 0 1 C 0 0 0 0 0.00500 0.00500 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 1 0 BREMER BANK NA 24.000000000000 1 0 0 0 1 C 0 1 0 0 1 0 BREMER BANK NA 24.000000000000 1 0 0 0 1 A 1 B 1 C 1 Schedule K Supplental Information GRACE LUTHERAN FOUNDATION IS RECEIVING THE PROCEEDS OF THIS BOND ISSUE AS NEEDED TO PAY THE COSTS OF CONSTRUCTING A NEW FACILITY. REMAINING FUNDS WILL BE ADVANCED AS CONSTRUCTION PROGRESSES. FINAL DISTRIBUTION 2017. AARON BESTUL SON OF RANDY BESTUL, OFFICER 55011 EMPLOYMENT COMPENSATION 0 Form 990, Part III, line 2 During 2016, Grace Lutheran Foundation completed the construction of two new skilled nursing facilities. Grace River Pines is a 50-bed skilled nursing facility and Grace Prairie Pointe is a 40-bed skilled nursing facility. Both skilled nursing facilities are located in Eau Claire, WI. Form 990, Part VI, Section A, line 7b DECISIONS ON THE CHANGES IN THE STRUCTURE OF THE GRACE LUTHERAN FOUNDATION, Inc., GOVERNING DOCUMENTS, OR EXPANSION OR CONTRACTION OF MORE THAN 5% MUST BE APPROVED BY THE GRACE LUTHERAN CHURCH. Form 990, Part VI, Section B, line 11b A COPY OF FORM 990 WAS PROVIDED TO THE MEMBERS OF THE Foundation's GOVERNING BODY prior to THE SUBMISSION OF THE RETURN. FORM 990 WAS ALSO REVIEWED BY Management PRIOR TO SUBMISSION OF THE RETURN. Form 990, Part VI, Section B, line 12c THE Foundation ANNUALLY REVIEWS UPDATED CONFLICT OF INTEREST STATEMENTS FROM MEMBERS OF THE BOARD OF DIRECTORS. ANY NOTED CONFLICTS ARE DISCUSSED, AND DURING THE YEAR, IF CONFLICTS ARE NOTED, THOSE CONFLICTING MEMBERS ABSTAIN FROM VOTING. Form 990, Part VI, Section B, line 15 GRACE LUTHERAN FOUNDATION, Inc.'S EXECUTIVE LEVEL EMPLOYEES AND KEY EMPLOYEES ARE PROVIDED COMPENSATION UNDER AN EMPLOYMENT CONTRACT which is APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION OF EXECUTIVE LEVEL EMPLOYEES IS ALSO REVEIWED BASED ON INDUSTRY DATA AND WAGE COMPARIBILITY STUDIES FOR OTHER ELDERLY CARE AND CARE CENTER ORGANIZATIONS IN THE REGION. Form 990, Part VI, Section C, line 19 GRACE LUTHERAN FOUNDATION, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION. Form 990, Part XI, line 9: Interest rate swap valuation adjustment -25,148. FORM 990, PAGE 12, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF GRACE LUTHERAN FOUNDATION, INC. REVIEWS THE AUDITED FINANCIAL STATEMENTS ANNUALLY AND IS RESPONSIBLE FOR THE OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE BOARD ALSO mAKES TIME available DURING THE PRESENTATION OF THE ANNUAL FINANCIAL STATEMENTS TO MEET WITH THE INDEPENDENT AUDITORS WITHOUT MANAGEMENT'S PRESENCE TO BE ABLE TO ASK QUESTIONS OF THE INDEPENDENT ACCOUNTANTS WITHOUT MANAGEMENT INVOLVEMENT. There has been no change to this process in the current year. CHIPPEWA VALLEY ECUMENICAL HOUSING ASSOCIATION INC 3410 SKY PARK BLVD PO BOX 287 EAU CLAIRE WI 54702 391503681 LOW INCOME HOUSING PROJECT WI 501(C)3 Line 10 GRACE LUTHERAN FOUNDATION INC 0 GRACE LUTHERAN CHURCH 202 W GRAND AVENUE EAU CLAIRE WI 54701 390845281 CHURCH WI 501(C)3 Line 1 N/A 0 GRACE DEVELOPMENT CORPORATION 3410 SKY PARK BLVD PO BOX 287 EAU CLAIRE WI 54701 INACTIVE WI GRACE LUTHERAN FOUNDATION INC C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0