2016-11-14T09:44:36-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2015-01-01 390806344 FOND DU LAC LUTHERAN HOME INC FOND 9209219520 244 N MACY STREET FOND DU LAC WI 549353393 JULIE MARKS CURRENT CFO 9209219520 2016-11-10 1 KIMBERLY ANDERSON CPA P00188889 6086628600 2016-11-09 2015 2017-02-10 21:41:12Z JULIE MARKS 244 N MACY STREET FOND DU LAC WI 549353393 7665401 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. 3 3 272 108 0 0 462 0 7674197 7612907 775 -1082 145500 51797 7820934 7663622 0 0 0 0 5465541 5375535 0 0 0 2566938 2428238 8032479 7803773 -211545 -140151 7148618 6758811 2450188 2191372 4698430 4567439 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 6365877 7639399 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 15,898 MEDICAID DAYS, 3,751 MEDICARE DAYS AND 28,418 TOTAL NURSING HOME DAYS IN 2015. 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 9,831 BED DAYS IN 2015. 6365877 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 1 0 0 0 1 25 0 1 272 1 0 0 0 0 0 0 0 0 0 0 X 3 3 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 244 N MACY STREET FOND DU LAC WI 54935 X TERRY SCHLEIF CHAIRPERSON 0.50 1.10 X X 0 0 0 DICK KLEINFELDT SECRETARY 0.50 0.00 X X 0 0 0 KIM SUHS TREASURER 0.50 2.10 X X 0 0 0 MARI BETH BOREK CEO UNTIL MARCH 2015 10.00 30.00 X 62318 0 13157 GARY THORPE CHIEF HUMAN RESOURCES OFFICER 40.00 0.00 X 62897 0 670 SAMER ABADEER NURSING HOME ADMINISTRATOR 40.00 0.00 X 42644 0 2108 DEAN DESILET CHIEF CHAPLAINCY OFFICER/INTERIM ADMINISTRATOR 10.00 30.00 X 39307 0 6164 JOHN EYERS CFO FROM JULY 2014 THROUGH MARCH 2015 10.00 30.00 X 10285 0 0 JERRY KELM CFO EFFECTIVE MARCH 2015 10.00 30.00 X 38269 0 0 255720 0 22099 0 0 0 0 VALLEY BAY THERAPY INC 3305C NORTH BALLARD RD APPLETON WI 54911 THERAPY (PT, OT AND SPEECH) PROVIDER 480799 REINHART FOOD SERVICE 2655 E RICHMOND ST SHAWANO WI 54166 FOOD AND RELATED SUPPLIER 205248 OMNICARE INC DEPT 781668 DETROIT MI 48278 PHARMACY 158413 WISCONSIN DEPT OF HEALTH SERVICES BOX 93594 MILWAUKEE WI 53293 BED LICENSES 127840 4 NURSING HOME 623000 6545628 6545628 RESIDENTIAL FACILITY 623000 1041974 1041974 BEAUTY SHOP REVENUE 900099 25305 25305 7612907 697 697 1779 -1779 -1779 -1779 MISC REVENUE 623000 51797 51797 51797 7663622 7639399 0 24223 146071 139674 6397 4001532 3497402 504130 25458 8629 16829 494502 78541 415961 707972 641569 66403 59515 41035 18480 35293 640 34653 380603 354517 26086 37185 23211 13974 72710 2421 70289 282734 282734 5153 3305 1848 75507 75507 462817 462817 74943 74943 SUPPLIES 469462 469462 BAD DEBT EXPENSE 92184 92184 REPAIRS AND MAINTENANCE 49241 46499 2742 INSTRUCTIONS & TRAINING 29333 13154 16179 301558 132576 168982 7803773 6365877 1437896 0 873729 846865 876766 793381 55787 74758 14600645 10451427 4459808 4149218 882528 894589 7148618 6758811 543910 437984 637959 651388 1267063 1102000 1256 0 2450188 2191372 X 4640858 4500735 57572 66704 4698430 4567439 7148618 6758811 X -140151 9160 X X 0 1 X 1 0 X 1300682 462 0 1301144 9375558 8259222 7976587 7674197 7612907 40898471 9375558 8259222 9277269 7674659 7612907 42199615 0 178226 178226 178226 178226 42021389 3048 1201 883 775 697 6604 3048 1201 883 775 697 6604 45748 145500 51797 243045 9378606 8260423 9323900 7820934 7665401 42449264 0.98990 0.99530 0.00020 0.00040 X 60413 60413 10725686 7219365 3506321 3694815 3146540 548275 119731 85522 34209 4149218 INTEREST IN NET ASSETS OF FOUNDATION 66718 DEFERRED CHARGES, NET 13376 UNEMPLOYMENT COMP DEPOSIT 178299 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES FOUNDATION, INC 532889 DUE FROM LUTHERAN HOMES AND HEALTH SERVICES, INC 19965 DUE FROM ST PETERS PLACE LLC 81351 DUE FROM HILLS AT CORTLAND RIDGE 1991 894589 7663622 0 7663622 0 7663622 7803773 0 7803773 0 7803773 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 11 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: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 9,160. 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 9 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 9 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 9 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